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Sample records for skin flap survival

  1. Effect of Systemic Antioxidant Allopurinol Therapy on Skin Flap Survival

    PubMed Central

    Rasti Ardakani, Mehdi; Al-Dam, Ahmed; Rashad, Ashkan; Shayesteh Moghadam, Ali

    2017-01-01

    BACKGROUND It has been reported that systemic administration of allopurinol improves cell survival. This study was aimed to evaluate effects of allopurinol on skin flaps in dogs. METHODS Twenty dogs underwent one skin flap surgery with a 2-week interval. The first procedure was performed according to the standard protocols. The second phase was started by a 1-week pretreatment with allopurinol. Length of the necrotic zone was measured and recorded daily. At each phase, flaps were removed and sent for histopathological study after 1 week observation. RESULTS Mean length of the necrotic zone in allopurinol treated skin flaps has been significantly less than normal flaps over all 7 days of observation (p<0.0001). Histopathology study showed less inflammation and more normal tissue structure in the allopurinol treated skin flaps. CONCLUSION It was demonstrated that systemic administration of allopurinol significantly improved skin flap survival. PMID:28289614

  2. Microvascular Fragment Transplantation Improves Rat Dorsal Skin Flap Survival

    PubMed Central

    Rathbone, Christopher R.

    2016-01-01

    Background: The development of flap necrosis distally remains a concern during microsurgical flap transfers because, at least in part, of decreased perfusion. Microvascular fragments (MVFs) are microvessels isolated from adipose tissue that are capable of improving tissue perfusion in a variety of tissue defects. The aim of this study was to determine whether the transplantation of MVFs in a dorsal rat skin flap model can improve flap survival. Methods: A 10 × 3 cm flap was raised in a cranial to caudal fashion on the dorsal side of 16 Lewis rats, with the caudal side remaining intact. The rats were equally divided into a treatment group (MVFs) and a control group (sterile saline). At the time of surgery, sterile saline with or without MVFs was injected directly into the flap. Microvessel density was determined after harvesting flap tissue by counting vessels that positively stained for Griffonia simplicifolia lectin I-isolectin B4. Laser Doppler was used to measure blood flow before and after surgery and 7 and 14 days later. Flap survival was evaluated 7 and 14 days after surgery by evaluating the percentage of viable tissue of the flap with photodigital planimetry. Results: Despite the lack of a significant difference in microvessel density and tissue perfusion, flap survival increased 6.4% (P < 0.05) in MVF-treated animals compared with controls. Conclusions: The use of MVFs may be a means to improve flap survival. Future studies are required to delineate mechanisms whereby this occurs and to further optimize their application. PMID:28293502

  3. Effects of calcitriol on random skin flap survival in rats

    PubMed Central

    Zhou, Kai-liang; Zhang, Yi-hui; Lin, Ding-sheng; Tao, Xian-yao; Xu, Hua-zi

    2016-01-01

    Calcitriol, a metabolite of vitamin D, is often used in osteoporosis clinics. However, the material has other bioactivities; for example, it accelerates angiogenesis, has anti-inflammatory properties, and inhibits oxidative stress. We investigated the effects of calcitriol in a random skin flap rat model. “McFarlane flap” models were established in 84 male Sprague Dawley rats, divided into two groups. One group received intraperitoneal injections of calcitriol (2 μg/kg/day) whereas control rats received intraperitoneal injections of saline. The percentage flap survival area and tissue water content were measured 7 days later, which showed that calcitriol improved flap survival area and reduced tissue edema. It also increased the mean vessel density and upregulated levels of VEGF mRNA/protein, both of which promote flap angiogenesis. Moreover, it decreased leukocyte and macrophage infiltration, reduced the inflammatory proteins IL1β and IL6, increased SOD activity, decreased MDA content, and upregulated the level of autophagy. Overall, our results suggest that calcitriol promotes skin flap survival by accelerating angiogenesis, having anti-inflammatory effects, reducing oxidative stress, and promoting autophagy. PMID:26732750

  4. Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models.

    PubMed

    Foroglou, Pericles; Karathanasis, Vasileios; Demiri, Efterpi; Koliakos, George; Papadakis, Marios

    2016-03-26

    The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adipose-derived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.

  5. Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models

    PubMed Central

    Foroglou, Pericles; Karathanasis, Vasileios; Demiri, Efterpi; Koliakos, George; Papadakis, Marios

    2016-01-01

    The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adipose-derived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals. PMID:27022440

  6. Effect of intraoperative platelet-rich plasma and fibrin glue application on skin flap survival.

    PubMed

    Findikcioglu, Fulya; Findikcioglu, Kemal; Yavuzer, Reha; Lortlar, Nese; Atabay, Kenan

    2012-09-01

    The experiment was designed to compare the effect of intraoperative platelet-rich plasma (PRP) and fibrin glue application on skin flap survival. In this study, bilateral epigastric flaps were elevated in 24 rats. The right-side flaps were used as the control of the left-side flaps. Platelet-rich plasma, fibrin glue, and thrombin had been applied under the flap sites in groups 1, 2, and 3, respectively. Five days later, all flap pedicles were ligated. Necrotic area measurements, microangiography, and histologic and immunohistochemical evaluations were performed to compare the groups. Platelet-rich plasma reduced necrotic area percentages as compared with other groups. Histologically and microangiographically increased number of arterioles were observed in PRP groups. Thrombin when used alone increased flap necrosis. Vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor β3 primary antibody staining showed increased neovascularization and reepithelialization in all PRP-applied flaps. This study demonstrated that PRP, when applied intraoperatively under the skin flap, may enhance flap survival. Thrombin used alone was found to be unsuitable in flap surgery.

  7. Pharmacologic enhancement of rat skin flap survival with topical oleic acid.

    PubMed

    Hsu, Oscar K; Gabr, Essam; Steward, Earl; Chen, Heidi; Kobayashi, Mark R; Calvert, Jay W; Sundine, Michael J; Kotchounian, Taline; Dhar, Sanjay; Evans, Gregory R D

    2004-06-01

    This study was instituted to investigate in a rat model the effect of topical coadministration of the penetration enhancer oleic acid (10% by volume) and RIMSO-50 (medical grade dimethyl sulfoxide, 50% by volume) on rat skin flap survival. A rectangular abdominal skin flap (2.5 x 3 cm) was surgically elevated over the left abdomen in 40 nude rats. The vein of the flap's neurovascular pedicle was occluded by placement of a microvascular clip, and the flap was resutured with 4-0 Prolene to its adjacent skin. At the end of 8 hours, the distal edge of the flap was reincised to gain access to the clips and the clips were removed. After resuturing of the flap's distal edge to its adjacent skin, the 40 flaps were randomly divided into four groups. Group 1 (control) flaps were treated with 5 g of saline, group 2 (dimethyl sulfoxide) flaps were treated with 2.7 g of dimethyl sulfoxide (50% by volume), group 3 flaps (oleic acid) were topically treated with 0.45 g of oleic acid (10% by volume), and group 4 (dimethyl sulfoxide plus oleic acid) flaps were treated with a mixture of 0.45 g of oleic acid (10% by volume) and 2.7 g of dimethyl sulfoxide (50% by volume) diluted in saline. Each flap was topically treated with 5 ml of drug-soaked gauze for 1 hour immediately after clip removal to attenuate reperfusion injury. Thereafter, drug was applied topically once daily for 4 more days. Digital photographs of each flap were then taken on day 6 and the flaps were then harvested. The percentage of skin survival in each flap was determined by computerized morphometry and planimetry. The mean surviving area of group 3 (oleic acid-treated flaps) was 23.60 +/- 4.19 percent and was statistically higher than that in group 1 (control, saline-treated flaps) at 7.20 +/- 2.56 percent. The mean surviving area of group 2 (dimethyl sulfoxide-treated flaps) at 18.00 +/- 5.23 percent and group 4 (oleic acid- and dimethyl sulfoxide-treated flaps) at 9.90 +/- 3.44 percent did not achieve

  8. Thrombolysis at a controlled pressure prolongs the survival of skin flaps treated with superoxide dismutase.

    PubMed

    Hirigoyen, M B; Prabhat, A; Zhang, W X; Urken, M L; Weinberg, H

    1996-04-01

    The role of thrombolysis in reestablishing patency in the microcirculation following ischemia, and thereby improving the efficacy of agents attenuating reperfusion injury, such as the oxygen free radical scavenger, superoxide dismutase (SOD), was investigated in a rat model. Abdominal skin flaps were subjected to normothermic ischemia induced by complete occlusion of the pedicle for periods of 12, 13, 14, 16, 18, 20, 22, and 24 hr. In Group 1 (n = 64), all animals received flap washout using 100,000U urokinase (manual injection) followed by 7,500 IU SOD given intra-arterially immediately prior to reperfusion. Animals in Group 2 received flap washout consisting of 100,000U urokinase given via a pressurized delivery system, followed by 7,500 IU SOD. Results demonstrated a statistically significant improvement in flap survival in Group 2. The authors concluded that thrombolytic therapy may be useful in improving the delivery of agents, such as SOD, which attenuate reperfusion injury in skin flaps.

  9. Effects of Rosmarinus officinalis on the survivability of random-patterned skin flaps: an experimental study.

    PubMed

    Ince, Bilsev; Yildirim, Alpagan Mustafa; Okur, Mehmet Ihsan; Dadaci, Mehmet; Yoruk, Ebru

    2015-04-01

    Improving survival of skin flaps used in soft-tissue reconstruction is clinically an important goal, and several systemic and local agents have been used for this purpose. However, a substance that prevents the flap necrosis has not yet been defined. This study aimed to investigate whether a Rosmarinus officinalis extract could improve the skin flap survival. In this study, 21 Wistar albino rats were divided into three groups. Rectangular 8 × 2 cm random-pattern flaps were elevated from the back of the rats. Group I was considered the control group. In Group II, a 0.5-cc of Rosmarinus officinalis oil was applied with an ear bud to the flap area 30 minutes before the flap elevation. After suturing the flaps to their location, the oil was administered twice a day for a week. In Group III, 0.5 cc of the oil was applied twice a day to the area that was elevated for a week until surgery. At the end of the week, the flaps were sutured to their location, and wiped postoperatively twice a day for a week with the oil. Mean percentage of these areas was found to be 29.81%, 58.99%, and 67.68% in Group I, Group II, and Group III, respectively. The mean percentage of the flap survival areas and vessel diameters were significantly greater in the Groups II and III than in the control group (p < 0.05). The results revealed that the topical use of the Rosmarinus officinalis extract can increase the flap survivability.

  10. Effects of diammonium glycyrrhizinate on random skin flap survival in rats: An experimental study

    PubMed Central

    Lv, Qing-Bo; Gao, Xiang; Lin, Ding-Sheng; Chen, Yun; Cao, Bin; Zhou, Kai-Liang

    2016-01-01

    Partial necrosis of skin flaps continues to restrict the survival of local skin flaps following plastic and reconstructive surgeries. The aim of the present study was to investigate the effects of diammonium glycyrrhizinate (DG), a salt of glycyrrhetinic acid that has been widely used in the therapy of chronic hepatitis and human immunodeficiency virus infection, on random skin flap survival in rats. McFarlane flaps were established in 60 male Sprague-Dawley rats randomly divided into three groups. Group I served as the control group and was injected with saline (10 mg/kg) once per day. Group II and group III were the experimental groups, and were injected with 10 mg/kg DG once and twice per day, respectively. On day 7, the survival area of the flap was measured. Tissue samples were stained with hematoxylin and eosin and immunohistochemically evaluated. Tissue edema, neutrophil density, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were evaluated. The mean survival areas of the flaps of group II were significantly larger when compared with those of group I (P<0.05), and the rats of group III exhibited significantly higher survival areas than group II (P<0.05). Histologic and immunohistochemical evaluation showed that microvessel development and the expression level of vascular endothelial growth factor were higher in the two experimental groups than in the control group. Furthermore, SOD activity was significantly increased (P<0.05), while the neutrophil density and MDA level were significantly reduced (P<0.05) in group II when compared with group I. Significant differences between group II and group III with regard to SOD activity and MDA level were also observed (P<0.05). Thus, DG may have a dose-dependent effect on promoting the survival of random skin flaps. PMID:27588181

  11. Favorable effects of progesterone on skin random flap survival in rats

    PubMed Central

    Dingsheng, Lin; Zengbing, Liu; Dong, Huang

    2016-01-01

    Objective(s): The aim of this study is to determine the effects of progesterone treatment on the survival of random skin flaps. Materials and Methods: McFarlane flaps were established and 40 male rats were randomly assigned to the progesterone-treated as the test group or normal saline-treated as the control group. Progesterone or normal saline (10 mg/kg) was administered intraperitoneally once daily. On postoperative day 2, malondialdehyde (MDA) and superoxide dismutase (SOD) were detected using test kits. Flap survival rates were evaluated with transparent graph paper under direct visualization, the levels of inflammation were examined by haematoxylin and eosin (H&E) staining, and the expression of vascular endothelial growth factor (VEGF) was immunohistochemically evaluated on day 7. Results: Compared to that in the control group, the mean survival area was significantly larger in the progesterone group. SOD activity was increased significantly, but the MDA levels in the test group were decreased. H&E-stained slices revealed that inflammation was inhibited in the test group. VEGF expression markedly increased in the progesterone group. Conclusion: This study showed that progesterone administered intraperitoneally significantly improved random skin flap survival in rats. PMID:27917271

  12. Skin flaps in reconstructive surgery.

    PubMed

    Pavletic, M M

    1990-01-01

    A skin flap (pedicle graft) is a partially detached segment of skin and subcutaneous tissue that includes a blood supply essential to its survival. As a result, skin flaps are capable of closing a variety of defects, including poorly vascularized wound beds that are incapable of maintaining free grafts. In many cases, skin flaps can bypass economically many of the potential problems associated with healing by second intention. This article presents an overview of pedicle grafts, with emphasis on the clinical use of local flap techniques.

  13. Use of Systemic Rosmarinus Officinalis to Enhance the Survival of Random-Pattern Skin Flaps

    PubMed Central

    İnce, Bilsev; Bilgen, Fatma; Gündeşlioğlu, Ayşe Özlem; Dadacı, Mehmet; Kozacıoğlu, Sümeyye

    2016-01-01

    Background Skin flaps are commonly used in soft-tissue reconstruction; however, necrosis can be a frequent complication. Several systemic and local agents have been used in attempts to improve skin flap survival, but none that can prevent flap necrosis have been identified. Aims This study aims to determine whether the use of systemic Rosmarinus officinalis (R. officinalis) extract can prevent flap necrosis and improve skin flap recovery. Study Design Animal experimentation. Methods Thirty-five Wistar albino rats were divided in five groups. A rectangular random-pattern flaps measuring 8×2 cm was elevated from the back of each rat. Group I was the control group. In Group II, 0.2 ml of R. officinalis oil was given orally 2h before surgery. R. officinalis oil was then applied orally twice a day for a week. In Group III, R. officinalis oil was given orally twice a day for one week before surgery. At the end of the week, 0.2 mL of R. officinalis oil was given orally 2 h before surgery. In Group IV, 0.2 mL of R. officinalis oil was injected subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. In Group V, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week prior to surgery. At the end of the week, one last 0.2 mL R. officinalis oil injection was administered subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. Results The mean percentage of viable surface area was significantly greater (p<0.05) in Groups II, III, IV, and V as compared to Group I. Mean vessel diameter was significantly greater (p<0.05) in Groups II, III, IV, and V as compared to Group I. Conclusion We have determined that, in addition to its anti-inflammatory and anti-oxidant effects, R. officinalis has vasodilatory effects that contribute to increased skin flap survival. PMID:27994918

  14. Effects of Acellular Amniotic Membrane Matrix and Bone Marrow-Derived Mesenchymal Stem Cells in Improving Random Skin Flap Survival in Rats

    PubMed Central

    Chehelcheraghi, Farzaneh; Eimani, Hossein; Homayoonsadraie, Seyed; Torkaman, Giti; Amini, Abdollah; Alavi Majd, Hamid; Shemshadi, Hashem

    2016-01-01

    Background The necrotic skin flap represents a great challenge in plastic and reconstructive surgery. In this study, we evaluated the effect of bioscaffolds, acellular amniotic membranes (AAMs), and bone marrow-derived mesenchymal stem cells (BM-MSCs) on random skin flap (RSF) survival in rats by applying a cell-free extracellular matrix scaffold as a supportive component for the growth and proliferation of BM-MSCs on RSFs. AAM matrix scaffolds were created by incubating AMs in ethylenediaminetetraacetic acid 0.05% at 37°C, and cell scrapers were used. Objectives The aim of the present study was to assess the effect of AAM as a scaffold in TE, and combined with transplanted BM-MSCs, on the survival of RSFs and on the biomechanical parameters of the incision-wound flap margins 7 days after flap elevation. Materials and Methods BM-MSCs and AAMs were transplanted into subcutaneous tissue in the flap area. On the 7th postoperative day, the surviving flap areas were measured using digital imaging software, and the flap tissue was collected for evaluation. Forty rats were randomly divided into four groups of 10 each: group 1 received an AAM injection; group 2 underwent BM-MSC transplantation; group 3 received both AAM injection + BM-MSC transplantation; and group 4 was the control group, receiving only saline. Results The survival area in the AAM/BM-MSC group was significantly higher than in the control group (18.49 ± 1.58 versus 7.51 ± 2.42, P < 0.05). The biomechanical assessment showed no significant differences between the experimental groups and the control group (P > 0.05), and there was no correlation with flap survival. Conclusions Our findings showed that the treatment of flaps with BM-MSC and AAM transplantations significantly promoted flap survival compared to a control group. The viability of the flap was improved by combining BM-MSCs with AAM matrix scaffolds. PMID:27621924

  15. Inhibitory effects of low-level laser therapy on skin-flap survival in a rat model

    PubMed Central

    Baldan, Cristiano S; Masson, Igor FB; Esteves Júnior, Ivaldo; Baldan, Alessandra Maria S; Machado, Aline F P; Casaroto, Raquel A; Liebano, Richard E

    2015-01-01

    BACKGROUND: Although several studies have demonstrated the effects of low-level laser therapy (LLLT) on skin flap viability, the role of higher doses has been poorly investigated. OBJECTIVE: To investigate the inhibitory effect of the LLLT (λ=670 nm) on the viability of random skin flaps in a rat model using an irradiation energy of 2.79 J at each point. METHODS: Sixteen Wistar rats were randomly assigned into two groups: sham laser irradiation (n=8); and active laser irradiation (n=8). Animals in the active laser irradiation group were irradiated with a 670 nm diode laser with an energy of 2.79 J/point, a power output 30 mW, a beam area of 0.028 cm2, an energy density of 100 J/cm2, an irradiance of 1.07 W/cm2 for 93 s/point. Irradiation was performed in 12 points in the cranial skin flap portion. The total energy irradiated on the tissue was 33.48 J. The necrotic area was evaluated on postoperative day 7. RESULTS: The sham laser irradiation group presented a mean (± SD) necrotic area of 47.96±3.81%, whereas the active laser irradiation group presented 62.24±7.28%. There was a significant difference in skin-flap necrosis areas between groups (P=0.0002). CONCLUSION: LLLT (λ=670 nm) increased the necrotic area of random skin flaps in rats when irradiated with an energy of 2.79 J (100 J/cm2). PMID:25821771

  16. An ameliorated skin flap model in rats for experimental research.

    PubMed

    Hosnuter, Mübin; Kargi, Eksal; Peksoy, Irfan; Babucçu, Orhan; Payasli, Cem

    2006-01-01

    There is a disagreement in the experimental design of random skin flaps owing to their vascular inconsistency. The definition of a reliable axial-pattern skin flap model is needed. The purpose of this study was to describe a new skin flap model to deal with entire drawbacks of existing random and axial pattern skin flap designs. This was accomplished by creating paired skin flaps including both skin and vascular pedicle on the dorsum of the same rat. This design was suitably termed as rando-axial flap. The present study offers a simple and reliable skin flap model with following advantages: (1) it has a predictable necrosis area, (2) it reveals a larger survival area (75 +/- 5%) when compared to other flaps in this study (Mann-Whitney U-test, p<0.001), (3) the vascular pedicle is consistent, (4) control and study flaps are placed on the same animal (5) it can be converted to a random, an axial or a free flap.

  17. Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

    PubMed Central

    Li, Xiucun; Cui, Jianli; Maharjan, Suraj; Lu, Laijin; Gong, Xu

    2016-01-01

    Objective The purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle. Methods This was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model. Results The overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection. Conclusion Flap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice. PMID:27930679

  18. Combination therapy for salvaging a failing, experimental skin flap.

    PubMed

    Shah, D K; Zhang, W X; Forman, D L; Prabhat, A; Urken, M L; Weinberg, H

    1996-08-01

    The failing free flap remains a major problem for the reconstructive surgeon. Many and varied pharmacologic agents have been utilized to reverse the effects of ischemia in these flaps. Treatments have been aimed at inhibiting presumed causative factors in the no-reflow phenomenon. Therapy has generally been single in nature and designed to affect only one of these presumed factors. In this study, several pharmacologic agents were utilized individually or in combination therapy as postischemic washouts, in an effort to attack the multiple causative factors in the no-reflow phenomenon and to improve flap survival in a rat abdominal skin flap model. The treatment agents included lactated Ringer's, superoxide dismutase, and urokinase, with each used independently as a postischemic perfusion washout. Combination therapy utilized an initial postischemic perfusion with urokinase, followed by a second perfusion washout with superoxide dismutase. After 18 hr of primary ischemia, there was increased flap survival in the animals undergoing perfusion washout with either superoxide dismutase alone or with combined urokinase and superoxide dismutase washouts, compared to all other treatments (p < 0.001). It was found that flaps undergoing combined urokinase and superoxide dismutase postischemic perfusion washouts demonstrated significantly improved survival after 20 hr of primary ischemia, compared to all other therapies (p < 0.05). By demonstrating improved survival when a thrombolytic agent is used in conjunction with an oxygen free radical scavenger, these findings may have implications in the treatment of clinically failing free flaps.

  19. Distally based venous flap: a new technique for the correction of syndactyly without skin graft in adult patients.

    PubMed

    Cil, Yakup; Kocman, Atacan Emre; Yapici, Abdul Kerim

    2009-12-01

    Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.

  20. DIEP flap sentinel skin paddle positioning algorithm.

    PubMed

    Laporta, Rosaria; Longo, Benedetto; Sorotos, Michail; Pagnoni, Marco; Santanelli Di Pompeo, Fabio

    2015-02-01

    Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P = 0.108), and time until take-back (P = 0.521) and flap salvage rate (P = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests.

  1. The relative survival of composite free flaps in head and neck reconstruction.

    PubMed

    Van Genechten, M L V; Batstone, M D

    2016-02-01

    Various composite free flaps are available for reconstruction of bony head and neck defects. The aim of this study was to compare the relative success of four different bony free flaps. One hundred and seventy-three microvascular composite free flap reconstructions for bony defects of the head and neck region, performed over the period April 2008 to April 2015, were reviewed retrospectively. The type of free flap, indication for free flap reconstruction, age at harvesting of the free flap, use of pre- or postoperative radiotherapy, and free flap failure were examined. For the 173 reconstructions performed, 84 fibula free flaps, 43 iliac crest free flaps, 32 scapula free flaps, and 14 osteocutaneous radial forearm free flaps were harvested. The mean age at time of harvesting was 40.7 years for the iliac crest, 57.3 years for the fibula, 64.3 years for the scapula, and 73.9 years for the osteocutaneous radial forearm free flap. No complete free flap failure was documented, nor was there any failure of bony segments. Three fibula flap skin paddles did not survive. No returns to theatre for salvage were required. This study showed no difference in the survival rates of these four types of composite free flap.

  2. Venous free flaps for the treatment of skin cancers of the digits.

    PubMed

    Park, Ji Ung; Kim, Kiwan; Kwon, Sung Tack

    2015-05-01

    Microvascular reconstruction using distant free flaps is often required after excision of skin cancers of the digits. The delivered flaps should be chosen with many factors taken into consideration, especially in the digits, in which a very thin, pliable, and durable flap is required to maintain both function and cosmetic appearance. Free flaps, such as perforator flaps, however, for distal or small defects of the hand after excision of skin cancer, require the sacrifices of the main arterial pedicle with deep dissection and exhibit potential limitations regarding flap size and location of the defect. Instead, arterialized venous free flap could be used as an alternative reconstructive method for skin cancers of the digits. Twelve soft tissue defects of the digits after excision of skin cancers (5 cases of malignant melanoma and 7 cases of squamous cell carcinoma) were reconstructed using arterialized venous free flaps from January 2009 to May 2011. The flaps ranged in size from 1 × 1.5 cm to 5 × 7 cm. The flaps completely survived in 9 cases. Partial necrosis developed in 3 cases; however, skin graft was necessary only for 1 case. There were no recurrences or metastases for at least 20 months after the last case. Recently in cases of noninvasive or low-grade skin cancer of the hand, the concept of "preservative surgery" has been a higher priority compared with functional and esthetic aspects. Particularly in cases of reconstruction of a small-sized fingertip defect as 1 functional unit, arterialized venous free flaps offer several advantages, such as thinness and color similar to the hand, technical ease with a short operative time, long vascular pedicle, less donor site morbidity with no sacrifice of a major vessel, applicable to any site, and modifiable to the appropriate size and shape. Arterialized venous free flap could serve as a useful and reliable method for soft tissue reconstruction after excision of skin cancers in the digits.

  3. Mastectomy skin flap necrosis: challenges and solutions

    PubMed Central

    Robertson, Stuart A; Jeevaratnam, Johann A; Agrawal, Avi; Cutress, Ramsey I

    2017-01-01

    Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. PMID:28331365

  4. [Ketanserin and random skin flaps. An experimental study in the rat].

    PubMed

    Achouche, J; Teisseire, B; Laccourreye, O; Hadjean, E

    1994-04-01

    This prospective randomised study in a rodent model was designed to analyse the value of a serotonin antagonist, ketanserin, on the survival of random skin flaps in Wistar rats. Our study demonstrates the statistical value of this molecule. The surface of skin necrosis was statistically lower in the group of rats treated with pre and post operative subcutaneous injection of ketanserin.

  5. A novel animal model for skin flap prelamination with biomaterials

    NASA Astrophysics Data System (ADS)

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-09-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible.

  6. A novel animal model for skin flap prelamination with biomaterials

    PubMed Central

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-01-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible. PMID:27659066

  7. Effects of Buflomedil and Pentoxifylline on Hamster Skin-Flap Microcirculation: Prediction of Flap Viability Using Orthogonal Polarization Spectral Imaging

    PubMed Central

    Coelho da Mota, Denise Salles; Furtado, Eliane; Bottino, Daniel Alexandre; Bouskela, Eliete

    2009-01-01

    OBJECTIVE This study investigated the effects of buflomedil and pentoxifylline, both of which are used in reconstructive surgery of hamster skin flap microcirculation, and evaluated the skin flap survival rate by orthogonal polarization spectral imaging. METHOD Twenty-four adult male Syrian golden hamsters were divided into three groups: a control (C, 0.1 ml 0.9% saline), buflomedil (B, 3 mg/kg/day), and pentoxifylline group (P, 14.5 mg/kg/day). Treatments administered intraperitoneally were initiated 1 hour before skin flap preparation and continued for 7 days post-operatively at 12-hour intervals. Preparations (skin flaps) were divided into 12 fields, which were organized into six bands. Functional capillary density (FCD, in mm/mm2), distance from the skin flap base to blood flow cessation (Distwith flow, in cm), percentage of viable skin (VA, in%), and qualitative analysis of blood flow by orthogonal polarization spectral imaging were performed at 1 and 24 hours and on the seventh post-operative day. RESULT Bands IV, V, and VI presented no flow independent of time. The functional capillary density group B was higher than that of groups C and P, primarily after 24 hours. All groups showed an increase in D with time but reached similar final distances (C = 2.73, B = 2.78 and P = 2.70 cm). Moreover, the percentage of viable areas remained at approximately 50%. The orthogonal polarization spectral imaging was useful to assess viability by counting fields with and without blood flow. CONCLUSIONS Functional capillary density values were higher in the buflomedil group compared to the control and pentoxifylline groups in this model. Functional capillary density did not influence D or the percentage of VA, and the technique showed favorable potential to assess/predict the viability of skin flaps within 1 h after surgery. PMID:19690666

  8. Reverse lateral supramalleolar adipofascial flap and skin grafting for one-stage soft tissue reconstruction of foot and ankle joint.

    PubMed

    Lee, Jae-Hoon; Chung, Duke-Whan

    2010-09-01

    The aim of this report is to present the clinical result and efficacy of reverse lateral supramalleolar adipofascial flap and skin grafting for one stage soft tissue reconstruction of the foot and ankle joints. Reconstruction using a reverse lateral supramalleolar adipofascial flap and skin grafting was performed in eight cases between January 2005 and March 2009. All the subjects were male with a mean age of 53 years. The mean follow-up period was 20 months. The reasons for soft tissue defects were diabetic foot, infected bursitis, open injuries of the foot, and chronic osteomyelitis. The mean size of the flaps was 3.5 (3-4) × 4.5 (4-6) cm. The flaps were elevated in the form of an adipofascial flap and split-thickness skin grafting was performed over the flaps and adjoining raw areas. Flaps survived in all cases. The implantation of the split-thickness skin graft over the flap was also successful in all cases. Neither partial necrosis in the adipofascial flap nor venous congestion was observed. At the last follow-up, there were no limited motions in the ankle and the toe. No cases complained of inconveniences in ambulation or had difficulties in selecting footwear. In cases that require a flap for the exposed bone or tendon of the foot with a small-sized defect, reverse lateral supramalleolar adipofascial flap and skin grafting is considered a useful method as it lowers the morbidity rate of the donor site and reconstructs soft tissues.

  9. The Effect of Hemodynamic Remodeling on the Survival of Arterialized Venous Flaps

    PubMed Central

    Yan, Hede; Kolkin, Jon; Zhao, Bin; Li, Zhefeng; Jiang, Shichao; Wang, Wei; Xia, Zhen; Fan, Cunyi

    2013-01-01

    Objective To evaluate the effect of hemodynamic remodeling on the survival status of the arterialized venous flaps (AVFs) and investigate the mechanism of this procedure. Materials and Methods Two 7 x 9 cm skin flaps in each rabbit (n=36) were designed symmetrically in the abdomen. The thoracoepigastric pedicle and one femoral artery were used as vascular sources. Four groups were included: Composite skin grafts group and arterial perfusion group were designed in one rabbit; AVF group and hemodynamic remodeling group by ligation of the thoracoepigastric vein in the middle were outlined in another rabbit. Flap viability, status of vascular perfusion and microvasculature, levels of epidermal metabolite and water content in each group were assessed. Results Highly congested veins and simple trunk veins were found using angiography in the AVF group; while a fairly uniform staining and plenty of small vessels were observed in the hemodynamic remodeling group. The metabolite levels of the remodeling group are comparable with those in the arterial perfusion group. There was no statistically significant difference in the percentage of flap survival between the arterial perfusion group and hemodynamic remodeling group; however, significant difference was seen between the AVF group and the hemodynamic remodeling group. Conclusions Under the integrated perfusion mode, the AVFs are in an over-perfusion and non-physiological hemodynamic state, resulting in unreliability and unpredictability in flap survival; under the separated perfusion mode produced by remodeling, a physiological-like circulation will be created and therefore, better flap survival can be expected. PMID:24265782

  10. Functional and structural evaluation of the vasculature of skin flaps after ischemia and reperfusion

    SciTech Connect

    Marzella, L.; Jesudass, R.R.; Manson, P.N.; Myers, R.A.; Bulkley, G.B.

    1988-05-01

    Free radicals and other toxic oxygen species play a role in the pathogenesis of ischemic organ damage. The abdominal skin flap has been used as a model to study the effects of superoxide dismutase on the survival of ischemic skin. We have evaluated the evolution of functional and structural injury to the vasculature after ischemic injury in superoxide dismutase-treated and control skin flaps. Ischemia was induced by creating abdominal skin flaps and occluding either the venous or both the venous and arterial blood supplies. Superoxide dismutase was administered immediately after the occlusion was released. At 1 hour of reflow, erythrocyte stasis, platelet deposition, neutrophil adherence, and injury to the endothelium of the large vessels and of the microvasculature were evident. The blood flow in the ischemic skin was only 3 percent of normal. Superoxide dismutase caused no change in the ultrastructure of the vasculature and a marginal decrease in vascular permeability in the ischemic skin at 1 hour of reflow. Increased fluorescent staining of the skin was evident after 24 hours of reflow in the superoxide dismutase-treated flaps. These findings indicate that injury to vascular endothelium by ischemia and reperfusion plays a role in the evolution of skin necrosis.

  11. Dynamic Change of CD34 Level during the Survival Process of Narrow Pedicle Flap

    PubMed Central

    Wu, Lijun; Zhao, Tianlan; Yu, Daojiang; Chen, Qi; Han, Wenya; Yu, Wenyuan; Sun, Wei

    2015-01-01

    Objective To evaluate the dynamic change of CD34 level during the survival process of narrow pedicle flaps. Methods Twenty-five white pigs were randomly and equally divided into 5 experimental groups. Five different type of narrow pedicle with different length-to-width ratio were employed, and each type of narrow pedicle was covered with 5 different size random flaps and which was classified into A, B, C, D and E for 5 groups. Group A was control group. Each type narrow pedicle with 5 different skin flaps were implanted onto the back of the pigs along the midline of back with a reverse direction. A 0.3 cm×0.3 cm full thickness skin flap in the middle of distal segment was collected and on 3rd, 5th, 7th and 14th days of post-operation. The expression of CD34 was measured by immunohistochemistry and enzyme-linked immunosorbent (ELISA). Results Histological examination showed that with the increasing of length-to-width ratio of the narrow pedicle skin flaps, the expression of CD34 increased in the skin flaps. Increased level of CD34 was found on 3rd day post-operation, and the peak expression was found on 7th day. Persistent high level of CD34 was found until 14th day. Conclusion Increased CD34 level in the distal skin flap, there is the association between CD34 level and ischemia injury. Moreover, CD34 expression plays an important role during the repair processes of pedicle flaps. PMID:26561392

  12. Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

    PubMed

    Cai, Qian; Liang, Faya; Huang, Xiaoming; Han, Ping; Pan, Yong; Zheng, Yiqing

    2015-02-01

    We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation.

  13. Novel Injury Site Targeted Fusion Protein Comprising Annexin V and Kunitz Inhibitor Domains Ameliorates Ischemia-Reperfusion Injury and Promotes Survival of Ischemic Rat Abdominal Skin Flaps.

    PubMed

    Shyu, Victor Bong-Hang; Hsu, Chung En; Wen, Chih-Jen; Wun, Tze-Chein; Tang, Rui; Achilefu, Samuel; Wei, Fu-Chan; Cheng, Hui-Yun

    2017-03-01

    Appropriate antithrombotic therapy is critical for successful outcomes in reconstructive microsurgical procedures involving free tissue transfer. The annexin V-6L15 (ANV-6L15) fusion protein was developed as a targeted antithrombotic reagent. Annexin V specifically binds to exposed phosphatidylserine on apoptotic or injured cells, and prevents coagulation and cell adhesion, whereas 6L15 inhibits tissue factor-VIIa pathway within the coagulation cascade. The treatment efficacy of ANV-6L15 on rat island muscle and pedicled abdominal fasciocutaneous flaps following ischemic injury and ischemia-reperfusion injury (IRI) was evaluated.

  14. The isolated perfused human skin flap model: A missing link in skin penetration studies?

    PubMed

    Ternullo, Selenia; de Weerd, Louis; Flaten, Gøril Eide; Holsæter, Ann Mari; Škalko-Basnet, Nataša

    2017-01-01

    Development of effective (trans)dermal drug delivery systems requires reliable skin models to evaluate skin drug penetration. The isolated perfused human skin flap remains metabolically active tissue for up to 6h during in vitro perfusion. We introduce the isolated perfused human skin flap as a close-to-in vivo skin penetration model. To validate the model's ability to evaluate skin drug penetration the solutions of a hydrophilic (calcein) and a lipophilic (rhodamine) fluorescence marker were applied. The skin flaps were perfused with modified Krebs-Henseleit buffer (pH7.4). Infrared technology was used to monitor perfusion and to select a well-perfused skin area for administration of the markers. Flap perfusion and physiological parameters were maintained constant during the 6h experiments and the amount of markers in the perfusate was determined. Calcein was detected in the perfusate, whereas rhodamine was not detectable. Confocal images of skin cross-sections shoved that calcein was uniformly distributed through the skin, whereas rhodamine accumulated in the stratum corneum. For comparison, the penetration of both markers was evaluated on ex vivo human skin, pig skin and cellophane membrane. The proposed perfused flap model enabled us to distinguish between the penetrations of the two markers and could be a promising close-to-in vivo tool in skin penetration studies and optimization of formulations destined for skin administration.

  15. A new agent for flap survival – Hippophae rhamnoides L. (sea buckthorn): An experimental study in rats

    PubMed Central

    Emsen, Ilteris Murat

    2005-01-01

    Hippophae rhamnoides L. (sea buckthorn) is a member of the Elaeagnaceae family, and is a temperate bush native to Europe and Asia. The antioxidant activity of H rhamnoides L. has been shown in vitro cell culture and animal studies. Different fractions of H rhamnoides L. fruits inhibit 2,2-azobis-(2,4 dimethylvaleronitrile) and ascorbate iron-induced lipid peroxidations in vitro. H rhamnoides L., as well as vitamin E, decrease the malondialdehyde content in hyperlipidemic rabbit serum-cultured smooth muscle cells. The aim of the present study was to investigate, in a rat model, the potential effect of H rhamnoides L. on survival of random pattern skin flaps. For this purpose, 30 Wistar Albino rats were used, and a McFarlane-type caudally based skin flap was created on the dorsum of the rat (2.5 cm × 8 cm). Rats were divided into three groups: one control (group A) and two treatment groups (groups B and C). H rhamnoides L. was administered orally to the experimental groups: group B received a single 15 mg/kg dose per day and group C received 15 mg/kg twice per day. The areas and lengths of flap necrosis were measured in each group. The extent of necrotic flap areas were evaluated as length and area of total flap area, and differences were studied by Student’s t tests. The areas and lengths of necrosis of skin flaps decreased depending on H rhamnoides L., but viability of the flaps treated with 15 mg/kg/day was not significantly different from the control group. The rats receiving H rhamnoides L. 15 mg/kg twice per day had the highest flap survival rate (P<0.001). In conclusion, H rhamnoides L. may have a dose-dependent effect to increase flap survival in random skin flaps. PMID:24227931

  16. Topical application of nitrosonifedipine, a novel radical scavenger, ameliorates ischemic skin flap necrosis in a mouse model.

    PubMed

    Fukunaga, Yutaka; Izawa-Ishizawa, Yuki; Horinouchi, Yuya; Sairyo, Eriko; Ikeda, Yasumasa; Ishizawa, Keisuke; Tsuchiya, Koichiro; Abe, Yoshiro; Hashimoto, Ichiro; Tamaki, Toshiaki

    2017-01-16

    Ischemic skin flap necrosis can occur in random pattern flaps. An excess amount of reactive oxygen species is generated and causes necrosis in the ischemic tissue. Nitrosonifedipine (NO-NIF) has been demonstrated to possess potent radical scavenging ability. However, there has been no study on the effects of NO-NIF on ischemic skin flap necrosis. Therefore, they evaluated the potential of NO-NIF in ameliorating ischemic skin flap necrosis in a mouse model. A random pattern skin flap (1.0 × 3.0 cm) was elevated on the dorsum of C57BL/6 mice. NO-NIF was administered by topical injection immediately after surgery and every 24 hours thereafter. Flap survival was evaluated on postoperative day 7. Tissue samples from the skin flaps were harvested on postoperative days 1 and 3 to analyze oxidative stress, apoptosis and endothelial dysfunction. The viable area of the flap in the NO-NIF group was significantly increased (78.30 ± 7.041%) compared with that of the control group (47.77 ± 6.549%, p < 0.01). NO-NIF reduced oxidative stress, apoptosis and endothelial dysfunction, which were evidenced by the decrease of malondialdehyde, p22phox protein expression, number of apoptotic cells, phosphorylated p38 MAPK protein expression, and vascular cell adhesion molecule-1 protein expression while endothelial nitric oxide synthase protein expression was increased. In conclusion, they demonstrated that NO-NIF ameliorated ischemic skin flap necrosis by reducing oxidative stress, apoptosis, and endothelial dysfunction. NO-NIF is considered to be a candidate for the treatment of ischemic flap necrosis.

  17. The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap

    PubMed Central

    Swartz, Justin E.; Aarts, Mark C.J.; Swart, Karin M.A.; Disa, Joseph J.; Gerressen, Marcus; Kuo, Yur-Ren; Wax, Mark K.; Grolman, Wilko; Braunius, Weibel W

    2016-01-01

    Background Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, that allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking. Objective of review To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction. Type of review Systematic review and multicenter, individual patient data meta-analysis. Search strategy MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of ‘anticoagulants’ and ‘free flap reconstruction’. Evaluation method Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis. Results Five studies were of adequate quality and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were: aspirin (12%), low-molecular weight dextran (18.3%), unfractioned heparin (28.1%), low-molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one percent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications. Conclusions The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition some anticoagulants may cause systemic complications. PMID:25823832

  18. Incisions for cochlear implant flaps and superficial skin temperature. Skin temperature/blood circulation in CI flaps.

    PubMed

    Pau, Hans Wilhelm; Sievert, Uwe; Graumüller, Sylke; Wild, Ernst

    2004-01-01

    Healing and integration of a cochlear implant is largely influenced by good blood circulation in the covering skin, which, on the other hand, is closely correlated to skin temperature. Measuring superficial flap temperatures by thermography is an easy way to get some clues about the corresponding blood supply. These data should allow some implications for the design of skin flaps in cochlear implant surgery. In 15 patients thermography was carried out prior to and after cochlear implantation, using the Agema 550 Thermovision system. It was evident, that the anatomic courses of the major superficial arteries were represented by areas of increased temperature. The pattern of temperature distribution may allow some conclusions concerning site and shape of surgical incisions. From our data we concluded, that most types of incisions do not interfere too much with the arterial blood supply. However, some types like the extended retroauricular C-incision may eventually cause problems. Our data suggest, that the straight or slightly curved vertical retroauricular incision causes the least impairment of blood circulation. After surgery, directly along the incisions (and later along the scars) temperature was diminished, indicating reduced blood circulation. In our series, the thickness of the implant did not impede blood circulation significantly. So far, we could not examine patients with local circulation disorders. Probably local scars, skin atrophies, angiopathies etc. may present typical patterns of temperature distribution, which require individual design of skin flaps. Thermography is an easy method which can give impressions of local blood circulation in skin flaps. If the courses of the major arteries and their branches are respected, blood circulation within the flap should not be problematic. Thermography is likely to help designing optimal flaps in cases with impeded blood circulation e.g. by pre-existing scar formations.

  19. A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: extended scalp and extended mastoid postauricular skin flaps.

    PubMed

    Hwang, Euna; Kim, Young Soo; Chung, Seum

    2014-06-01

    Before visiting a plastic surgeon, some microtia patients may undergo canaloplasty for hearing improvement. In such cases, scarred tissues and the reconstructed external auditory canal in the postauricular area may cause a significant limitation in using the posterior auricular skin flap for ear reconstruction. In this article, we present a new method for auricular reconstruction in microtia patients with previous canaloplasty. By dividing a postauricular skin flap into an upper scalp extended skin flap and a lower mastoid extended skin flap at the level of a reconstructed external auditory canal, the entire anterior surface of the auricular framework can be covered with the two extended postauricular skin flaps. The reconstructed ear shows good color match and texture, with the entire anterior surface of the reconstructed ear being resurfaced with the skin flaps. Clinical question/level of evidence; therapeutic level IV.

  20. AdVEGF-All6A+ Preconditioning of Murine Ischemic Skin Flaps Is Comparable to Surgical Delay

    PubMed Central

    Gersch, Robert P.; Fourman, Mitchell S.; Phillips, Brett T.; Nasser, Ahmed; McClain, Steve A.; Khan, Sami U.; Dagum, Alexander B.

    2015-01-01

    Background: Surgical flap delay is commonly used in preconditioning reconstructive flaps to prevent necrosis. However, staged procedures are not ideal. Pharmacologic up-regulation of angiogenic and arteriogenic factors before flap elevation poses a nonsurgical approach to improve flap survival. Methods: Male Sprague Dawley rats were divided into control (n = 16), surgical delay (Delay), AdNull, AdEgr-1, and AdVEGF (n ≥ 9/group) groups. Delay rats had a 9 cm × 3 cm cranial based pedicle skin flap incised 10 days prior to elevation. Adenoviral groups received 28 intradermal injections (109 pu/animal total) throughout the distal two thirds of the flap 1 week prior to elevation. At postoperative day (POD) 0 flaps were elevated and silicone sheeting was placed between flap and wound bed. Perfusion analysis in arbitrary perfusion units of the ischemic middle third of the flap using laser Doppler imaging was conducted preoperatively and on POD 0, 3, and 7. Clinical and histopathologic assessments of the skin flaps were performed on POD 7. Results: AdVEGF (50.8 ± 10.9 APU) and AdEgr-1 (39.3 ± 10.6 APU) perfusion levels were significantly higher than controls (16.5 ± 4.2 APU) on POD 7. Delay models were equivalent to controls (25.9 ± 6.8 APU). AdVEGF and Delay animals showed significantly more viable surface area on POD 7 (14.4 ± 1.3 cm2, P < 0.01 and 12.4 ± 1.2 cm2, P < 0.05, respectively) compared with Controls (8.7 ± 0.7 cm2). Conclusions: AdVEGF preconditioning resulted in flap survival comparable to surgical delay. Adenoviral preconditioning maintained perfusion levels postoperatively while surgical delay did not. PMID:26495207

  1. Skin flaps and grafts -- self-care

    MedlinePlus

    ... drainage from the wound Drainage becoming thick, tan, green, or yellow, or smells bad (pus) Your temperature is above 100°F (37.8°C) for more than 4 hours Red streaks appear that lead away from the wound Alternative Names Autograft - self-care; Skin transplant - self-care; Split-skin graft - self- ...

  2. Acute effects of cigarette smoke exposure on experimental skin flaps

    SciTech Connect

    Nolan, J.; Jenkins, R.A.; Kurihara, K.; Schultz, R.C.

    1985-04-01

    Random vascular patterned caudally based McFarlane-type skin flaps were elevated in groups of Fischer 344 rats. Groups of rats were then acutely exposed on an intermittent basis to smoke generated from well-characterized research filter cigarettes. Previously developed smoke inhalation exposure protocols were employed using a Maddox-ORNL inhalation exposure system. Rats that continued smoke exposure following surgery showed a significantly greater mean percent area of flap necrosis compared with sham-exposed groups or control groups not exposed. The possible pathogenesis of this observation as well as considerations and correlations with chronic human smokers are discussed. Increased risks of flap necrosis by smoking in the perioperative period are suggested by this study.

  3. Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore–Mid Foot Skin Defect

    PubMed Central

    Wu, Hao; Sheng, Jia-Gen

    2016-01-01

    Background: Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside. Methods: We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting. Results: Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely. Conclusion: This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot. PMID:27975013

  4. Acute ischemic preconditioning of skeletal muscle prior to flap elevation augments muscle-flap survival.

    PubMed

    Carroll, C M; Carroll, S M; Overgoor, M L; Tobin, G; Barker, J H

    1997-07-01

    Ischemic preconditioning of the myocardium with repeated brief periods of ischemia and reperfusion prior to prolonged ischemia significantly reduces subsequent myocardial infarction. Following ischemic preconditioning, two "windows of opportunity" (early and late) exist, during which time prolonged ischemia can occur with reduced infarction size. The early window occurs at approximately 4 hours and the late window at 24 hours following ischemic preconditioning of the myocardium. We investigated if ischemic preconditioning of skeletal muscle prior to flap creation improved subsequent flap survival and perfusion immediately or 24 hours following ischemic preconditioning. Currently, no data exist on the utilization of ischemic preconditioning in this fashion. The animal model used was the latissimus dorsi muscle of adult male Sprague-Dawley rats. Animals were assigned to three groups, and the right or left latissimus dorsi muscle was chosen randomly in each animal. Group 1 (n = 12) was the control group, in which the entire latissimus dorsi muscle was elevated acutely without ischemic preconditioning. Group 2 (n = 8) investigated the effects of ischemic preconditioning in the early window. In this group, the latissimus dorsi muscle was elevated immediately following preconditioning. Group 3 (n = 8) investigated the effects of ischemic preconditioning in the late window, with elevation of the latissimus dorsi muscle 24 hours following ischemic preconditioning. The preconditioning regimen used in groups 2 and 3 was two 30-minute episodes of normothermic global ischemia with intervening 10-minute episodes of reperfusion. Latissimus dorsi muscle ischemia was created by occlusion of the thoracodorsal artery and vein and the intercostal perforators, after isolation of the muscle on these vessels. Muscle perfusion was assessed by a laser-Doppler perfusion imager. One week after flap elevation, muscle necrosis was quantified in all groups by means of computer-assisted digital

  5. Vertically Set Sombrero-shaped Abdominal Flap for Asian Breast Reconstruction after Skin-sparing Mastectomy

    PubMed Central

    Yoshimura, Kotaro; Asahi, Rintaro; Sarukawa, Syunji; Sunaga, Ataru; Kamochi, Hideaki; Sugawara, Yasushi

    2016-01-01

    Background: Immediate autologous breast reconstruction after skin-sparing mastectomy is an esthetically superior method, and a free abdominal flap is often used. However, in Asian patients, little redundant abdominal skin and thin subcutaneous tissue are common, necessitating the development of a more suitable flap design and setting. We devised a narrow flap, the sombrero-shaped flap (S-flap), set vertically, to reduce postoperative abdominal morbidity without sacrificing cosmetic results. Methods: To assess this new flap design and setting, the recipient- and donor-site complications of consecutive patients treated by S-flap (n = 40) and conventional flap (C-flap) (n = 22) were retrospectively investigated. Postoperative abdominal pain, stiffness, and patient activity were also assessed in each group with our original grading scale. Results: Compared with the C-flap group, the S-flap group had a significantly lower skin paddle vertical height (mean, 14.0 and 10.2 cm, respectively; P < 0.001), lower abdominal stiffness (P = 0.023), and higher rate of double-pedicled flap use (27.3% and 52.5%, respectively; P < 0.048). The rates of donor and recipient site complications, postoperative abdominal pain, and activity did not significantly differ between the groups. Conclusions: For immediate breast reconstruction after skin-sparing mastectomy in Asian patients, our newly designed S-flap and vertical flap setting achieved cosmetically good, consistent results with low abdominal morbidity, even though the abdominal flap was thin and narrow. The viability of the S-flap, including medial fan-shaped adipose flap, was reliable, even though the flap often required elevation with double pedicles. PMID:28293497

  6. Tadalafil significantly reduces ischemia reperfusion injury in skin island flaps

    PubMed Central

    Kayiran, Oguz; Cuzdan, Suat S.; Uysal, Afsin; Kocer, Ugur

    2013-01-01

    Introduction: Numerous pharmacological agents have been used to enhance the viability of flaps. Ischemia reperfusion (I/R) injury is an unwanted, sometimes devastating complication in reconstructive microsurgery. Tadalafil, a specific inhibitor of phosphodiesterase type 5 is mainly used for erectile dysfunction, and acts on vascular smooth muscles, platelets and leukocytes. Herein, the protective and therapeutical effect of tadalafil in I/R injury in rat skin flap model is evaluated. Materials and Methods: Sixty epigastric island flaps were used to create I/R model in 60 Wistar rats (non-ischemic group, ischemic group, medication group). Biochemical markers including total nitrite, malondialdehyde (MDA) and myeloperoxidase (MPO) were analysed. Necrosis rates were calculated and histopathologic evaluation was carried out. Results: MDA, MPO and total nitrite values were found elevated in the ischemic group, however there was an evident drop in the medication group. Histological results revealed that early inflammatory findings (oedema, neutrophil infiltration, necrosis rate) were observed lower with tadalafil administration. Moreover, statistical significance (P < 0.05) was recorded. Conclusions: We conclude that tadalafil has beneficial effects on epigastric island flaps against I/R injury. PMID:23960309

  7. Impact of different antithrombotics on the microcirculation and viability of perforator-based ischaemic skin flaps in a small animal model

    PubMed Central

    Fichter, Andreas M.; Ritschl, Lucas M.; Robitzky, Luisa K.; Wagenpfeil, Stefan; Mitchell, David A.; Wolff, Klaus-Dietrich; Mücke, Thomas

    2016-01-01

    The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival. Clopidogrel and hirudin significantly improved the amount of viable flap tissue in comparison with controls, while unfractioned heparin had a negative effect on flap survival. Low molecular weight heparin, aspirin, pentoxifylline, and hydroxyethyl starch had no impact on the amount of viable flap tissue. A higher complication rate was observed in all experimental groups, but only clopidogrel had a negative impact on the flap viability. Our results add to the body of evidence supporting the conclusion that perioperative antithrombotic treatment improves flap survival. Clopidogrel and hirudin are effective pharmacological agents that significantly increased the viability of perforator-based skin flaps in rats, but at a higher risk of postoperative bleeding. PMID:27767060

  8. Assessment of skin flaps using optically based methods for measuring blood flow and oxygenation.

    PubMed

    Payette, Jeri R; Kohlenberg, Elicia; Leonardi, Lorenzo; Pabbies, Arone; Kerr, Paul; Liu, Kan-Zhi; Sowa, Michael G

    2005-02-01

    The objective of this study was to compare two noninvasive techniques, laser Doppler and optical spectroscopy, for monitoring hemodynamic changes in skin flaps. Animal models for assessing these changes in microvascular free flaps and pedicle flaps were investigated. A 2 x 3-cm free flap model based on the epigastric vein-artery pair and a reversed MacFarlane 3 x 10-cm pedicle flap model were used in this study. Animals were divided into four groups, with groups 1 (n = 6) and 2 (n = 4) undergoing epigastric free flap surgery and groups 3 (n = 3) and 4 (n = 10) undergoing pedicle flap surgery. Groups 1 and 4 served as controls for each of the flap models. Groups 2 and 3 served as ischemia-reperfusion models. Optical spectroscopy provides a measure of hemoglobin oxygen saturation and blood volume, and the laser Doppler method measures blood flow. Optical spectroscopy proved to be consistently more reliable in detecting problems with arterial in flow compared with laser Doppler assessments. When spectroscopy was used in an imaging configuration, oxygen saturation images of the entire flap were generated, thus creating a visual picture of global flap health. In both single-point and imaging modes the technique was sensitive to vessel manipulation, with the immediate post operative images providing an accurate prediction of eventual outcome. This series of skin flap studies suggests a potential role for optical spectroscopy and spectroscopic imaging in the clinical assessment of skin flaps.

  9. Management of Tissue Ischemia in Mastectomy Skin Flaps: Algorithm Integrating SPY Angiography and Topical Nitroglycerin

    PubMed Central

    Sanniec, Kyle; Teotia, Sumeet

    2016-01-01

    Summary: Tissue ischemia can be managed in several different ways based on the cause of the perfusion defect, including topical nitroglycerin or surgical intervention. However, there are times when tissue perfusion is questioned and clinical examination is unable to determine definitively the cause of ischemic tissue and whether it will survive. In this technique article, we describe our comprehensive algorithm for the management of tissue ischemia in mastectomy skin flaps, which can be applied to other plastic surgery procedures by integrating SPY angiography and topical nitroglycerin. PMID:27826472

  10. The possibility for use of venous flaps in plastic surgery

    SciTech Connect

    Baytinger, V. F. Kurochkina, O. S. Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  11. The possibility for use of venous flaps in plastic surgery

    NASA Astrophysics Data System (ADS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  12. An alternative method for facial resurfacing: supraclavicular skin prefabrication by perforator fascia flap.

    PubMed

    Hocaoğlu, Emre

    2014-01-01

    Prefabrication of supraclavicular skin provides a useful source for flaps congruent with the face skin. Among various vascular sources that have been used for this purpose, anterolateral thigh fascia seems to represent a greater value because of having a long and strong vascular pedicle and negligible donor-site morbidity. In this regard, we present a technical report on using the lateral circumflex femoral artery perforator flap harvest technique in preparing an anterolateral thigh fascia flap for the prefabrication of the supraclavicular skin. The technique proved successful in resurfacing the facial skin of a young female patient with a giant congenital melanocytic hairy nevus on the left side of her face.

  13. Bilobed skin paddle fibula flap for large oromandibular defects.

    PubMed

    Longo, Benedetto; Belli, Evaristo; Pugliese, Pierfrancesco; Ferri, Germano; Santanelli, Fabio

    2013-07-01

    Although the fibula free flap (FFF) is a useful choice for mandible reconstruction, its application for large oromandibular defects is still debated upon. We report the use of FFF with a bilobed perforator-based skin paddle for combined hemiglossectomy, floor-of-the-mouth, tonsillar pillar, and mandibular body defect. A case of an 84-year-old woman with a 2.5 × 3.5-cm exophytic ulcerated mass on the right side of the tongue, extended to omolateral gengival fornix, tonsillar pillar, and mandibular body, is reported. An osteocutaneus FFF with a 7-cm bone strut and a 17 × 10-cm bilobed shaped skin paddle was performed. The longer lobe was used to restore tongue shape, whereas the smaller lobe was used to line the pelvic floor, gingival, and tonsillar pillar. The postoperative period was uneventful. The patient was capable to protrude her neotongue beyond the virtual incisors line and to touch the hard palate at different degrees of mouth opening. The bilobed perforator-based skin paddle FFF is felt to be a sound option for large compound oromandibular defects offering the possibility to safely base the skin component on a single peroneal perforator while achieving effective tongue mobility preservation.

  14. Reconstruction of the external genitals and repair of skin defects of the perineal region using three types of lateral groin flap.

    PubMed

    Sun, G C; Zhong, A G; He, W; Du, P; Song, W M; Ma, J G

    1990-04-01

    Three types of lateral groin flap have been applied to reconstruct the external genitals and to repair skin defects in the perineal region. A single lateral groin flap was used to construct a vagina for 2 patients who had congenital absence of vagina. A composite flap containing iliac crest bone was applied to reconstruct the penis in 11 patients: 8 suffered traumatic amputation and 3 had congenital micropenis. A coaxial pedicle flap of the lateral groin and abdominal area was used to repair skin defects of the penis and scrotum after resection of the elephantiasis caused by recurrent erysipelas in 2 patients, and to relieve postburn scar contracture in the perineal region in another. Using this operative technique, 14 flaps survived completely with satisfactory results; 70% of one composite flap was lost as a result of hematoma. In the single-flap group, the distal portion (3 x 5 cm) of one flap necrosed and was resected and resurfaced with a free skin graft; the final result was good.

  15. Experience in Reconstruction for Small Digital Defects With Free Flaps.

    PubMed

    Hung, Min-Hsiang; Huang, Kuo-Feng; Chiu, Haw-Yen; Chao, Wai-Nang

    2016-03-01

    Traumatic injuries to the digits resulting in soft tissue or bone loss require reconstruction. Traditionally, local flaps, such as homodigital flaps, heterodigital flaps, pedicled flaps, or distant flaps, are used for digital resurfacing. However, free tissue transfers can be used in selected patients. In this study, we present the use of different free flaps including groin skin flaps, groin osteocutaneous flaps, groin chimeric flaps, second dorsal metacarpal artery flaps, and partial toe flaps for digital reconstruction. A total of 19 digits were treated with 16 free flaps in our hospital. Of the flaps used, 5 were free groin skin flaps, 4 were free partial toe flaps, 3 were free groin chimeric flaps, 2 were free groin osteocutaneous flaps, and 2 were free second dorsal metacarpal artery flaps. The average flap size was 4.7 × 2.0 cm (range, 1.5 × 1 to 5 × 4 cm), and the average operative time was 6.0 hours (range, 4-9 hours). All flaps survived without partial or total necrosis. In conclusion, the free flap is a reliable and safe alternative for digital reconstruction. Moreover, the free groin flap provides not only a chimeric pattern for multiple fingers coverage but also an osteocutaneous pattern for thumb lengthening. The free second dorsal metacarpal artery flap provides a tenocutaneous pattern for tendon reconstruction and soft tissue coverage simultaneously, and the free partial toe flap is an excellent alternative for pulp reconstruction in terms of aesthetic appearance and functional outcome.

  16. A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft

    PubMed Central

    Lim, Hyoseob; Han, Dae Hee; Lee, Il Jae

    2014-01-01

    Background Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. Methods We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. Results Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. Conclusions A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft. PMID:24665420

  17. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

    PubMed

    Longo, Benedetto; Laporta, Rosaria; Pagnoni, Marco; Campanale, Antonella; Grippaudo, Francesca Romana; Santanelli Di Pompeo, Fabio

    2015-03-01

    Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

  18. Local Flaps of The Hand

    PubMed Central

    Rehim, Shady A.; Chung, Kevin C.

    2014-01-01

    Synopsis A local flap consists of skin and subcutaneous tissue that is harvested from a site nearby a given defect while maintaining its intrinsic blood supply. When a soft tissue defect of the hand is not amenable to primary closure or skin grafting, local skin flaps can be a used as a reliable source of soft tissue replacement that replaces like with like. Flaps are categorized based on their composition, method of transfer, flap design and blood supply, yet flap circulation is considered the most critical factor for the flap survival. This article reviews the classification of local skin flaps of the hand and offers a practical reconstructive approach for several soft tissue defects of the hand and digits. PMID:24731606

  19. New advances in the mesenchymal stem cells therapy against skin flaps necrosis

    PubMed Central

    Zhang, Fu-Gui; Tang, Xiu-Fa

    2014-01-01

    Mesenchymal stem cells (MSCs), multipotential cells that reside within the bone marrow, can be induced to differentiate into various cells, such as osteoblasts, adipocytes, chondrocytes, vascular endothelial progenitor cells, and other cell types. MSCs are being widely studied as potential cell therapy agents due to their angiogenic properties, which have been well established by in vitro and in vivo researches. Within this context, MSCs therapy appears to hold substantial promise, particularly in the treatment of conditions involving skin grafts, pedicle flaps, as well as free flaps described in literatures. The purpose of this review is to report the new advances and mechanisms underlying MSCs therapy against skin flaps necrosis. PMID:25258671

  20. Survival of a free flap after arterial disconnection at six days.

    PubMed

    Kissun, D; Shaw, R J; Vaughan, E D

    2004-04-01

    We know of no definition of how long it takes for a free flap to develop its own independent blood supply from its recipient bed. In this case report, we describe survival of a free flap after loss of the arterial anastomosis at 6 days.

  1. Improvement of blood flow, expression of nitric oxide, and vascular endothelial growth factor by low-energy shockwave therapy in random-pattern skin flap model.

    PubMed

    Yan, Xiaoyu; Zeng, Bingfang; Chai, Yimin; Luo, Congfeng; Li, Xiaolin

    2008-12-01

    Extracorporeal shock wave therapy (ESWT) can improve flap survival, but its mechanism remains unclear. In this study, we aim to investigate whether ESWT can improve blood flow in ischemic skin flaps and the possible mechanism. Cranially based random-pattern flap (3 x 10 cm) model was established, and its ischemic portion was treated with or without ESWT at 0.09 mJ/mm2 with 750 impulses (1.5 Hz), immediately after operation. Survival area, blood flow, vessel distribution, microvessel density, and expression of nitric oxide and vascular endothelial growth factor were evaluated at 1, 3, and 10 days postoperatively. The results showed that blood perfusion, expression of nitric oxide and vascular endothelial growth factor, vasodilatation of pre-existing vessels at early postoperative stage, neovascularization at late stage, and flap survival were all significantly promoted in treatment group. In conclusion, ESWT can improve skin flap surviving rate through enhanced vasodilatation at early postoperative stage and neovascularization at late stage via modulation of angio-active factors expression.

  2. Hydrogen clearance: Assessment of technique for measurement of skin-flap blood flow in pigs

    SciTech Connect

    Thomson, J.G.; Kerrigan, C.L. )

    1991-10-01

    The hydrogen clearance technique has been used for many years by investigators to determine brain blood flow and has been partially validated in this setting using other methods of blood flow measurement. The method has been modified to allow blood flow measurements in skin, but the accuracy of H2 clearance for measuring skin blood flow has not been determined. Multiple blood flow measurements were performed using H2 clearance and radioactive microspheres on skin flaps and control skin in pigs. On 12 pigs, a total of 117 flap and 42 control skin measurements were available for analysis. There was no significant difference between the two techniques in measuring mean control skin blood flow. In skin flaps, H2 clearance was significantly correlated to microsphere-measured blood flow, but it consistently gave an overestimate. Sources of error may include injury to the tissues by insertion of electrodes, consumption of H2 by the electrodes, or diffusion of H2 from the relatively ischemic flap to its well-vascularized bed. Further studies are necessary to determine the cause of this error and to measure the technique's accuracy in skeletal muscle and other flaps.

  3. Wound tension in rhytidectomy. Effects of skin-flap undermining and superficial musculoaponeurotic system suspension.

    PubMed

    Burgess, L P; Casler, J D; Kryzer, T C

    1993-02-01

    This study was conducted to determine the effects of skin-flap undermining and superficial musculoaponeurotic system (SMAS) suspension on wound-closing tension. Nine sides from five fresh-frozen cadavers were used, with closing tension measured at the two main anchor points, anteriorly (A) and posteriorly (P), with and without SMAS plication for minimal (MIN), intermediate (INT), and maximal (MAX) skin-flap undermining. Results indicated that closing tension was significantly decreased with SMAS plication, both A and P, for all three levels of skin undermining. The average decrease in closing tension with SMAS plication was: A-MIN 191 g, A-INT 95 g, A-MAX 83 g, P-MIN 235 g, P-INT 68 g, and P-MAX 70 g (P < .001 for all). Considering the effect of skin-flap undermining alone, closing tension decreased with wider skin-flap undermining, both with and without SMAS plication. The tension-reducing effect of SMAS plication was decreased with wider skin-flap undermining. Regression analysis determined a second-order exponential curve relating closing tension to skin excision.

  4. Predictive Capability of Near-Infrared Fluorescence Angiography in Submental Perforator Flap Survival

    PubMed Central

    Matsui, Aya; Lee, Bernard T.; Winer, Joshua H.; Laurence, Rita G.; Frangioni, John V.

    2010-01-01

    Background Perforator flaps have become increasingly popular in reconstructive surgery as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, our laboratory described the intraoperative use of near-infrared (NIR) fluorescence angiography for patient-specific perforator-flap design. This study evaluates the predictive capability of NIR fluorescence angiography for flap survival in submental flap reconstruction. Methods NIR angiography was performed using indocyanine green at 0, 0.5, 24, 48, and 72 h post-surgery after flap creation in 12 pigs. A single perforator artery was preserved during flap creation based on location (central or non-central) and dominance (dominant or non-dominant). Venous drainage, arterial perfusion, and perfused area as percentage of total flap were analyzed. Clinical assessments of perfusion were compared with those made using NIR imaging and histology. Results Use of NIR fluorescence angiography immediately after flap creation accurately predicted areas of perfusion at 72 h (p = 0.0013), compared to the initial clinical assessment (p = 0.3085). Identification of necrosis by histology at 72 h correlated with NIR findings of insufficient arterial perfusion immediately after flap creation. No statistically significant differences in perfusion metrics were detected based on location or dominance of the preserved perforator; however, flaps containing central perforators had a higher percent perfused area than those with non-central perforators. Conclusions The use of NIR angiography immediately after flap creation can predict areas of perfusion at 72 h. This predictive capability may permit intraoperative revision of compromised flaps that have a high likelihood of failure. PMID:21042109

  5. Prevention of ischemia-reperfusion injury in a rat skin flap model: the role of mast cells, cromolyn sodium, and histamine receptor blockade.

    PubMed

    Cordeiro, P G; Lee, J J; Mastorakos, D; Hu, Q Y; Pinto, J T; Santamaria, E

    2000-02-01

    The objective of this study was to examine the role of mast cells and their principal product, histamine, in ischemia/reperfusion injury. Cromolyn sodium, diphenhydramine, and cimetidine were administered to ischemic flaps just before reperfusion and evaluated for flap survival, mast cell count, neutrophil count, and myeloperoxidase levels. Epigastric island skin flaps were elevated in 49 rats; they were rendered ischemic by clamping the artery for 10 hours. Thirty minutes before reperfusion, the rats were treated with intraperitoneal saline (n = 11), cimetidine (n = 11), diphenhydramine (n = 11), or cromolyn sodium (n = 10). Flap survival was evaluated at 7 days. Neutrophil counts, mast cell counts, and myeloperoxidase levels were evaluated 12 hours after reperfusion. Flap necrosis in the sham group of animals (n = 6) was 0.0 percent, as expected, whereas the control group (saline-treated animals) had 47.3+/-33.4 percent necrosis. Animals treated with diphenhydramine and cimetidine demonstrated a significant decrease in flap necrosis to 17.7+/-8.8 percent and 19.4+/-14.7 percent, respectively. This protective effect was not seen with cromolyn sodium (44.3+/-35.6 percent). Both neutrophil and mast cell counts were significantly decreased in flaps from antihistamine-treated and sham animals versus both saline- and cromolyn sodium-treated groups. The administration of diphenhydramine and cimetidine before reperfusion can significantly reduce the extent of flap necrosis and the neutrophil and mast cell counts caused by ischemia/reperfusion. This protective effect is not seen with cromolyn sodium. The protective effect of antihistamines on flap necrosis might be related to the decrease in neutrophils and, possibly, mast cells within the flap.

  6. BCL-2 and Bax Expression in Skin Flaps Treated with Finasteride or Azelaic Acid

    PubMed Central

    Ayatollahi, Seyyed Abdulmajid; Ajami, Marjan; Reyhanfard, Hamed; Asadi, Yasin; Nassiri-Kashani, Mansour; Rashighi Firoozabadi, Mehdi; Davoodi, Sayed Hossein; Habibi, Esmaeil; Pazoki-Toroudi, Hamidreza

    2012-01-01

    Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between – to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein (p < 0.05) and decrease the expression of bax protein (p < 0.05). These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult. PMID:24250563

  7. The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response.

    PubMed

    Demirci, Ugur; Basut, Oguz; Noyan, Behzat; Demir, Uygar Levent; Afsin Ozmen, O; Kasapoglu, Fikret; Hakan Coskun, H; Onart, Selcuk

    2014-01-01

    The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.

  8. Pre-expanded and Prefabricated Abdominal Superthin Skin Perforator Flap for Total Hand Resurfacing.

    PubMed

    Wang, Chunmei; Zhang, Junyi; Yang, Sifen; Song, Ping; Yang, Lun; Pu, Lee L Q

    2017-01-01

    Reconstruction of the postburn hand remains a challenge for surgeons. For cosmetic and functional requirements, the desired flap should be thin enough to ensure the flexibility of the hand. Conventional perforator flaps serve as a viable option when reconstructing the postburn hand to regain functionality. However, limitations include the discrepancy in tissue thickness and the difficulty with donor site closure. Thus, a preexpanded superthin skin perforator flap is an ideal choice for postburn hand reconstruction, with the trade-off being a longer treatment course (3-4 months), but with results that satisfy both patients and their surgeons.

  9. Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy.

    PubMed

    Basut, Oguz; Noyan, Behzat; Demirci, Ugur

    2014-01-01

    In the present study, we evaluated the efficacy of flaps via measurement of galvanic skin responses (GSR) in patients who had undergone superficial parotidectomy either with or without sternocleidomastoid (SCM) muscle flaps. Retrospective study design was used. The setting included University of Uludag School of Medicine Department of Otorhinolaryngology. Eleven patients who had undergone superficial parotidectomy for benign diseases in our clinic between June 2003 and August 2006 were included in the study. SCM muscle flaps were used in four patients. The GSR of the patients were measured using a MP 30 System. The Mann-Whitney U test was used for the analysis of data. There were complaints that resembled Frey's syndrome in three patients in whom flaps had not been performed. Patients with flaps had no complaints. In patients with flaps, no significant GSR changes were observed between the control and operated sides (P > 0.05). In patients without flaps, the GSR levels were significantly higher on the operated side compared to the control side (P < 0.05). GSR values on the control side did not show any differences between patients with and without a flap. However, there were significantly higher GSR values for the operated side in patients without flaps compared to patients with flaps (P < 0.05). Application of a SCM flap is an efficient method by which to prevent Frey's syndrome, and the GSR test is beneficial both in diagnosiing and determining the severity of the disease as well as evaluating the efficacy of surgical techniques used to prevent Frey's syndrome.

  10. Reconstruction of through-and-through oromandibular defects by the double-skin paddle fibula osteocutaneous flap: can the skin paddle always be divided?

    PubMed

    Kubo, Tateki; Osaki, Yoko; Hattori, Ryo; Kanazawa, Shigeyuki; Hosokawa, Ko

    2013-02-01

    Reconstruction of the through-and-through defects of the oral cavity, involving oral mucosa, bone, and external skin is a major challenge. A single fibula osteocutaneous flap providing two skin islands is an option for such composite reconstruction. The number, location, and size of skin perforators were studied in the distal two thirds of the lower legs in 22 cases of fibula osteocutaneous flap mandibular reconstruction, and whether the skin paddle of the fibula flap could always be divided completely based on two distal perforators was examined. In this study, only 50% of the flaps had two or more distal perforators; thus, it was concluded that the skin paddle of the fibula osteocutaneous flap could not always be divided based on two distal skin perforators.

  11. Local Rhomboid Flap Reconstruction for Skin Defects After Excising Large Parotid Gland Tumors.

    PubMed

    Hung, Min-Hui; Liao, Chun-Ta; Kang, Chung-Jan; Huang, Shiang-Fu

    2017-01-01

    Most parotid tumors grow slowly, and sometimes these patients do not request surgical treatment until the tumors become large and affect their appearance. The surgical treatment of these large tumors is usually accompanied by large skin defects after excision, and it is challenging for surgeons to close the defect primarily. This report describes the case of a 68-year-old man with a left parotid gland tumor (largest dimension, 110 mm) and the case of a 79-year-old man with a left parotid gland tumor measuring approximately 77 mm that had existed for decades. These patients underwent facial nerve dissection and parotidectomy with skin sacrifice. The large skin defects after the parotidectomy were successfully reconstructed with local rhomboid flaps. No facial palsy, wound disruption, flap edge loss, or major complications occurred after the surgeries. Except for the scars, the color of the cheek flap was not apparent from the periphery. In conclusion, local rhomboid flap reconstruction is a rapid and practical technique for reconstructing medium to large skin defects in the cheek and upper neck regions after tumor excisions. The flap was reliable in blood supply and cosmetic outcome.

  12. Salient Points in Reconstruction of Nasal Skin after Tumor Ablation with Local Flaps

    PubMed Central

    Ebrahimi, Ali; Motamedi, Mohammad Hosein Kalantar; Nejadsarvari, Nasrin; Ebrahimi, Azin; Rasouli, Hamid Reza

    2016-01-01

    Objective: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation. Patients and Methods: From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected. Results: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications. Conclusion: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate. PMID:27761088

  13. Perfusion and Oxygenation of Random Advancement Skin Flaps Depend More on the Length and Thickness of the Flap Than on the Width to Length Ratio

    PubMed Central

    Memarzadeh, Khashayar; Sheikh, Rafi; Blohmé, Jonas; Torbrand, Christian

    2016-01-01

    Objective: The aim was to investigate the relationship between the dimensions (length, width, and thickness) of random advancement skin flaps and retained tissue perfusion and oxygenation. Methods: Flaps were raised on the flanks of pigs. The flaps were either 0.5 or 1.0 cm wide, thin (dissected halfway through the subcutaneous tissue) or thick (dissected down to the muscle fascia). Tissue perfusion was measured by laser Doppler velocimetry, and tissue oxygenation (pO2) was measured using a Licox system, every 0.5 cm along the flaps’ length. Tissue temperature was visualized by high-resolution infrared camera. Results: Perfusion and oxygenation decreased gradually from the base to the tip of the flap, reaching approximately 40% of presurgical values (2.0 cm) and approximately 20% (2.5 cm) from the base of the flap. There was virtually no blood flow, nor oxygen tension, 3.0 cm from the base of the flap. The width to length ratio of the flap did not determine blood flow or oxygenation, being approximately 30% in a 0.5 cm wide and 2 cm long flap, and 0% in a 1.0 cm wide and 4 cm long flap, both with a width to length ratio of 1:4. Blood flow and oxygenation were preserved to a greater extent in the thick flaps (∼40%) than in the thin flaps (∼20%), in a 0.5 cm wide and 2 cm long flap. Conclusions: The dissection of a random advancement flap results in hypoperfusion and oxygenation that cannot be predicted by the width to length ratio but depend on the length and thickness of the flap. PMID:26958105

  14. Use of the angularis oris cutaneous flap for repair of a rostral mandibular skin defect in a cat.

    PubMed

    Bradford, M; Degner, D A; Bhandal, J

    2011-01-01

    The angularis oris axial pattern flap is based on the blood supply of the angularis oris artery and vein. While the use of this flap for repair of canine facial wounds is well documented, this technique has not been reported in the cat. This case report presents the reconstruction of a large ventral chin and rostral lip wound with the use of this flap. Complete survival of this flap was observed in this patient.

  15. Paradoxical effects of heme arginate on survival of myocutaneous flaps

    PubMed Central

    Czopek, Alicja; Wigmore, Stephen J.; Kluth, David C.

    2013-01-01

    Ischemia reperfusion injury (IRI) contributes to partial flap and solid organ transplant failure. Heme-oxygenase 1 (HO-1) is an inducible, cytoprotective enzyme which protects against IRI in solid organ transplant models. Heme arginate (HA), a HO-1 inducer, is a promising, translatable, preconditioning agent. This study investigated the effects of preconditioning with HA on the clinical outcome of a myocutaneous IRI model. Forty male Lewis rats were randomized to intravenously receive 1) Control-NaCl, 2) HA, 3) HA and tin mesoporphyrin (SnMP), a HO-1 inhibitor; and 4) SnMP alone. Twenty-four hours later, an in situ transverse rectus abdominis myocutaneous flap was performed under isoflurane anesthesia. Viability of flaps was measured clinically and by laser-Doppler perfusion scanning. In vitro work on human epidermal keratinocytes (HEKa) assessed the effects of HA, SnMP, and the iron chelator desferrioxamine on 1) cytotoxicity, 2) intracellular reactive oxygen species (ROS) concentration, and 3) ROS-mediated DNA damage. In contrast to our hypothesis, HA preconditioning produced over 30% more flap necrosis at 48 h compared with controls (P = 0.02). HA-containing treatments produced significantly worse flap perfusion at all postoperative time points. In vitro work showed that HA is cytotoxic to keratinocytes. This cytotoxicity was independent of HO-1 and was mediated by the generation of ROS by free heme. In contrast to solid organ data, pharmacological preconditioning with HA significantly worsened clinical outcome, thus indicating that this is not a viable approach in free flap research. PMID:24089372

  16. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    PubMed Central

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative. PMID:23197233

  17. Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy.

    PubMed

    Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan

    2016-02-01

    Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point.

  18. Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy

    PubMed Central

    Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan

    2016-01-01

    Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point. PMID:26977363

  19. Skin flap complications after decompressive craniectomy and cranioplasty: Proposal of classification and treatment options

    PubMed Central

    Di Rienzo, Alessandro; Pangrazi, Pier Paol; Riccio, Michele; Colasanti, Roberto; Ghetti, Ilaria; Iacoangeli, Maurizio

    2016-01-01

    Background: The list of complications reported after decompressive craniectomy (DC) and cranioplasty is progressively increasing. Nonetheless, the exact incidence of these events is still ill-defined. Problems affecting skin flaps after DC and cranioplasty have never been accurately analyzed in papers and their impact on patients’ prognosis is largely underestimated. Methods: In a 10-year time, we treated by DC 450 patients, 344 of whom underwent cranioplasty, either with autologous bone or artificial implants (hydroxyapatite, polyetheretherketone, titanium, polymethylmethacrylate). Complications involving skin flaps and requiring re-surgery were observed and treated in 38 cases. We classified three main types of lesions: (1) dehiscence, (2) ulcer, and (3) necrosis. In all cases surgical decision making was performed in cooperation with plastic surgeons, to select the best treatment option. Results: Dehiscence was reported in 28 cases, ulcer in 6, and necrosis in 4. Surgeries included flap re-opening and re-suturing, Z-plasty, rotational, advancement, or free flaps. Treatment complications required further surgical procedures in six patients. Conclusions: In our experience, complications involving skin flaps after DC and post-DC cranioplasty cannot be considered a minor event because of their potential to further compromise the yet fragile conditions of these patients. Their management is complex and requires a multidisciplinary approach to get the better results. PMID:27904753

  20. The rat saphenous flap: a fasciocutaneous free flap model without panniculus carnosus.

    PubMed

    Mutaf, M; Tasaki, Y; Tanaka, K; Fujii, T

    1995-10-01

    The rat saphenous flap is described as a new experimental model for free flap studies. This is a fasciocutaneous free flap based on the saphenofemoral vascular pedicle. The flap may include the entire medial aspect of the lower leg between the knee and ankle. Thirty flaps were harvested from 15 inbred rats. Each flap was transferred to the anterior neck of a recipient rat of the same inbred strain so that 15 flaps were vascularized free flaps using the standard end-to-end microvascular technique and the other 15 flaps were nonvascularized free grafts. All but two (technical failure) of the vascularized flaps showed complete survival, whereas all nonvascularized flaps completely necrosed 2 weeks after transfer. It was concluded that the rat saphenous flap has several advantages such as a long and consistent vascular pedicle, ease of harvest, and an all-or-none survival pattern. Furthermore, as a unique feature of this flap, histological analysis revealed that the rat saphenous flap is composed of the skin and underlying fascia without panniculus carnosus. We therefore suggest that the rat saphenous flap is the first true fasciocutaneous free flap model in the rat. In this paper, in addition to illustrating the anatomy of the saphenous vessels and describing a new fasciocutaneous free flap model based on these vessels, we have documented some anatomical details of the rat leg that have never been described in the literature related to the rat anatomy.

  1. Diabetic foot reconstruction using free flaps increases 5-year-survival rate.

    PubMed

    Oh, Tae Suk; Lee, Ho Seung; Hong, Joon Pio

    2013-02-01

    The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with free flaps and analyse the preoperative risk factors. This study reviews 121 cases of reconstructed diabetic foot in 113 patients over 9 years (average follow-up of 53.2 months). Patients' age ranged from 26 to 78 years (average, 54.6 years). Free flaps used were anterolateral thigh (ALT, 90), superficial circumflex iliac artery perforator (SCIP, 20), anteromedial thigh (AMT, 5), upper medial thigh (UMT, 3), and other perforator free flaps (3). Correlation between the surgical outcome and preoperative risk factors were analysed using logistic regression model. Total loss was seen in 10 cases and 111 free-tissue transfers were successful (flap survival rate of 91.7%). During follow-up, limb was eventually lost in 17 patients and overall limb salvage rate was 84.9% and the 5-year survival was 86.8%. Correlation between flap loss and 14 preoperative risk factors (computed tomography (CT) angiogram showing intact numbers of major vessels, history of previous angioplasty, peripheral arterial disease (PAD), heart problem, chronic renal failure (CRF), American Society of Anaesthesiologists (ASA) physical status classification system, smoking, body mass index (BMI), HBA1c, lymphocyte count, ankle-brachial index (ABI), osteomyelitis, C-reactive protein (CRP) level and whether taking immunosuppressive agents) were analysed. Significant odds ratio were seen in patients who underwent lower extremity angioplasties (odds ratio: 17.590, p<0.001), with PAD (odds ratio: 10.212, p=0.032) and taking immunosuppressive agents after kidney transplantation (odds ratio: 4.857, p<0.041). Diabetic foot reconstruction using free flaps has a high chance for success and significantly increases the 5-year survival rate. Risk factors such as PAD, history of angioplasties in the extremity and using immunosuppressive agents after transplant may increase the chance for flap loss.

  2. Hirudin promotes angiogenesis by modulating the cross-talk between p38 MAPK and ERK in rat ischemic skin flap tissue.

    PubMed

    Pan, Xin-Yuan; Peng, Liu; Han, Zhi-Qiang; Yin, Guo-Qian; Song, Yan-Kun; Huang, Jun

    2015-06-01

    Hirudin's ability to increase angiogenesis in ischemic flap tissue and improve the flaps survival has been demonstrated in our previous studies. However, the knowledge about hirudin functional role in angiogenesis is still limited. In the present study, we investigate the effects of locally injected hirudin on the expression of VEGF, endostatin and thrombospondin-1 (TSP-1) using rat model. Caudally based dorsal skin flaps were created and were treated with hirudin or normal saline. Result showed that the flap survival was improved by hirudin treatment relative to the control. Treatment of flaps with hirudin exerted significant angiogenic effect as evidenced by increased VEGF expression and reduced endostatin and TSP-1 production (p<0.01), and promoted neovascularization (microvascular density, p<0.01). Moreover, hirudin treatment increased the ERK1/2 phosphorylation, while attenuated the phosphorylation of p38 MAPK, and the addition of thrombin could reverse these effects of hirudin on ERK1/2 and p38 MAPK activity. The MEK inhibitor blocked the hirudin-induced VEGF expression, and the p38 MAPK inhibitor attenuated the thrombin-induced TSP-1 expression. Furthermore, a specific inhibitor of p38 MAPK activates ERK1/2 in ischemic flaps, suggesting that cross-talk between p38 MAPK and ERK might exist in rat ischemic flap tissue. Moreover, either the hirudin or SCH79797 (PAR1 antagonist) could attenuate the p38 MAPK phosphorylation and increases the ERK1/2 phosphorylation, indicating that the cross-talk between p38 MAPK and ERK1/2 modulated by thrombin/PAR1 signaling may participate in the process of hirudin-stimulated ERK1/2 signaling. In conclusion, these observations suggest that hirudin exerts its angiogenesis effect by regulating the expression of angiogenic and antiangiogenic factors via a cross-talk of p38 MAPK-ERK pathway.

  3. Designing Flaps for Closure of Circular and Semicircular Skin Defects.

    PubMed

    Alvarado, Alfredo

    2016-01-01

    Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved.

  4. SU-E-T-560: Commissioning An HDR Freiburg Flap Applicator for Skin Lesion Treatment

    SciTech Connect

    Dou, K; Li, B; Lerma, F; Aroumougame, V; Sarfaraz, M; Laser, B; Jacobs, M

    2014-06-01

    Purpose: Flexible Freiburg flap used with high dose rate afterloaders is easy to cut into any size for any body site and to dwell with a precise source position, conforms to curved skin surface and then to the planned target. However, unlike intracavity or interstitial situations, incomplete scatter environment due to flap applicators exposed to air might lead to dose difference between the delivered and planned. This research is focused on the dose deviation of incomplete scatter versus full scatter. Methods: A 12x12 cm of Freiburg flap applicator was used for the validation. A Nucletron Oncentra Brachy Ver. 4.3 treatment planning system (TPS) was used for treatment planning. However, no heterogeneity correction incorporated into the brachytherap TPS needs to be considered. A Philips Brilliance CT Big Bore was employed for CT scan. Radiation was delivered using a Nucletron HDR remote afterloader system. A 10cm bolus was used to cover the flap for obtaining a full scatter. An OSL, ion chamber, and Gafchromic EBT2 film were used for commissioning the flap applicator. Results: The applicator calibration at 5mm depth was performed using an OSL dosimeter. Applicator source dwelling positions with 1D and 2D array exposed to and recorded by Gafchromic EBT2 film showed an agreement within 1mm. 1D array of Freiburg flap exhibited 4.2% cooler in dose with incomplete scatter than full scatter. 2D array showed 7.1% lower in dose for incomplete scatter than full scatter. The deviation was found more than 10% beyond 8cm in depth. Conclusion: Significant dose deviation caused by the incomplete scatter environment was found to be 7.1% at 1cm depth. This deviation was increased with increasing depth. The inaccuracy resulted from the incomplete scatter can be fixed by either placing a bolus on the top of the flap or making the plan at least 7% hotter.

  5. Survival of the fastest: Evolving wings for flapping flight

    NASA Astrophysics Data System (ADS)

    Ramananarivo, Sophie; Mitchel, Thomas; Ristroph, Leif

    2014-11-01

    To optimize flapping flight with regard to wing shape, we use an evolutionary or genetic algorithm to improve the forward speed of 3d-printed wings or hydrofoils that heave up-and-down and self-propel within water. In this scheme, ``genes'' are mathematical parameters specifying wing shape, and ``breeding'' involves the merging and mutation of genes from two parent wings to form a child. A wing's swimming speed is its ``fitness'', which dictates the likelihood of breeding and thus passing on its genes to the next generation. We find that this iterative process leads to marked improvements in relatively few generations, and several distinct shape features are shared among the fastest wings. We also investigate the favorable flow structures produced by these elite swimmers and compare their shape and performance to biologically evolved wings, fins, tails, and flippers.

  6. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema.

    PubMed

    Nicoli, Fabio; Orfaniotis, Georgios; Lazzeri, Davide; Lim, Seong Yoon; Kiranantawat, Kidakorn; Chen, Pei-Yu; Ciudad, Pedro; Chilgar, Ram M; Sapountzis, Stamatis; Sacak, Bulent; Chen, Hung-Chi

    2016-11-01

    Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016.

  7. Double-skin paddled superficial temporofascial flap for the reconstruction of full-thickness cheek defect.

    PubMed

    Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet Hamdi

    2013-01-01

    The most common causes of cheek defects include trauma, burn, and tumor resections. In the reconstruction of the defects in this region, it is essential to use similar or adjacent tissue considering the aesthetic and functional properties. For this purpose, numerous local, regional, or distant free flaps were described. The local flaps harvested from the head and neck region are the most frequent methods because of the similar skin color, texture, and compatibility with cheek.In this study, the reconstruction in a 29-year-old male patient who had a full-thickness cheek defect due to tumor resection on the left side was performed, wherein a hairless skin island was carried through the frontal branch of superficial temporal artery for oral mucosa, and a hairy skin island through the parietal branch of the same pedicle was carried for the bearded skin defect. No complication occurred postoperatively and both aesthetic and functional satisfactory results were obtained, providing the oral mucosal and natural beard integrity. Donor-site scarring and temporal alopecia were recorded as the disadvantages of this method.This technique is a useful method for the reconstruction of full-thickness cheek defects because of its advantages including compatibility of color and texture, reliable blood supply, requiring single-session procedure, and being able to carry 2 different skin islands on the same pedicle.

  8. Utilization of skin flap for reconstruction of the genitalia after an electric burn.

    PubMed

    Castro, Rodrigo B; Oliveira, Ana B; Favorito, Luciano A

    2006-01-01

    The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.

  9. Development of In Vitro Isolated Perfused Porcine Skin Flaps for Study of Percutaneous Absorption of Xenobiotics

    DTIC Science & Technology

    1985-11-01

    during the postoperative period. This experi- ment was considered to be successful when it was determined that ,I 10 4 CA 12 C1 A. Sage I sro pedre...axial-pattern tubed flap could be raised and survive the entire length for an appropriate postoperative period. In the stage 2 procedure, each female...with 1-2 ml of 2% lidocaine hydrochloride to minimize vasospasm during subsequent manipulations. Aided by 3X microsurgical lenses, the CSEa was isolated

  10. A 3-dimensional model for teaching local flaps using porcine skin.

    PubMed

    Hassan, Zahid; Hogg, Fiona; Graham, Ken

    2014-10-01

    The European Working Time Directive and streamlined training has led to reduced training time. Surgery, as an experience-dependent craft specialty is affected more than other medical specialties. Trainees want to maximize all training opportunities in the clinical setting, and having predeveloped basic skills acquired on a simulated model can facilitate this.Here we describe the use of a novel model to design and raise local flaps in the face and scalp regions. The model consists of mannequin heads draped with porcine skin which is skewered with pins at strategic points to give a 3-dimensional model which closely resembles a cadaveric head.The advantages of this model are that it is life size and incorporates all the relevant anatomical features, which can be drawn on if required.This model was used on a recent course, Intermediate Skills in Plastic Surgery: Flaps Around the Face, at the Royal College of Surgeons England. The trainees found that practicing on the porcine skin gave them an opportunity to master the basics of flap design and implementation.In summary, this innovative 3-dimensional training model has received high levels of satisfaction and is currently as close as we can get to cadaveric dissection without the constraints and cost of using human tissue.

  11. CASE REPORT Reconstruction and Characterization of Composite Mandibular Defects Requiring Double Skin Paddle Fibular Free Flaps

    PubMed Central

    Badeau, Austin M.; Deleyiannis, Frederic W.-B.

    2013-01-01

    Objective: Fibular free flaps are the preferred method for reconstruction of composite lateral mandibular defects. This reconstructive technique is limited by the skin paddle's inability to freely rotate when attempting to fill 2 poorly aligned defects. Reconstructive surgeons have been exploring multiple methods of creating 2 independent skin paddles based on the same peroneal blood supply. We present a variation of these techniques. Method: Our patient with a history of squamous cell carcinoma presented with a left retromolar recurrence and osteoradionecrosis of the mandible with a draining anterior sinus tract. The combination of these defects warranted further composite resection with fibular free flap reconstruction. Results: A subperiosteal dissection was performed to create 2 separate septocutaneous skin paddles based on the same peroneal blood supply. This dissection and discard of proximal fibula provided the rotational freedom needed for the 2 skin islands to fill both a lateral oral defect and anterior cutaneous defect. Conclusion: Although similar reconstructive methods have been reported in the literature, the characterization of defects benefiting from these techniques is scarce and unclear. We describe clear and concise characteristics of these defects, which should be meaningful to the reconstructive surgeon when considering operative technique. PMID:23653822

  12. Long-term survival after chest-wall reconstruction with musculocutaneous flaps

    SciTech Connect

    Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. )

    1990-10-01

    Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures.

  13. An alternative approach in the treatment of Dupuytren's contracture skin defects: first dorsal metacarpal artery island flap.

    PubMed

    Ozdemir, Oguz; Coskunol, E; Ozalp, T

    2004-03-01

    Skin defects are often present following surgery for Dupuytren's contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytren's contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger.

  14. [Scapular/parascapular double skin-paddle free flap for transfixing blast injuries of the hand. A case report].

    PubMed

    Colson, T; Pozetto, M; Gibert, N; Dautel, G

    2014-06-01

    Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction.

  15. Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.

    PubMed

    Wong, Chin-Ho; Teoh, Lam-Chuan; Lee, Jonathan Y-L; Yam, Andrew K-T; Khoo, David B-A; Yong, Fok-Chuan

    2008-03-01

    The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap. Four patients with large finger wounds were reconstructed with free digital artery flap. Our indications for digital artery free flap were concomitant injuries to adjacent fingers that precluded their use as donor sites. The arterial supply of the flap was from the digital artery and the venous drainage was from the dominant dorsal vein of the finger. The flap was harvested from the ulnar side of the finger. The digital nerve was left in situ to minimize donor morbidity. The donor site was covered with a full-thickness skin graft and secured with bolster dressings. Early intensive mobilization was implemented for all patients. All flaps survived. No venous congestion was noted and primary healing was achieved in all flaps. In addition to providing well-vascularized tissue for coverage of vital structures, the digital artery was also used as a flow-through flap for finger revascularization in one patient. Donor-site morbidity was minimal, with all fingers retaining protective pulp sensation and the distal and proximal interphalangeal joints retaining full ranges of motion. In conclusion, the free digital artery flap is a versatile flap that is ideal for coverage of large-sized finger defects in situations where local flaps are unavailable. Donor-site morbidity can be minimized by preservation of the digital nerve, firmly securing the skin graft with bolster dressings, and early mobilization of the donor finger.

  16. Effect of systemic piracetam treatment on flap survival and vascular endothelial growth factor expression after ischemia-reperfusion injury.

    PubMed

    Tuncer, Serhan; Ayhan, Suhan; Findikcioglu, Kemal; Ergun, Hakan; Tuncer, Ilhan

    2011-09-01

    The effects of piracetam on flap survival, ischemia-reperfusion (I/R) injury, and vascular endothelial growth factor (VEGF) expression were evaluated in this study. Unipedicled epigastric flap model was used in 36 rats and was evaluated within 4 groups. The flap was elevated and untreated in Group 1. Postoperative piracetam treatment was given for 7 days in Group 2. In Group 3, 4 hours of ischemia and 2 hours of reperfusion were applied. I/R was applied to Group 4 and piracetam was given 30 minutes before reperfusion and postoperatively for 7 days. Laser Doppler flowmetry was used to measure blood flow changes. VEGF expression was determined using immunohistochemical methods on tissue samples taken after the completion of 2 hours reperfusion in groups 3 and 4. Flap necrosis was measured on the day 7 in all groups. Blood flow rates did not show significant difference between piracetam treated and untreated I/R groups. Piracetam significantly reduced necrosis area both in ischemic and nonischemic flaps ( P < 0.05). VEGF expression was significantly increased in piracetam-treated Group 4 compared with Group 3 ( P = 0.005). This experimental study demonstrates that systemic piracetam treatment improves survival of pedicled flaps, reduces necrosis amounts, and increases VEGF expression in I/R induced flaps.

  17. A Flap Endonuclease (TcFEN1) Is Involved in Trypanosoma cruzi Cell Proliferation, DNA Repair, and Parasite Survival.

    PubMed

    Ponce, Ivan; Aldunate, Carmen; Valenzuela, Lucia; Sepúlveda, Sofia; Garrido, Gilda; Kemmerling, Ulrike; Cabrera, Gonzalo; Galanti, Norbel

    2016-12-09

    FLAP endonucleases (FEN) are involved both in DNA replication and repair by processing DNA intermediaries presenting a nucleotide flap using its phosphodiesterase activity. In spite of these important functions in DNA metabolism, this enzyme was not yet studied in Trypanosomatids. Trypanosoma cruzi, the ethiological agent of Chagas disease, presents two dividing cellular forms (epimastigote and amastigote) and one non-proliferative, infective form (trypomastigote). The parasite survives DNA damage produced by reactive species generated in its hosts. The activity of a T. cruzi FLAP endonuclease (TcFEN1) was determined in the three cellular forms of the parasite using a DNA substrate generated by annealing three different oligonucleotides to form a double-stranded DNA with a 5' flap in the middle. This activity showed optimal pH and temperature similar to other known FENs. The substrate cut by the flap endonuclease activity could be ligated by the parasite generating a repaired DNA product. A DNA flap endonuclease coding sequence found in the T. cruzi genome (TcFEN1) was cloned, inserted in parasite expression vectors and transfected to epimastigotes. The purified native recombinant protein showed DNA flap endonuclease activity. This endonuclease was found located in the parasite nucleus of transfected epimastigotes and its over-expression increased both parasite proliferation and survival to H2 O2 . The presence of a flap endonuclease activity in T. cruzi and its nuclear location are indicative of the participation of this enzyme in DNA processing of flap fragments during DNA replication and repair in this parasite of ancient evolutive origin. J. Cell. Biochem. 9999: 1-11, 2016. © 2016 Wiley Periodicals, Inc.

  18. Morphological study of rat skin flaps treated with subcutaneous dimethyl sulfoxide combined with hyperbaric oxygen therapy.

    PubMed

    Almeida, K G; Oliveira, R J; Dourado, D M; Filho, E A; Fernandes, W S; Souza, A S; Araújo, F H S

    2015-12-28

    This study investigated the effects of hyperbaric oxygen therapy (HBOT) and dimethyl sulfoxide (DMSO) in tissue necrosis, genotoxicity, and cell apoptosis. Random skin flaps were made in 50 male Wistar rats, randomly divided into the following groups. Control group (CT), wherein a rectangular skin section (2 x 8 cm) was dissected from the dorsal muscle layer, preserving the cranial vessels, lifted, and refixed to the bed; distilled water (DW) group, in which DW was injected into the distal half of the skin flap; DMSO group, wherein 5% DMSO was injected; HBOT group, comprising animals treated only with HBOT; and HBOT + DMSO group, comprising animals treated with 100% oxygen at 2.5 atmospheres absolute for 1 h, 2 h after the experiment, daily for 10 consecutive days. A skinflap specimen investigated by microscopy. The percentage of necrosis was not significantly different between groups. The cell viability index was significantly different between groups (P < 0.001): 87.40% (CT), 86.20% (DW), 84.60% (DMSO), 86.60% (DMSO + HBO), and 91% (HBO) (P < 0.001), as was the cell apoptosis index of 12.60 (CT), 12.00 (DW), 15.40 (DMSO), 9.00 (HBO), and 12.00 (DMSO + HBO) (P < 0.001). The genotoxicity test revealed the percentage of cells with DNA damage to be 22.80 (CT), 22.60 (DW), 26.00 (DMSO), 8.80 (DMSO + HBO), and 7.20 (HBO) (P < 0.001). Although the necrotic area was not different between groups, there was a significant reduction in the cellular DNA damage and apoptosis index in the HBOT group.

  19. Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft.

    PubMed

    Dessy, Luca Andrea; Figus, Andrea; Fioramonti, Paolo; Mazzocchi, Marco; Scuderi, Nicolò

    2010-05-01

    Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone to delay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p<0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours.

  20. Immunologically augmented skin flap as a novel dendritic cell vaccine against head and neck cancer in a rat model.

    PubMed

    Inoue, Keita; Saegusa, Noriko; Omiya, Maho; Ashizawa, Tadashi; Miyata, Haruo; Komiyama, Masaru; Iizuka, Akira; Kume, Akiko; Sugino, Takashi; Yamaguchi, Ken; Kiyohara, Yoshio; Nakagawa, Masahiro; Akiyama, Yasuto

    2015-02-01

    Local recurrence is a major clinical issue following surgical resection in head and neck cancer, and the dissemination and lymph node metastasis of minimal residual disease is relatively difficult to treat due to the lack of suitable therapeutic approaches. In the present study, we developed and evaluated a novel immunotherapy using a skin flap transfer treated with sensitized dendritic cells (DC), termed the "immuno-flap," in a rat tumor model. After the local round area of skin was resected, SCC-158 cells (a rat head and neck cancer cell line) were inoculated into the muscle surface; lastly, the groin skin flap injected with mature DC was overlaid. Two weeks after the second DC injection, systemic immunological reactions and tumor size were measured. The DC-treated group showed a significant reduction in tumor size compared with the control. Although the induction of CTL activity in spleen cells was marginal, Th1 cytokines such as interleukin-2 and interferon-γ were elevated in the DC-treated group. These results suggest that a novel immunotherapy based on the immuno-flap method has the potential for clinical application to prevent the local recurrence of head and neck cancer patients.

  1. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap.

    PubMed

    Abhyankar, Suhas V; Kulkarni, Ananta; Agarwal, Naveen Kumar

    2009-10-01

    Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

  2. A Previously Discounted Flap Now Reconsidered: MatriDerm and Split-Thickness Skin Grafting for Tendon Cover Following Dorsalis Pedis Fasciocutaneous Flap in Lower Limb Trauma

    PubMed Central

    Dunne, Jonathan A.; Wilks, Daniel J.; Rawlins, Jeremy M.

    2014-01-01

    Objective: The dorsalis pedis flap has reliable vascularity; however, its use is limited by reports of donor site morbidity including infection, delayed healing, exposure of tendons, and later contractures. The purpose of this study was to demonstrate its continued role in lower limb trauma when the donor site is reconstructed with MatriDerm to avoid complications. Methods: A 65-year-old man presented with a displaced, Gustilo 3b open transverse fracture of his left distal fibula. He had a 2 cm2 open wound over his lateral malleolus. Results: Following review of possible local options, a dorsalis pedis fasciocutaneous flap was deemed best for coverage, and the donor site was closed with 1-mm MatriDerm dermal matrix and a 6/1000 inch split-thickness skin graft (STSG) in a single stage. Three months postoperatively, the foot had excellent function and cosmesis, with toes in a neutral position and a full range of movement. Conclusions: The dorsalis pedis flap is a valuable reconstructive option for defects of the foot and ankle. Its major limitation donor site morbidity can be overcome by the additional application of a dermal substitute such as MatriDerm under the STSG. PMID:24917893

  3. IN VITRO BIODISTRIBUTION OF SILVER NANOPARTICLES IN ISOLATED PERFUSED PORCINE SKIN FLAPS

    PubMed Central

    Leavens, Teresa L.; Monteiro-Riviere, Nancy A.; Inman, Alfred O.; Brooks, James D.; Oldenburg, Steven J.; Riviere, Jim E.

    2012-01-01

    Nanomaterials increasingly are playing a role in society for uses ranging from biomedicine to microelectronics; however pharmacokinetic studies, which will be necessary for human health risk assessments, are limited. Currently the most widely used nanoparticle in consumer products is silver (Ag). The objective of this study was to quantify the local biodistribution of two types of Ag nanoparticles, Ag-citrate and Ag-silica, in the isolated perfused porcine skin flap (IPPSF). IPPSFs were perfused for 4 h with 0.84 μg/ml Ag-citrate or 0.48 μg/ml Ag-silica followed by a 4-h perfusion with media only during a washout phase. Arterial and venous concentrations of Ag were measured in the media by ICP-OES. Venous concentrations of Ag for both types of nanoparticles were best fit with a two compartment model. The normalized volumes of distribution estimated from the noncompartmental analysis of the venous concentrations indicated distribution of Ag greater than the vascular space, however, because total Ag was measured, the extravascular distribution could be attributed to diffusion of Ag ions. The estimated clearance for both types of Ag nanoparticles was 1 ml/min, which was equal to the flap perfusion rate, indicating no detectable elimination of Ag from the system. By 4 hrs following infusion of the Ag nanoparticles, the recovery of Ag in the venous effluent was 90 ± 5.0% and 87 ± 22 % of the infused Ag for Ag-citrate and Ag-silica, respectively. PMID:22760951

  4. Total Maxillary Reconstruction Using a Double-Barreled and Double Skin Paddle Fibular Flap after Total Maxillectomy

    PubMed Central

    Sanchez, Gerardo; Lopez, Jaime; Perez, Adrian; Naal, Norberto

    2013-01-01

    Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence. PMID:24286054

  5. Total maxillary reconstruction using a double-barreled and double skin paddle fibular flap after total maxillectomy.

    PubMed

    de la Parra, Miguel; Sanchez, Gerardo; Lopez, Jaime; Perez, Adrian; Naal, Norberto

    2013-11-01

    Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence.

  6. Analysis of the Survival of Arterialized Venous Toenail Flap with Reference to Changes in Blood Circulation during the Postoperative Period in 2 Patients

    PubMed Central

    Ishii, Naohiro; Shimizu, Yusuke; Aoki, Marie; Suzuki, Ayaka; Kishi, Kazuo

    2016-01-01

    Summary: Various techniques for nail reconstruction have been reported until now; however, a simple one providing good esthetic results was difficult to find. Arterialized venous toenail flap is a free flap that includes the nail bed and matrix with a pedicle formed solely by the subcutaneous vein of the toe. The use of this flap is minimally invasive and easy, and the flap has a high survival rate. The mechanism of graft survival remains unknown given the nonphysiologic circulation. To the best of our knowledge, no studies have explained this mechanism with reference to detailed postoperative course. We herein present 2 cases of nail reconstruction performed using arterialized venous toenail flap. We analyzed the postoperative course in detail, which enabled us to postulate on the mechanism of graft survival. PMID:27826474

  7. Low level laser therapy increases angiogenesis in a model of ischemic skin flap in rats mediated by VEGF, HIF-1α and MMP-2*

    PubMed Central

    Cury, Vivian; Moretti, Ana Iochabel Soares; Assis, Lívia; Bossini, Paulo; de Souza Crusca, Jaqueline; Neto, Carlos Benatti; Fangel, Renan; de Souza, Heraldo Possolo; Hamblin, Michael R; Parizotto, Nivaldo Antonio

    2013-01-01

    It is known that low level laser therapy is able to improve skin flap viability by increasing angiogenesis. However, the mechanism for new blood vessel formation is not completely understood. Here, we investigated the effects of 660 nm and 780 nm lasers at fluences of 30 and 40 J/cm2 on three important mediators activated during angiogenesis. Sixty male Wistar rats were used and randomly divided into five groups with twelve animals each. Groups were distributed as follows: skin flap surgery non-irradiated group as a control; skin flap surgery irradiated with 660 nm laser at a fluence of 30 or 40 J/cm2 and skin flap surgery irradiated with 780 nm laser at a fluence of 30 or 40 J/cm2. The random skin flap was performed measuring 10 × 4 cm, with a plastic sheet interposed between the flap and the donor site. Laser irradiation was performed on 24 points covering the flap and surrounding skin immediately after the surgery and for 7 consecutive days thereafter. Tissues were collected, and the number of vessels, angiogenesis markers (vascular endothelial growth factor, VEGF and hypoxia inducible factor, HIF-1α) and a tissue remodeling marker (matrix metalloproteinase, MMP-2) were analyzed. LLLT increased an angiogenesis, HIF-1α and VEGF expression and decrease MMP-2 activity. These phenomena were dependent on the fluences, and wavelengths used. In this study we showed that LLLT may improve the healing of skin flaps by enhancing the amount of new vessels formed in the tissue. Both 660 nm and 780 nm lasers were able to modulate VEGF secretion, MMP-2 activity and HIF-1α expression in a dose dependent manner. PMID:23831843

  8. Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

    PubMed

    Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

    2015-08-01

    Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

  9. Vertical frontal subtotal laryngectomy and immediate reconstruction of larynx with cervical skin flap.

    PubMed

    Wang, T D; Zhu, P

    1990-11-01

    Vertical frontal subtotal laryngectomy, a procedure that can remove as much as 90% of the larynx, was used to produce a functionally acceptable neolarynx with adjacent cervical skin flaps. Thirty-four patients with laryngeal carcinoma underwent this operation. All patients were staged according to their physical findings before operation. Of these patients, 1 was lost to follow-up and 2 died from other causes 6 months and 4 years after operation respectively. The remainder are living and well without recurrence. The longest follow-up was 8 years and the shortest 14 months. Laryngeal functions were restored completely in 27 patients and partially in 7. We conclude that the procedure is best suited for the removal of anterior commissure tumor extending from both vocal cords to the anterior 1/3 or the entire length of the true cords and that if the tumor extends to the supraglottis or subglottis, this procedure is adequate as long as the posterior part of the larynx is not involved, leaving a sufficient safety margin.

  10. Coverage of Amputation Stumps Using a Latissimus Dorsi Flap With a Serratus Anterior Muscle Flap: A Comparative Study.

    PubMed

    Kim, Sang Wha; Jeon, Seung Bae; Hwang, Kyu Tae; Kim, Youn Hwan

    2016-01-01

    Amputation of the extremities is a definitive reconstructive option, and surgeons should aim to preserve maximum overall function. If the exposed bone cannot be adequately covered using local tissues, the stump can be reconstructed using a number of well-described free flap transfer techniques. Between January 2002 and December 2011, 31 patients with severe injuries to the lower extremities underwent above-the-knee, below-the-knee, and Chopart and Ray amputations. Bony stumps were covered using latissimus dorsi myocutaneous flaps alone (group 1), or together with serratus anterior muscle flaps (group 2). The groups were compared with respect to age, flap survival, skin flap size, immediate complications, wound sloughing, deep ulceration, need for bone amputation, limb visual analog scale score, time to prosthesis, and follow-up duration. The mean area of the latissimus dorsi skin flap was 255.9 cm, and immediate complications occurred in 8 (25.8%) patients. In the double-padding group, there were fewer cases of deep ulceration than in the single-flap group, and prostheses could be worn sooner. There were no statistically significant differences in other parameters. Successful reconstruction of amputation stumps requires an adequate, durable, weight-bearing, and well-contoured soft tissue cover. A latissimus dorsi musculocutaneous flap together with a serratus anterior muscle flap provides well-vascularized muscle tissue and a durable skin paddle, leading to less ulceration than conventional flap techniques.

  11. The role of the large superficial vein in survival of proximally based versus distally based sural veno-neuro-fasciocutaneous flaps in a rabbit model.

    PubMed

    Chang, Shi-Min; Gu, Yu-Dong; Li, Ji-Feng

    2005-01-01

    A sural veno-neuro-fasciocutaneous flap in the New Zealand White rabbit was developed, and the role of the large subcutaneous lesser saphenous vein was investigated in proximally based versus distally based flaps. Retrograde dye injection showed that the lesser saphenous vein in rabbits has many valves with strong resistance against reflux. Twenty rabbits were randomly allocated into four groups of 10 flaps each. Group I consisted of proximally based flaps with the lesser saphenous vein intact (outflow) in the veno-neuro-adipofascial pedicle. Group II also consisted of proximally based flaps but the lesser saphenous vein was ligated at 1 cm proximal to the pedicle. Group III consisted of distally based flaps with the lesser saphenous vein intact (inflow) in the veno-neuro-adipofascial pedicle. Group IV also consisted of distally based flaps, but the lesser saphenous vein was ligated at 1 cm distal to the pedicle. The results showed that the mean flap survival area in group I (88.8 percent) was statistically higher than that in group II (62.6 percent, p < 0.001), and was higher in group IV (55.5 percent) than in group III (22.7 percent, p < 0.01). However, group II and group IV had no significant difference (p > 0.05). This experiment demonstrated that flap viability is determined by its intrinsic vascularization, both arterial and venous. The large superficial subcutaneous vein has a positive role (venous outflow) in proximally based flaps but a negative role (venous inflow) in distally based flaps. If the effect of the large subcutaneous vein is excluded, distally based flaps are not inherently inferior to proximally based flaps.

  12. Skin paddle vascularity of free fibula flap – A study of 386 cases and a classification based on contribution from axial vessels of the leg

    PubMed Central

    Yadav, Prabha S.; Ahmad, Quazi G.; Shankhdhar, Vinay K.; Nambi, G.I.

    2012-01-01

    Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems. Materials and Methods: A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied. While majority of the skin paddles received their blood supply from the peroneal septocutaneous perforators, a few had their dominant supply from the soleus musculocutaneous perforators in addition to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous perforators were the sole source of blood supply to the skin paddle. The limitation in this study was the inability to augment the clinical observation with cadaveric study. Results: The skin paddle of the free fibula flap was classified into four different types (a–d) based on the dominance of vascular contribution by axial vessels of the leg. Conclusion: The skin paddle of the free fibula flap has reliable blood supply, but a thorough knowledge of the variations in vascular pattern of the skin paddle is required especially to salvage the larger paddles used in the reconstruction complex oro-mandibular defects. PMID:22754154

  13. Non-invasive terahertz imaging of tissue water content for flap viability assessment

    PubMed Central

    Bajwa, Neha; Au, Joshua; Jarrahy, Reza; Sung, Shijun; Fishbein, Michael C.; Riopelle, David; Ennis, Daniel B.; Aghaloo, Tara; St. John, Maie A.; Grundfest, Warren S.; Taylor, Zachary D.

    2016-01-01

    Accurate and early prediction of tissue viability is the most significant determinant of tissue flap survival in reconstructive surgery. Perturbation in tissue water content (TWC) is a generic component of the tissue response to such surgeries, and, therefore, may be an important diagnostic target for assessing the extent of flap viability in vivo. We have previously shown that reflective terahertz (THz) imaging, a non-ionizing technique, can generate spatially resolved maps of TWC in superficial soft tissues, such as cornea and wounds, on the order of minutes. Herein, we report the first in vivo pilot study to investigate the utility of reflective THz TWC imaging for early assessment of skin flap viability. We obtained longitudinal visible and reflective THz imagery comparing 3 bipedicled flaps (i.e. survival model) and 3 fully excised flaps (i.e. failure model) in the dorsal skin of rats over a postoperative period of 7 days. While visual differences between both models manifested 48 hr after surgery, statistically significant (p < 0.05, independent t-test) local differences in TWC contrast were evident in THz flap image sets as early as 24 hr. Excised flaps, histologically confirmed as necrotic, demonstrated a significant, yet localized, reduction in TWC in the flap region compared to non-traumatized skin. In contrast, bipedicled flaps, histologically verified as viable, displayed mostly uniform, unperturbed TWC across the flap tissue. These results indicate the practical potential of THz TWC sensing to accurately predict flap failure 24 hours earlier than clinical examination. PMID:28101431

  14. Combined vacuum-assisted closure treatment with laparoscopic mobilization of an omental flap and meshed skin grafts for reconstruction of infected sternotomy wounds: two cases.

    PubMed

    Veir, Zoran; Smud, Sanda; Bogdanić, Branko; Cvjeticanin, Bruno; Bagatin, Dinko; Dujmović, Anto; Duduković, Mladen; Ivrlac, Radojko; Bulić, Kresimir; Mijatović, Davor

    2009-12-01

    In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thickens skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds.

  15. Peroneal Flap: Clinical Application and Cadaveric Study

    PubMed Central

    Ha, Yooseok; Yeo, Kwan Koo; Piao, Yibo

    2017-01-01

    Background The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. Methods The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. Results We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from 2.0 cm×4.5 cm to 8.0 cm×8.0 cm. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures. Conclusions The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap. PMID:28352602

  16. SU-E-T-09: A Clinical Implementation and Optimized Dosimetry Study of Freiberg Flap Skin Surface Treatment in High Dose Rate Brachytherapy

    SciTech Connect

    Syh, J; Syh, J; Patel, B; Wu, H; Durci, M

    2015-06-15

    Purpose: This case study was designated to confirm the optimized plan was used to treat skin surface of left leg in three stages. 1. To evaluate dose distribution and plan quality by alternating of the source loading catheters pattern in flexible Freiberg Flap skin surface (FFSS) applicator. 2. To investigate any impact on Dose Volume Histogram (DVH) of large superficial surface target volume coverage. 3. To compare the dose distribution if it was treated with electron beam. Methods: The Freiburg Flap is a flexible mesh style surface mold for skin radiation or intraoperative surface treatments. The Freiburg Flap consists of multiple spheres that are attached to each other, holding and guiding up to 18 treatment catheters. The Freiburg Flap also ensures a constant distance of 5mm from the treatment catheter to the surface. Three treatment trials with individual planning optimization were employed: 18 channels, 9 channels of FF and 6 MeV electron beam. The comparisons were highlighted in target coverage, dose conformity and dose sparing of surrounding tissues. Results: The first 18 channels brachytherapy plan was generated with 18 catheters inside the skin-wrapped up flap (Figure 1A). A second 9 catheters plan was generated associated with the same calculation points which were assigned to match prescription for target coverage as 18 catheters plan (Figure 1B). The optimized inverse plan was employed to reduce the dose to adjacent structures such as tibia or fibula. The comparison of DVH’s was depicted on Figure 2. External beam of electron RT plan was depicted in Figure 3. Overcall comparisons among these three were illustrated in Conclusion: The 9-channel Freiburg flap flexible skin applicator offers a reasonably acceptable plan without compromising the coverage. Electron beam was discouraged to use to treat curved skin surface because of low target coverage and high dose in adjacent tissues.

  17. Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.

    PubMed

    de Sena, David P; Fabricio, Daniela D; Lopes, Maria Helena I; da Silva, Vinicius D

    2013-01-01

    The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery) board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill) protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL) group had superior performance as confirmed by checklist scores (p<0.002), overall global assessment (p = 0.017) and post-test results (p<0.001). All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.

  18. Reconstruction of large head and neck deformities: experience with free gracilis muscle and myocutaneous flaps.

    PubMed

    Del Frari, Barbara; Schoeller, Thomas; Wechselberger, Gottfried

    2010-01-01

    Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. The authors describe their experience with the gracilis free flap and the myocutaneous gracilis free flap with reconstruction of head and neck defects. Eleven patients underwent 12 free tissue transfer to the head and neck region. The reconstruction was performed with the transverse myocutaneous gracilis (TMG) flap (n = 7) and the gracilis muscle flap with skin graft (n = 5). The average patient age was 63.4 years (range, 17-82 years). The indications for this procedure were tumor and haemangioma resections. The average patient follow-up was 20.7 months (range, 1 month-5.7 years). Total flap survival was 100%. There were no partial flap losses. Primary wound healing occurred in all cases. Recipient site morbidities included one hematoma. In our experience for reconstruction of moderate volume and surface area defects, muscle flaps with skin graft provide a better color match and skin texture relative to myocutaneous or fasciocutaneous flaps. The gracilis muscle free flap is not widely used for head and neck reconstruction but has the potential to give good results. As a filling substance for large cavities, the transverse myocutaneus gracilis flap has many advantages including reliable vascular anatomy, relatively great plasticity and a concealed donor area.

  19. [Falciform anemia and Plasmodium falciparum malaria: a threat to flap survival?].

    PubMed

    Mariéthoz, S; Pittet, B; Loutan, L; Humbert, J; Montandon, D

    1999-02-01

    Plasmodium falciparum malaria, a parasitic disease, and sickle cell anemia, a hereditary disease, are two diseases affecting erythrocyte cycle, occurring with a high prevalence in tropical Africa. They may induce microthrombosis inducing vaso-occlusion, organ dysfunction and flap necrosis. During the acute phase of Plasmodium falciparum malaria, destruction of parasitized and healthy erythrocytes, release of parasite and erythrocyte material into the circulation, and secondary host reaction occur. Plasmodium falciparum infected erythrocytes also sequester in the microcirculation of vital organs and may interfere with microcirculatory flow in the flap during the postoperative period. The lower legs of homozygous sickle cell anemia patients are areas of marginal vascularity where minor abrasions become foci of inflammation. Inflammation results in decreased local oxygen tension, sickling of erythrocytes, increased blood viscosity and thrombosis with consequent ischemia, tissue breakdown and leg ulcer. Tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg although flaps may become necrotic. The aim of this study is to analyse circumstances predisposing to surgical complications and to define preventive and therapeutic measures. A review of the literature will describe the current research and the new perspectives to treat sickle cell anemia, for example hydroxyurea and vasoactive substances (pentoxifylline, naftidrofuryl, buflomedil).

  20. Coverage of defects over toes with distally based local flaps: A report of four cases.

    PubMed

    Koul, Ashok Raj; Patil, Rahul K; Philip, Vinoth Kumar

    2008-01-01

    Reconstruction of the distal foot, especially of the toe has always been a challenging problem. Various methods have been tried with variable success rates and limitations. Presented here is a series of four cases, where distally based flaps were used. Two of them were Extensor Digitorum Brevis (EDB) muscle flaps and the other two were first dorsal metatarsal artery (FDMA) based skin flaps. One in each of the two was augmented with a plantar V-Y advancement flap. All flaps survived completely without any flap- or donor site-related complications. The patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. Distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.

  1. Enhanced survival from radiation pneumonitis by combined irradiation to the skin

    PubMed Central

    Gao, Feng; Fish, Brian L.; Szabo, Aniko; Schock, Ashley; Narayanan, Jayashree; Jacobs, Elizabeth R.; Moulder, John E.; Lazarova, Zelmira; Medhora, Meetha

    2015-01-01

    Purpose To develop mitigators for combined irradiation to the lung and skin. Methods Rats were treated with X-rays as follows: (1) 12.5 or 13 Gy whole thorax irradiation (WTI) (2) 30 Gy soft X-rays to 10% area of the skin only (3) 12.5 or 13 Gy WTI+30 Gy skin irradiation after 3 hours (4) 12.5 Gy WTI+skin irradiation and treated with captopril (160 mg/m2/day) started after 7 days. Our end points were survival (primary) based on IACUC euthanization criteria and secondary measurements of breathing intervals and skin injury. Lung collagen at 210 days was measured in rats surviving 13 Gy WTI. Results After 12.5 Gy WTI with or without skin irradiation, one rat (12.5 Gy WTI) was euthanized. Survival was less than 10% in rats receiving 13 Gy WTI, but was enhanced when combined with skin irradiation (p<0.0001). Collagen content increased at 210 days after 13 Gy WTI vs 13 Gy WTI+30 Gy skin irradiation (p<0.05). Captopril improved radiation-dermatitis after 12.5 Gy WTI+30 Gy skin irradiation (p=0.008). Conclusions Radiation to the skin given 3 hours after WTI mitigated morbidity during pneumonitis in rats. Captopril enhanced the rate of healing of radiation-dermatitis after combined irradiations to the thorax and skin. PMID:24827855

  2. Development of the isolated perfused porcine skin flap for in vitro studies of percutaneous absorption pharmacokinetics and cutaneous biotransformation

    SciTech Connect

    Carver, M.P.

    1988-01-01

    The isolated perfused porcine skin flap (IPPSF) has proven to be a valuable in vitro tool for studying the physiology and biochemistry of skin and for identifying biochemical and histological markers of direct cutaneous toxicity. The present experiments were undertaken for two purposes: (1) to develop a pharmacokinetic model, based on dermal penetration in the IPPSF, which is predictive of percutaneous absorption in vivo, and (2) to examine cutaneous biotransformation of the important agricultural poison parathion (P). Dosing solutions of {sup 14}C-radiolabelled compounds representing 3 chemical classes-organic acid/base (benzoic acid (B), caffeine (C)), organophosphate (OP) pesticides, and steroid hormones, were applied topically in ethanol at 40 {mu}m cm{sup {minus}2}, both in vivo and on the IPPSF. A 3-compartment pharmacokinetic model describing mass transfer from the surface (C{sub 1}), diffusion through epidermis and dermis (C{sub 2}), and transfer into the perfusate (C{sub 3}), was developed based on flux through the IPPSF from 0-8 hr. Model simulations were predictive of percutaneous absorption in vivo for the OP's and steroids. Modification of the basic 3-compartment model to account for fast and slow tissue-release processes (B) and for flux-dependent perfusage flow increases (C), provided excellent in vivo-in vitro correlation over all 7 compounds.

  3. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn.

    PubMed

    Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

    2015-02-01

    Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.

  4. Sandwich Fascial Anterolateral Thigh Flap in Head and Neck Reconstruction: Evolution or Revolution?

    PubMed Central

    Berli, Jens; Turri-Zanoni, Mario; Battaglia, Paolo; Maggiulli, Francesca; Corno, Martina; Tamborini, Federico; Montrasio, Edoardo; Castelnuovo, Paolo; Valdatta, Luigi

    2017-01-01

    Introduction: The anterolateral thigh perforator flap (ALT) represents the workhorse for most reconstructive efforts in the head and neck regions. The main advantages of this flap are its versatility, the length of the pedicle, and the low morbidity of the donor site. The major drawback is the bulkiness of this flap with the frequent need for secondary revisions. To overcome this, we have developed a novel way to harvest and inset the ALT, called the sandwich fascial ALT flap (SALT). Methods: All patients undergoing head and neck reconstruction using the SALT flap from January 2013 to March 2016 were included in this retrospective analysis. The SALT flap was harvested as a composite flap including the superficial fascia, the subscarpal fat, and the deep fascia. At the recipient site, the flap was inset with the deep fascia facing out. A split thickness skin graft (± dermal substitute) was used to cover the deep fascia and the pedicle. Results: Eleven patients were included: 8 cases of orbital exenteration, 1 case of forehead reconstruction, and 2 cases of palatal reconstruction after radical maxillectomy. Flap survival was 100%. One patient required an early take back for venous thrombosis. The reconstruction was effective in all cases, allowing a prosthetic rehabilitation when required. Donor-site morbidity was minimal. Conclusions: The reconstruction of head and neck defects with a bulky fasciocutaneous ALT flap might not be the best option in every case. The SALT flap could represent a valid alternative for selected cases, with encouraging functional and cosmetic outcomes. PMID:28203499

  5. Blue laser light increases perfusion of a skin flap via release of nitric oxide from hemoglobin.

    PubMed

    Mittermayr, Rainer; Osipov, Anatoly; Piskernik, Christina; Haindl, Susanne; Dungel, Peter; Weber, Carina; Vladimirov, Yuri A; Redl, Heinz; Kozlov, Andrey V

    2007-01-01

    It has recently been shown that nitrosyl complexes of hemoglobin (NO-Hb) are sensitive to low-level blue laser irradiation, suggesting that laser irradiation can facilitate the release of biologically active nitric oxide (NO), which can affect tissue perfusion. The aim of this study was to evaluate the therapeutic value of blue laser irradiation for local tissue perfusion after surgical intervention. Blood was withdrawn from a rat, exposed to NO and infused back to the same rat or used for in vitro experiments. In vitro, an increase of NO-Hb levels (electron paramagnetic resonance spectroscopy) up to 15 microM in rat blood did not result in the release of detectable amounts of NO (NO selective electrode). Blue laser irradiation of NO-Hb in blood caused decomposition of NO-Hb complexes and release of free NO. Systemic infusion of NO-Hb in rats affected neither systemic circulation (mean arterial pressure) nor local tissue perfusion (Doppler blood flow imaging system). In contrast, a clear enhancement of local tissue perfusion was observed in epigastric flap when elevated NO-Hb levels in blood were combined with local He-Cd laser irradiation focused on the left epigastric artery. The enhancement of regional tissue perfusion was not accompanied by any detectable changes in systemic circulation. This study demonstrates that blue laser irradiation improves local tissue perfusion in a controlled manner stimulating NO release from NO-Hb complexes.

  6. Digital reconstruction and donor site resurfacing: a two-flap technique.

    PubMed

    Kang, Qing-Lin; Chai, Yi-Ming; Chen, Weijia; Zeng, Bing-Fang

    2007-01-01

    Use of a great toe pulp flap is one of the methods to repair partial soft-tissue defect of the thumb or other digits. However, the conventional application of free skin grafts to close the donor site may bring donor-site morbidity. The authors present a two-flap technique that a reverse first dorsal metatarsal artery (FDMA) flap resurfaces the defect of the free great toe pulp flap. Six patients with soft-tissue defects of the thumbs or fingers were treated with this technique. Both the pulp and reverse flaps survived uneventfully after reconstruction of the thumbs and fingers. The reverse flap to resurface the donor site on the great toe was sensate and durable. Satisfactory appearance and function were gained in all patients. Results revealed that this technique can be accepted as an alternative method when treating soft tissue defect of the thumb or finger.

  7. Novel flaps for head and neck reconstruction.

    PubMed

    Ahmad, Quazi Ghazwan; Shankhdhar, Vinay Kant

    2010-04-01

    The head and neck region is important both functionally and aesthetically and its reconstruction poses a formidable challenge for plastic surgeons. A perforator flap is a flap of skin or subcutaneous tissue supplied by a vessel that perforates the deep fascia to gain access to flap. With improvement in our knowledge of the anatomy of blood supply to the skin, the perforator flaps have opened a whole new horizon for the plastic surgeon to choose flaps with better function and cosmesis. The locally available perforators enable flaps to be designed with excellent match in tissue characteristics. Perforator flaps limit donor site morbidity and as they are islanded complete insetting is possible in a single stage. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supra-clavicular artery flap used in the head and neck reconstruction are discussed. The more commonly used flaps are the free radial artery forearm flap and the anterolateral thigh flap while the novel ones are the thoracodorsal artery perforator flap, medial sural artery perforator flap and the toe-web flap for commissure reconstruction. The indications, reach and drawbacks of these flaps have been discussed in this review.

  8. Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model

    PubMed Central

    Ersel, Murat; Uyanikgil, Yigit; Akarca, Funda Karbek; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavusoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Cetin, Emel Oyku

    2016-01-01

    Background The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of a sericin-containing gel formulation in an incision wound model in rats. Material/Methods Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9×3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. The Placebo group received placebo gel without sericin applied to the incision area once a day from day 0 to day 9. The Sericin Group 3 received 1% sericin gel applied to the incision area once a day from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied for histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase), and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area. Results Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration, and necrosis were decreased in Sericin group in comparison to the Placebo group and the Sham operated group. Malonyldialdehyde (MDA) levels were decreased, but superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were increased in the sericin group. Conclusions We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds. PMID:27032876

  9. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region.

    PubMed

    Horn, Dominik; Jonas, Rene; Engel, Michael; Freier, Kolja; Hoffmann, Jürgen; Freudlsperger, Christian

    2014-12-01

    Tailoring the most suitable reconstructive approach to each patient remains challenging especially in the head and neck region. To compare the applicability of the latissimus dorsi (LD) and anterolateral thigh (ALT) flap, we retrospectively analyzed patients who had reconstruction of extensive and/or bulky composite tissue defects in the head and neck area. We performed 85 free tissue transfers (44 LD and 41 ALT flaps). LD mean flap surface was 115.8 cm(2). ALT mean flap surface was 67.0 cm(2). Pedicle length ranged from 8 to 16 cm in LD and 11-16 cm in ALT flaps. The survival rate was 93% in ALT and 91% in LD flaps. Donor site morbidity occurred in 5% (ALT) and 7% (LD). A Two-team-approach was possible in 24% of the LD group, whereas all ALT flaps were raised in a Two-team-approach. Both flaps present excellent opportunities for the reconstruction of extensive and/or bulky defects. They largely meet the requirements of an ideal soft tissue flap in terms of versatility, skin texture and tissue stock. Both flaps can be raised with a double skin paddle. The advantages and disadvantages of each flap have to be weighed up against each other and both flaps should be in the repertoire of every microvascular surgeon.

  10. The submental island flap.

    PubMed

    Sterne, G D; Januszkiewicz, J S; Hall, P N; Bardsley, A F

    1996-03-01

    The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.

  11. Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

    PubMed Central

    Hou, Ruixing; Ju, Jihui; Zhao, Qiang; Liu, Yuefei

    2012-01-01

    The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n  =  765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4–36 months). The wider pedicled fascial flap (1.0–1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds. PMID:23294073

  12. Inferiorly based thigh flap for reconstruction of defects around the knee joint

    PubMed Central

    Akhtar, Md. Sohaib; Khan, Arshad Hafeez; Khurram, Mohammed Fahud; Ahmad, Imran

    2014-01-01

    Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh. PMID:25190918

  13. The effect of platelet rich plasma on angiogenesis in ischemic flaps in VEGFR2-luc mice.

    PubMed

    Sönmez, Tolga Taha; Vinogradov, Alexandra; Zor, Fatih; Kweider, Nisreen; Lippross, Sebastian; Liehn, Elisa Anamaria; Naziroglu, Mustafa; Hölzle, Frank; Wruck, Christoph; Pufe, Thomas; Tohidnezhad, Mersedeh

    2013-04-01

    To improve skin flap healing, one promising strategy in reconstructive surgery might be to optimize platelet rich plasma (PRP) bioactivity and the ischemia-altered expression of genes. We studied both the effect of PRP on ischemic flaps, and whether in vivo bioluminescence imaging (BLI) is a suitable method for the longitudinal monitoring of angiogenesis in surgical wounds. Axial murine skin flaps were created in four experimental groups. In vivo measurements of VEGFR2 expression levels were made every other day until the 14th day. The local VEGF level and microvessel density were quantified on the 14th day via ELISA and immunohistochemistry, and flap survival rates were measured. We demonstrated that PRP and induced ischemia have a beneficial influence on angiogenesis and flap healing. Combining the two resulted in a significantly robust increase in angiogenesis and flap survival rate that was corroborated by bioluminescence imaging of VEGFR2 activity. This study shows that angiogenic effects of PRP may be potentialized by the stimulus of induced ischemia during free flap harvesting, and thus the two procedures appear to have a synergistic effect on flap healing. This study further demonstrates that BLI of modulated genes in reconstructive surgery is a valuable model for longitudinal in vivo evaluation of angiogenesis.

  14. Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

    PubMed Central

    Li, Ning; Liu, Wen; Su, Tong; Chen, Xinqun; Zheng, Lian; Jian, Xinchun

    2014-01-01

    The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck. PMID:25180680

  15. Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps

    PubMed Central

    Li, Xiucun; Cui, Jianli; Maharjan, Suraj; Yu, Xin; Lu, Laijin; Gong, Xu

    2016-01-01

    Abstract Purpose: Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed. Methods: From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days. Results: All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery. Conclusion: Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option. PMID:27399142

  16. Recovery of sensation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps after breast-conservative surgery and skin-sparing mastectomy.

    PubMed

    Tomita, Koichi; Yano, Kenji; Hosokawa, Ko

    2011-04-01

    In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

  17. Local full-thickness skin graft of the donor arm--a novel technique for the reduction of donor site morbidity in radial forearm free flap.

    PubMed

    Riecke, B; Assaf, A T; Heiland, M; Al-Dam, A; Gröbe, A; Blessmann, M; Wikner, J

    2015-08-01

    A novel technique to reduce donor site morbidity after radial forearm free flap (RFFF) harvest, using a local full-thickness skin graft (FTSG), is described. Thirty consecutive patients undergoing RFFF for head and neck reconstruction were enrolled in a prospective study. Donor site defect closure was performed with spindle-shaped FTSGs excised from the wavelike skin incision made for the vascular pedicle. Both the removal site of the FTSG on the volar forearm and the covered RFFF donor site healed uneventfully in 29 cases, with no impairment of function related to the skin graft. No skin graft failure and no exposure, tenting, or adherence of the flexor tendons occurred. All patients expressed satisfaction with postoperative pain, the functional outcome, and cosmetic appearance. Primary donor site defect closure could be achieved in all cases with the use of a local FTSG. This graft can be gained at the access incision for the vascular pedicle, avoids expansion of the incision for a local flap technique, and does not prolong wound healing, and thus reduces both donor site and graft site morbidity of the RFFF. This technique leads to an inconspicuous aesthetic result with no apparent relevant functional deficits and avoids the need for a second donor site.

  18. Predictable Pattern Digital Artery Perforator Flap

    PubMed Central

    Epameinondas, Kostopoulos; Christos, Agiannidis; Petros, Konofaos; Avraam, Dounavis; Othon, Papadopoulos; Vincent, Casoli

    2016-01-01

    Background: The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. Methods: From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. Results: Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. Conclusions: Authors introduced the concept of a “predictable pattern” in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option. PMID:27418896

  19. Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

    PubMed Central

    Kwon, Soo-Ha; Tsai, Chia-Hsuan; Chang, Kai-Ping; Kao, Huang-Kai

    2017-01-01

    Introduction Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use. Materials and methods From December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted. Results A 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding. Conclusion The MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake. PMID:28182639

  20. [1984-1994: Ten years of skin flaps. Development of transfer techniques. New methods of autoplasty described during this period].

    PubMed

    Martin, D

    1995-10-01

    Ten years of flaps represent a little and a lot. It is little compared to the 2600 years since the first flap in plastic surgery: the Susruta Indian flap, but it is a lot in view of the phenomenal acceleration of this speciality since the Second World War. In 1994 alone, more than two hundred references are listed under the heading "new flaps". As it is impossible to be exhaustive, the author has chosen to focus on two main aspects: a theoretical review of new transfer techniques, dealing successively with: the principles of reverse flow flaps, venous flaps, neurocutaneous flaps, so-called "extracorporeal" transfers, reverse flow YV technique; and practical aspects based on a review of eighteen autoplasties or donor sites selected for their surgical value, their reproductibility and their innovative nature. The author's objective is not to present a technical treatise, but rather to make the reader aware of several key points or even, in some cases, the very existence of these autoplasties. This paper is designed to be didactic, with extensive references, in order to act as a practical guide. It also demonstrates, as if there were any need, to what extent plastic surgery is able to create new solutions and the essential value of continuing research.

  1. Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap

    PubMed Central

    Zhao, Feng; He, Wei; Zhang, Guoping; Liu, Shaojun; Yu, Kunlun; Bai, Jiangbo; Zhang, Hongjuan; Tian, Dehu

    2015-01-01

    Background In the absence of scientific evidence regarding the effectiveness of shoulder management strategies after stage I of fingertip reconstruction, the purpose of this study was to compare the clinical outcomes of various rehabilitation procedures. Material/Methods Patients who underwent fingertip reconstruction with a random-pattern abdominal skin flap between March 2007 and February 2013 were enrolled in the study (n=95). Thirty performed only active exercise (group A), 29 performed only passive exercise (group B), and 32 received a combination of active exercise and pulsed electromagnetic field (PEMF) (group C). The mean age at the time of treatment was 30.2 years in group A, 29.6 years in group B, and 31.8 years in group C. Results At the final follow-up, there were significant differences between group A and B in terms of Constant score (P=.001), VAS (P=.047), forward flexion of the shoulder (P=0.049), and muscle strength with forward flexion and external rotation (P=0.049 and P=0.042, respectively). A higher Constant score was observed in group C compared to group A, and although there were no differences in the other evaluations between groups A and C, a trend toward better function of the shoulder was demonstrated in group C. Conclusions The most important findings in our study are that a combination of active exercise and PEME produces superior patient-reported outcomes regarding relief of shoulder signs and symptoms. Given the limitations of this study, better-designed studies with large sample sizes and long-term follow-up are required. PMID:26449682

  2. A totally laparoscopic peritoneal free flap for reconstruction of hand.

    PubMed

    Guo, En-Qi; Xie, Qing-Ping

    2016-10-01

    Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm ×12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.

  3. Outcomes of Anatomic Reconstruction of Gunshot-Inflicted Lower Face Defects by Free Osteoseptocutaneous Fibula Flap and Expanded or Nonexpanded Temporal Scalp Flap Combination in Males.

    PubMed

    Eser, Cengiz; Gencel, Eyüphan; Kesiktaş, Erol; Yavuz, Metin

    2016-07-01

    Reconstruction of gunshot-inflicted composite lower face defects is a challenge for plastic surgeons. Functional and aesthetic repair of such defects mostly requires free or pedicled flap applications or combinations of both.In this study, the authors evaluated 7 males with gunshot-inflicted composite mandibular defects. All patients underwent reconstruction with a free osteoseptocutaneous fibula flap (FOCF) for the composite mandibular defect and a pre or nonexpanded temporal artery-based scalp flap for beardless facial skin. All patients were evaluated aesthetically and functionally with a postoperative evaluation scale. Average patient follow-up time was 3.5 years.All FOCFs survived completely. Expander exposition was observed in 2 preexpanded temporal scalp flaps. The problem was solved by rapid expansion and early flap application. All patients had acceptable functional and aesthetic results.In conclusion, the scalp flap should be considered in male beardless skin reconstruction due to its ease of application, reliability, and proximity to the defect. Preexpansion of this flap can decrease donor area morbidities. Moreover, the FOCF and scalp flap combination is a convenient procedure for gunshot-inflicted lower face defects, and such procedures produce good aesthetic and functional long-term outcomes.

  4. Reverse Adipofascial Radial Forearm Flap Surgery for Soft-Tissue Reconstruction of Hand Defects

    PubMed Central

    Karamese, Mehtap; NebilSelimoglu, Muhammed; Akatekin, Ahmet; Abacı, Malik; Sutcu, Mustafa; Tosun, Zekeriya

    2016-01-01

    Objective: The reverse radial forearm flap has been used for soft-tissue hand defect surgical procedures worldwide. One of the major drawbacks of this flap, however, is donor site morbidity, as the donor site is closed with a skin graft. Problems with skin graft donor areas include adhesion, contracture, and wound-healing complications. In this study, only the adipofascial component of a reverse radial forearm flap was used to prevent these problems; in addition, a skin graft was applied over the flap instead of over the donor site. Methods: Between January 2011 and December 2013, a total of 13 hand defects were reconstructed with a reverse adipofascial radial forearm flap. Patients were evaluated for functional results using total active motion criteria and disability of the arm, shoulder, and hand scores, operation time, hospitalization time, and patient satisfaction. Results: All flaps and grafts placed on flaps survived completely and donor sites healed without complications. The total active motion criteria and the disability of the arm, shoulder, and hand score demonstrated that the functional outcomes were successful. Patient satisfaction scores using the visual analog scale had a mean of 88.3 (SD = 2.95) mm. Operation time for the flap surgery was 126.1 (SD = 21.80) minutes, and patients were discharged at an average of 6.3 (SD = 1.44) days. Conclusion: Use of an adipofascial component in reverse radial forearm flap surgery is appropriate for reducing problems with donor site skin grafts. Patients' functional outcomes denoted that the reverse adipofascial radial forearm flap is a reliable and effective method to cover soft-tissue defects of the hand. Level of Evidence: IV PMID:28090241

  5. [The use of bi-pedical rotatory door muscle-skin flap reconstruction in extended partial laryngectomy for late (T3 and T4) glottic cancer].

    PubMed

    Zhao, S; Sun, X; Lu, S

    1998-12-01

    The purpose is to radical treatment for late glottic cancer by surgery, to restore the essential function of the larynx, 62 patients of late (T3 and T4) glottic cancer were treated by extended vertical partial and subtotal laryngectomy. At the same time, an appropriate method of reconstruction of laryngeal function by bi-pedical rotatory door muscle-skin flap was presented. The decannulation rate was 87.1% and 85.0% cases enjoyed satisfactory voice. All cases resumed normal mouth-food-taking. The conclusion is that selective treated with extended partial laryngectomy is effective for T3 and T4 glottic cancer.

  6. Delayed type IV muscle flap in a feline model.

    PubMed

    Snyder, Ned; Craven, Cameron; Phillips, Linda G

    2006-03-01

    The concept of delaying a skin flap is well established and has been implemented into plastic surgery practice for years. Some investigators have delayed musculocutaneous flaps to improve the perforator inflow. To our knowledge, the concept of delaying a muscle flap had previously never been tested in a model with segmental pedicles. Five cats each underwent 3 sequential operations providing them with a sartorius muscle whose blood supply was a single distal pedicle. The opposite leg was used as a control. Our delayed type IV muscle flap demonstrated perfusion to the proximal tip of the sartorius muscle without necrosis or loss of muscle mass (P < 0.0001). The control showed no evidence of perfusion beyond the distal portion of the muscle when infused through the distal pedicle. The delayed flap can survive on a distal blood supply that would not be adequate in a single-stage procedure. This flap has an increased arc of rotation that may provide solutions to difficult reconstructive problems in the groin, lower abdomen, genitalia, knee, proximal leg, and might be suitable as a free flap.

  7. Optimal administration routes for adipose-derived stem cells therapy in ischaemic flaps.

    PubMed

    Lee, Dong Won; Jeon, Yeo Reum; Cho, Eul Je; Kang, Jong Hwa; Lew, Dae Hyun

    2014-08-01

    Improvement of flap survival represents an ongoing challenge in reconstructive surgery. The angiogenic potential of adipose-derived stem cells (ASCs) offers a promising approach to improve the viability of random pattern flaps. Recently, to maximize the therapeutic effects of ASCs, increasing focus is being placed on how to deliver the stem cells to target lesions. The purpose of the present study was to compare the effectiveness of different administration routes of ASCs to improve the viability of the random pattern skin flap. ASCs labelled with PKH26 were applied via four methods to the cranially-based random pattern skin flaps of rats: (a) intravenous injection; (b) subcutaneous injection; (c) application with collagen sponge seeding; and (d) application with fibrin glue seeding. ASCs led to a significant increase in flap viability in the subcutaneous injection group and the collagen sponge group. Cutaneous blood flow was increased in the intravenous injection, subcutaneous injection and collagen sponge groups. Capillary density in the intravenous injection group and collagen sponge group was significantly greater than in the control group (no treatment). PKH26-positive cells via the collagen sponge were distributed more densely within the flap than in other groups. This study demonstrated that the collagen sponge method delivered ASCs most effectively within the flap and increased flap vascularity. The clinical therapeutic effects of ASCs can therefore be maximized when the optimal delivery route is chosen.

  8. Lower extremity soft tissue defect reconstruction with the serratus anterior flap.

    PubMed

    Mastroianni, Melissa; Leto Barone, Angelo A; Shanmugarajah, Kumaran; Leonard, David A; Di Rosa, Luigi; Feingold, Randall S; Israeli, Ron; Cetrulo, Curtis L

    2014-03-01

    Reconstruction of limb-threatening lower extremity defects presents unique challenges. The selected method must provide adequate coverage of exposed bone, joints, and tendons while maximizing function of the limb. The traditional workhorse flaps, the free latissimus dorsi and rectus abdominis flaps, have been associated with donor site morbidity and bulkiness that can impair rehabilitation. We report a case series (n = 18) in which the free serratus anterior muscle flap and split thickness skin graft (STSG) was used for lower limb soft tissue coverage. Injuries were due to diabetes (9/18), trauma (7/18), and chronic venous stasis (2/18). A 94% flap survival rate was observed and all but one patient was ambulatory. No donor site morbidity was reported. Our series demonstrates that serratus anterior is an advantageous, reliable free flap with minimal donor site morbidity.

  9. [A case of iatrogenic scrotal elephantiasis: reconstruction of the scrotal purse and the cutaneous sleeve of the penis with local skin flaps].

    PubMed

    Masia, D-R; Castus, P; Delia, G; Casoli, V; Martine, D

    2008-02-01

    Scrotal elephantiasis is a pathology of often unknown etiology. Symptomatology is characterized by an oedematius infiltration of skin and subcutaneous tissue, hard-bound aspect and purplished color. The scrotum, the penis and the perineal area are gradually affected. This pathology is very invalidating for the patient, on functional, sexual and aesthetic aspects. The authors present the case of a 58-year-old man with an enormous scrotal mass invading the penis and drowning the testicular elements, which were impossible to palpate. The aetiology was determined by exclusion and an iatrogenic origin following the cure of bilateral inguinal hernia was retained. Resection of the scrotal mass was performed. The reconstruction of the scrotal purse and the cutaneous sleeve of the penis were carried out using local flaps of the remaining healthy skin.

  10. Flap monitoring by transcutaneous PO2 and PCO2: importance of transcutaneous PCO2 in determining follow-up treatment for compromised free flaps.

    PubMed

    Hashimoto, Ichiro; Nakanishi, Hideki; Takiwaki, Hirotsugu; Takase, Maki Toda; Yamano, Masahiro; Sedo, Hiromichi

    2007-07-01

    The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO (2)) and transcutaneous carbon dioxide pressure (TcPCO (2)) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO (2) and TcPCO (2) were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO (2) decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO (2) increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO (2) more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO (2) 80 mmHg or less, survived completely without further treatment. The TcPO (2) of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO (2) is more sensitive than TcPCO (2) to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO (2) alone. The authors believe that a congested flap with a TcPCO (2) more than 90 mmHg requires further treatment.

  11. FTY720 treatment prolongs skin graft survival in a completely incompatible strain combination.

    PubMed

    Lima, R S M; Nogueira-Martins, M F; Silva, H T; Pestana, J O M; Bueno, V

    2004-05-01

    FTY720 has shown potent immunomodulatory activity in a variety of animal organ transplant models. However, the in vivo immunosuppressive mechanism of FTY720 is still not fully understood. It has been suggested that the marked decrease in the number of peripheral blood lymphocytes during FTY720 administration could be responsible for its immunosuppressive effects. Our aims were: (1) to study the effects of FTY720 treatment on skin graft survival using a fully mismatched strain combination and (2) to evaluate lymphocyte numbers in different sites at 5 days after skin transplant. C57BL/6 mice and BALB/c mice were the donors and recipients respectively. BALB/c mice received FTY720 (1 mg/kg/d) orally for 4 consecutive days. Drug administration started 1 day before skin transplants. A small segment of tail skin was affixed on the right dorsal side of the mouse via sutures. The administration of FTY720 (4 mg/kg) prolonged skin graft survival from 12.6 +/- 2.2 days (no treatment) to 16.6 +/- 4.2 days. The histologic findings of rejection were similar for all groups. Five days after transplant, lymphocyte numbers were significantly increased in lymph nodes compared with nontransplanted or isogenic graft mice. FTY720 decreased lymphocyte numbers only in the spleen. In conclusion, FTY720 prolonged skin graft survival in a fully mismatched strain combination when administered for 4 days (day -1 to day +2) at a dose of 1 mg/kg/d. The decreased number of lymphocytes in the spleen suggests that the spleen may be a target of FTY720 activity, during the early posttransplant period.

  12. Transfer of free vascular cutaneous flaps by microvascular anastomosis. Results in six dogs.

    PubMed

    Fowler, J D; Miller, C W; Bowen, V; Johnston, G H

    1987-01-01

    Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases.

  13. Scrotal reconstruction with modified pudendal thigh flaps.

    PubMed

    Mopuri, Nabil; O'Connor, Edmund Fitzgerald; Iwuagwu, Fortune C

    2016-02-01

    Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We used a modified pudendal thigh flap to reconstruct scrotal defects in five patients. This study describes the vascularity of the flap, technique of elevation and the inset of the flap. The elevation and particularly the insetting make it different from other flaps raised on this vascular network for scrotal reconstruction. This pedicled flap is robust, reliable, resilient and produces a neo-scrotum that looks natural in appearance, offers good-quality skin cover and cushion to the testes as well as protective sensation.

  14. Open-book Splitting of a Distally Based Peroneus Brevis Muscle Flap to Cover Large Leg and Ankle Defects

    PubMed Central

    2015-01-01

    Abstract Background: Large soft-tissue defects in the lower leg and ankle are a major problem for plastic surgeons. Many local flaps that are either proximally or distally based have been previously described to cover small defects. Larger defects may require a distant flap that is either pedicled or free. The peroneus brevis muscle flap is a well-known distally based safe flap that is used to cover a small defect. Methods: Ten distally based peroneus brevis muscle flaps were elevated in 10 patients (8 males and 2 females) with major lower third leg and ankle defects that were 6–12 cm in length and 6–10 cm in width, with open-book splitting of the proximal portion of the muscle to cover these large defects. Results: Flap survival was excellent, and partial skin graft loss in two cases healed with dressing. The average flap length was 10 cm, ranging between 6 and 12 cm. The average flap width was 8 cm, ranging between 6 and 10 cm. The donor site also healed uneventful. Conclusions: Open-book splitting of the distally based peroneus brevis muscle flap is ideally suited for moderate to large defects in the distal third of the lower leg and ankle. This modification of the distally based peroneus brevis muscle flap offers a convincing alternative for covering large defects of up to 12 × 10 cm in the distal leg and ankle region. PMID:26893997

  15. Lack of correlation between basal cell survival and gross response in irradiated swine skin

    SciTech Connect

    Shymko, R.M.; Hauser, D.L.; Archambeau, J.O.

    1984-07-01

    The relationship between basal cell survival and gross response in irradiated swine skin was tested by comparing dose survival curves derived from time-dose isoeffect data with curves obtained directly from basal cell counts in histological sections. Assuming equal effect per exposure and constant cell survival at isoeffect, best-fitting single-hit multi-target and liner-quadratic response curves were determined for time-dose schedules resulting in non-healing of 50% of irradiated fields. Basal cell survivals for single doses of 970, 1649, 2231, and 2619 rad were estimated 1) by counting regenerating islands and 2) by monitoring total basal cell counts through time. The dose survival curve derived from the isoeffect data was steeper than the curve obtained from direct basal cell counts. Furthermore, the direct basal cell survival curve extrapolates to less than 100% at zero dose, indicating the presence of a resistant basal cell subpopulation. The data show that the isoeffect in this case is not strongly coupled to basal cell survival.

  16. Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children.

    PubMed

    El-Gammal, Tarek A; El-Sayed, Amr; Kotb, Mohamed M; Saleh, Waleed Riad; Ragheb, Yasser Farouk; El-Refai, Omar; El Fahar, Mohammed Hassan Ali

    2013-05-01

    Very limited literature described the use of the free anterolateral thigh (ALT) among other flaps for pediatric lower limb reconstruction. The aim of this study is to present our experience using the free ALT flap for reconstruction of soft tissue defects over the dorsum of the foot and ankle in children. The study included 42 children aged 2.5-13 years with a mean of 6.18 years. Three children had crush injuries while the rest were victims of run over car accidents. All of the flaps were vascularized by at least two perforators; 88.23% were musculocutaneous and 11.77 were septocutaneous perforators. All flaps were raised in a subfascial plane. Initial thinning was performed in five flaps and 35% required subsequent debulking. Mean Flap surface area was 117.11 cm(2). The recipient arteries were the anterior tibial artery in 38 cases and posterior tibial artery in four cases. Venous anastomosis was performed to one vena commitant and in nine cases the long saphenous vein was additionally used. Mean ischemia time of the flap was 2 hours while total operative time averaged 6.3 hours. About 41% of donor sites were closed primarily while 59% required skin grafting. Primary flap survival rate was 92.8% (39/42 cases). Three flaps showed venous congestion. After venous reanastomosis, two flaps showed partial loss and one flap was lost completely. Post-operative hospital stay averaged 7.5 days. The free ALT flap could be as safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss.

  17. Lowering the pivot point of sural neurofasciocutaneous flaps to reconstruct deep electrical burn wounds in the distal foot.

    PubMed

    Li, Yong; Xu, Jin; Zhang, Xiang-zhou

    2013-06-01

    Due to the thinness of the skin and soft tissues in the foot, tendons and bones tend to become exposed and necrotic after injury; therefore, it is difficult to reconstruct foot injuries, especially distally. Reconstruction with free skin flaps is highly risky as it demands technologies and equipment, while patients suffer greatly from the use of cross-leg skin flaps. Sural neurofasciocutaneous flaps are often used for reconstruction of wounds in the lower leg, malleolus, and the proximal end of the foot but are not feasible for wound repair in the distal foot; this is because, with the pivot point of 5-7 cm above the tip of the lateral malleolus, the flaps are not able to cover defects in the distal foot. In this study, we used a sural neurofasciocutaneous flaps with a lowered pivot point for reconstruction of distal foot wounds caused by electrical burns. An ultrasound flow detector and Doppler flow imaging were used to detect the diameter, the perforating point and the blood flow of the lateral retromalleolar perforator. Twelve patients with the perforator diameter greater than 0.6 mm and the peak systolic flow more than 0.15 m/s were included. The pivot point of sural neurofasciocutaneous flaps was lowered to 0-3 cm above the tip of the lateral malleolus and the size of the flaps ranged from 6 cm × 5 cm to 12 cm × 18 cm. Eleven of the 12 flaps survived completely. One flap developed necrosis approximately 1cm at the far point but was managed successfully by daily dressing. We demonstrated that lowering the pivot point of sural neurofasciocutaneous flaps is feasible for reconstruction of distal foot injury with the advantages of reliable blood supply and easy operation. The use of Doppler flow imaging provides useful information for the design of the flaps.

  18. Anatomical bases of the second toe composite dorsal flap for simultaneous skin defect coverage and tendinous reconstruction of the dorsal aspect of the fingers.

    PubMed

    Wavreille, G; Cassio, J-B; Chantelot, C; Mares, O; Guinand, R; Fontaine, C

    2007-01-01

    Coverage of the dorsal aspect of the fingers is difficult, especially when the soft tissue defect is large and involves extensor apparatus and joints. Tendinous and/or articular reconstruction is not usually performed simultaneously with cutaneous repair. The aims of this study were: (1) to accurately determine the precise position of the first common dorsal metatarsal artery (FDMA) on the dorsal aspect of the foot, and (2) to enumerate the anatomical structures which could be harvested 'en-bloc' in order to design composite flaps. The precise position of the FDMA was studied from 22 anatomical specimens after selective injection of the arterial network. Its cutaneous area measured 75 x 40 mm on average. The extensor apparatus of the second toe was supplied by the FDMA and its lateral branch to the second toe by 2.7 branches on average over a length of approximately 75 mm. The medial dorsal digital artery was generally the main source of blood supply to the proximal interphalangeal joint (PIP), capsule, ligaments, head of proximal phalanx and base of middle phalanx. It is then possible to design composite flaps including both skin and extensor apparatus, and total or partial PIP joint, if necessary, based on the FDMA and the medial dorsal digital artery, without prejudice to the second toe. The average length of the arterial pedicle (60 mm) makes its suture to the dorsal metacarpal artery, the dorsal carpal branch or the radial artery easy. The harvesting technique for such a flap is described for each anatomical type of FDMA; it has to be adapted to both the type and extent of the defect. Its use is in accordance with the modern classical principle of 'all in one stage with early mobilisation', thanks to adequate coverage whose blood supply does not depend on local vascularisation, and which brings its own physiological vascular supply.

  19. Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects.

    PubMed

    Gong, Zhao-jian; Zhang, Sheng; Wang, Kai; Tan, Hong-yu; Zhu, Zhao-fu; Liu, Jin-bing; Ren, Zhen-hu; He, Zhi-jing; Wu, Han-jiang

    2015-02-01

    Reconstruction of through-and-through oral and maxillofacial defects has always been difficult. We have evaluated the feasibility and reconstructive efficacy of chimeric flaps pedicled with the lateral circumflex femoral artery in the reconstruction of 41 through-and-through oral and maxillofacial defects after resections for cancer. There were 29 chimeric anterolateral thigh and anterolateral thigh flaps and 12 chimeric anterolateral thigh and anteromedial thigh flaps, the sizes of which ranged from 5×8 to 9×11 cm. The chimeric flaps provided separate flaps to reconstruct the intraoral mucosa and extraoral skin defects, and 40/41 of them survived. The appearance and function were satisfactory in all patients after the reconstruction. Chimeric flaps pedicled with the lateral circumflex femoral artery are a good choice for the reconstruction of through-and-through oral and maxillofacial defects.

  20. Ischemic Tissue Injury in the Dorsal Skinfold Chamber of the Mouse: A Skin Flap Model to Investigate Acute Persistent Ischemia

    PubMed Central

    Harder, Yves; Schmauss, Daniel; Wettstein, Reto; Egaña, José T.; Weiss, Fabian; Weinzierl, Andrea; Schuldt, Anna; Machens, Hans-Günther; Menger, Michael D.; Rezaeian, Farid

    2014-01-01

    Despite profound expertise and advanced surgical techniques, ischemia-induced complications ranging from wound breakdown to extensive tissue necrosis are still occurring, particularly in reconstructive flap surgery. Multiple experimental flap models have been developed to analyze underlying causes and mechanisms and to investigate treatment strategies to prevent ischemic complications. The limiting factor of most models is the lacking possibility to directly and repetitively visualize microvascular architecture and hemodynamics. The goal of the protocol was to present a well-established mouse model affiliating these before mentioned lacking elements. Harder et al. have developed a model of a musculocutaneous flap with a random perfusion pattern that undergoes acute persistent ischemia and results in ~50% necrosis after 10 days if kept untreated. With the aid of intravital epi-fluorescence microscopy, this chamber model allows repetitive visualization of morphology and hemodynamics in different regions of interest over time. Associated processes such as apoptosis, inflammation, microvascular leakage and angiogenesis can be investigated and correlated to immunohistochemical and molecular protein assays. To date, the model has proven feasibility and reproducibility in several published experimental studies investigating the effect of pre-, peri- and postconditioning of ischemically challenged tissue. PMID:25489743

  1. Treatment of nasal microcystic adnexal carcinoma with an expanded rotational forehead skin flap: A case report and review of the literature

    PubMed Central

    ZHOU, RONG-RONG; ZHAO, QI-MING; ZHANG, XU-DONG; GAN, JING-BING

    2015-01-01

    Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive adenocarcinoma with low-grade malignancy. The present study describes the first reported case and treatment of a Chinese male with a MAC located on the nasal dorsum and nosewing. A 44-year-old man presented with a nasal deformity caused by local repeated infections following an accidental injury to the nose 20 years previously. The nose had been injured by a brick, and treatment at a local hospital 12 years previously had resulted in a nasal scar and a gradually enlarging mass. A physical examination revealed a hypertrophic deformity of the nose and an indurated scar plaque, measuring 2.0×2.0 cm, on the nasal dorsum and nosewing. Microscopic examination revealed a tumor consisting of solid cell nests and a cystic structure with a capsular space. In addition, ductal cells of an adnexal cell origin were visible in the outer epithelium. The medial portion exhibited a microductal structure and invasion of deeper tissues without evident atypia. The tumor cells presented normal nuclear to cytoplasmic ratios and minimal mitotic activity. Pathological examination verified that the tumor was a MAC of low-grade malignancy. A complete surgical resection was performed via Mohs micrographic surgery (MMS), and reconstruction was achieved using an expanded rotational forehead skin flap. No tumor recurrence was detected after a three-year follow-up period. Therefore, for effective treatment of similar MAC cases, complete surgical resection using MMS is recommended, and successful reconstruction may be achieved using an expanded skin flap. PMID:26622465

  2. PREDICTIVE MODEL FOR SURVIVAL AND GROWTH OF SALMONELLA TYPHIMURIUM DT104 ON CHICKEN SKIN DURING TEMPERATURE ABUSE

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To better predict risk of Salmonella infection from chicken subjected to temperature abuse, a study was undertaken to develop a predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin with native micro flora. For model development, chicken skin portions were inocula...

  3. There is no donor side specificity of fibula free flap for complex oromandibular reconstruction

    PubMed Central

    Yadav, Prabha S.; Ahmad, Quazi G.; Shankhdhar, Vinay Kant; Nambi, G. I.

    2010-01-01

    Background: The objective of this study was to prove that there is no significance to the donor side (right or left) of the free fibula osteocutaneous flap (FFOCF) in the reconstruction of complex oromandibular defects (COMD) and proper flap planning, designing and tailoring are important in reconstructing different types of COMD after tumour-ablative surgery. Materials and Methods: Three hundred and eighty-six consecutive patients who where reconstructed with FFOCF for COMD from Jan 2005 to Dec 2009 over a period of 5 years were studied. Except in seven patients, all fibula flaps were harvested from the left leg as per convenience and to facilitate a simultaneous, two-team approach. Depending on the condition of the neck vessels, vascular anastomosis was performed on the right or the left side, irrespective of the side of the defect. Results: Complete flap survival was seen in 334 patients (86.52%). Superficial skin necrosis was seen in 20 patients, and was managed conservatively (5.18%). Partial flap loss was seen in 20 patients (5.18%). There were 39 re-explorations. Complete flap loss was seen in 12 patients (3.10%). Conclusion: We found no significance in terms of the results as far as the side of flap donor leg or primary defect were concerned. Flap tailoring in terms of meeting the tissue requirement and vessel orientation were rather more important. PMID:21217976

  4. SIRT1 regulates MAPK pathways in vitiligo skin: insight into the molecular pathways of cell survival

    PubMed Central

    Becatti, Matteo; Fiorillo, Claudia; Barygina, Victoria; Cecchi, Cristina; Lotti, Torello; Prignano, Francesca; Silvestro, Agrippino; Nassi, Paolo; Taddei, Niccolò

    2014-01-01

    Vitiligo is an acquired and progressive hypomelanotic disease that manifests as circumscribed depigmented patches on the skin. The aetiology of vitiligo remains unclear, but recent experimental data underline the interactions between melanocytes and other typical skin cells, particularly keratinocytes. Our previous results indicate that keratinocytes from perilesional skin show the features of damaged cells. Sirtuins (silent mating type information regulation 2 homolog) 1, well-known modulators of lifespan in many species, have a role in gene repression, metabolic control, apoptosis and cell survival, DNA repair, development, inflammation, neuroprotection and healthy ageing. In the literature there is no evidence for SIRT1 signalling in vitiligo and its possible involvement in disease progression. Here, biopsies were taken from the perilesional skin of 16 patients suffering from non-segmental vitiligo and SIRT1 signalling was investigated in these cells. For the first time, a new SIRT1/Akt, also known as Protein Kinase B (PKB)/mitogen-activated protein kinase (MAPK) signalling has been revealed in vitiligo. SIRT1 regulates MAPK pathway via Akt-apoptosis signal-regulating kinase-1 and down-regulates pro-apoptotic molecules, leading to decreased oxidative stress and apoptotic cell death in perilesional vitiligo keratinocytes. We therefore propose SIRT1 activation as a novel way of protecting perilesional vitiligo keratinocytes from damage. PMID:24410795

  5. Preventing postoperative congestion in reverse pedicle digital island flaps when reconstructing composite tissue defects in the fingertip: a patient series.

    PubMed

    Matsuzaki, Hironori; Kouda, Hisao; Yamashita, Haruyoshi

    2012-01-01

    For reconstructing an injured fingertip, a reverse pedicle digital island flap can restore excellent function and appearance. However, postoperative flap congestion may lead to flap necrosis. We tested a method for dissecting the vascular pedicle to prevent congestion and to provide more reliable results. Between August 2002 and December 2010, we reconstructed 14 fingertips in 13 patients (average age, 43 years; range, 24 to 68 years; 9 men). Through a small zigzag incision, the digital artery and a 4-mm-wide subcutaneous venous network were elevated in retrograde fashion to facilitate venous drainage. All flaps healed completely without severe congestion or necrosis. Slight flexion contractures remained in the PIP (mean, 12°) and DIP (mean, 14°) joints. Our procedure is simpler and more reliable than other techniques, such as adding a narrow skin bridge to the pedicle or a venous anastomosis to prevent venous congestion, and it assures the survival of the flap.

  6. Reusing of the Failing Free Flap “Nutrient Flap” as Salvage Procedure

    PubMed Central

    Takahashi, Koji; Hsieh, Ching-Hua

    2014-01-01

    Summary: A 26-year-old woman sustained a traffic accident injury to her left medial malleolus. A soft-tissue defect 15 × 7 cm with exposure of bone was found and underwent free anterolateral thigh flap to cover it. On the second postoperative day, venous congestion occurred and re-exploration was performed. Re-anastomosis of the vein was done after the thrombectomy; unfortunately, the flap did not recover. We found there was a good granulation bed under the failing flap and thinned the failing flap and used it as a full-thickness skin graft. The graft survived completely; 9 months later, the graft site was softer and of good texture. The patient can wear the same size shoes without a debulking procedure. The free flap provided nutrients to the raw surface and nurtured a good granulation bed while it survived for 50 hours; as a result, it was used as “the nutrient flap.” Reuse of the failing free flap as “the nutrient flap” is useful as an alternative backup procedure. PMID:25289290

  7. Arterialized venous free flap for reconstruction of burned face.

    PubMed

    Iglesias, Martín; Butrón, Patricia; Chávez-Muñoz, Claudia; Ramos-Sánchez, Iván; Barajas-Olivas, Alexandra

    2008-01-01

    In this study, a forearm arterialized venous free flap (23 cm x 14 cm) was used in a 25-year-old male with facial burns sequels to reconstruct both cheeks, chin, lips, nose, columnella, nasal tip, and nostrils. It was arterialized by the facial artery to an afferent vein anastomosis. The venous flow was drained by four efferent vein to vein anastomoses. Although it developed small inferior marginal necrosis in the lower lip, the rest of the flap survived with good quality of the skin in both texture and color, with self-delimitation of the different esthetics units of the center of the face such as the nasogenian folds, nostrils, and upper lip filtrum, without the need of additional thinning surgical procedures. From all of the above, the arterialized venous free flap is an alternative reconstructive option for the treatment of burn sequels especially those that include the centrofacial region.

  8. The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.

    PubMed

    Ibrahim, Amir; Atiyeh, Bishara; Karami, Reem; Adelman, David M; Papazian, Nazareth J

    2016-03-01

    Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications.

  9. Survival after squamous cell and basal cell carcinoma of the skin: A retrospective cohort analysis.

    PubMed

    Rees, Judy R; Zens, M Scot; Celaya, Maria O; Riddle, Bruce L; Karagas, Margaret R; Peacock, Janet L

    2015-08-15

    A retrospective cohort analysis of survival after keratinocyte cancer (KC) was conducted using data from a large, population-based case-control study of KC in New Hampshire. The original study collected detailed information during personal interviews between 1993 and 2002 from individuals with squamous (SCC) and basal (BCC) cell carcinoma, and controls identified through the Department of Transportation, frequency-matched on age and sex. Participants without a history of non-skin cancer at enrolment were followed as a retrospective cohort to assess survival after either SCC or BCC, or a reference date for controls. Through 2009, cancers were identified from the New Hampshire State Cancer Registry and self-report; death information was obtained from state death certificate files and the National Death Index. There were significant differences in survival between those with SCC, BCC and controls (p = 0.040), with significantly greater risk of mortality after SCC compared to controls (adjusted hazard ratio [HR] 1.25; 95% confidence interval 1.01-1.54). Mortality after BCC was not significantly altered (HR 0.96; 95% CI 0.77-1.19). The excess mortality after SCC persisted after adjustment for numerous personal risk factors including time-varying non-skin cancer occurrence, age, sex and smoking. Survival from the date of the intervening cancer, however, did not vary (HR for SCC 0.98; 95% CI 0.70-1.38). Mortality also remained elevated when individuals with subsequent melanoma were excluded (HR for SCC 1.30; 95% CI 1.05-1.61). Increased mortality after SCC cannot be explained by the occurrence of intervening cancers, but may reflect a more general predisposition to life threatening illness that merits further investigation.

  10. A composite medial plantar flap for the repair of an achilles' tendon defect: a case report.

    PubMed

    Dumont, C E; Kessler, J

    2001-12-01

    The surgical management of infected necrosis of the Achilles' tendon and overlying skin is very demanding, and reconstruction with vascularized tendon and skin flaps is considered the benchmark procedure. The authors report a 65-year-old man who sustained a chronic wound after operative repair of a chronic rupture of the Achilles' tendon. A pedicled medial plantar flap including the surrounding vascularized plantar aponeurosis was elevated. The plantar aponeurosis was split and used to bridge the 4-cm-long tendon defect. The flap donor site was covered with a thin skin graft. The flap survived completely without recurrence of the infection. At the 7-month follow-up, the reconstructed Achilles' tendon showed a good functional result and a normal range of dorsi- and plantar flexion of the foot. This technique is of great interest in comparison with free flaps because it does not require vascular anastomosis in a septic environment or a secondary debulking operation, yet it still provides both vascularized tendon and skin graft.

  11. Buttock Reconstruction in Sarcoma Surgery: An Esthetic Sigmoidplasty Closure for Large Circular Defects Using Double Opposing Skin Flaps

    PubMed Central

    Daya, Mahendra

    2016-01-01

    Background: Large defects arising from extirpation surgery of buttock sarcomas requiring adjuvant radiotherapy are best closed with flap surgery. The traditional solutions are derived from an approach to pressure sores, which were designed for the ischial, sacral, or trochanteric areas, and have now been adapted for true buttock defects. This invariably destroys the esthetics of the buttock. We describe a novel technique of sigmoidplasty, which preserves most of the esthetic features. Methods: We report on a retrospective review of 11 consecutive buttock sarcomas managed at our institution between 2009 and 2014, focusing on those for which the described reconstruction method was used (N = 5). Results: The immediate outcome was very good. In 1 patient, partial loss of 1 of the flaps and the management thereof resulted in a minor contour deformity. In general, the buttock volume was significantly decreased but the shape was preserved. This was obtained without secondary donor defect and with minimal contour irregularity. Long-term follow-up remained pleasing, and all patients were satisfied with the outcomes. Conclusions: The described technique of buttock defect closure satisfies the oncoplastic principles of tumor surgery with the added benefit of superior esthetics. We suggest that it is a versatile adjunct to the reconstructive surgeon’s armamentarium for buttock reconstruction after sarcoma excision, particularly when the gluteal artery perforator systems are unavailable. PMID:27826466

  12. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.

  13. Tanshinone IIA pretreatment renders free flaps against hypoxic injury through activating Wnt signaling and upregulating stem cell-related biomarkers.

    PubMed

    Xu, Zihan; Zhang, Zhenxin; Wu, Lijun; Sun, Yaowen; Guo, Yadong; Qin, Gaoping; Mu, Shengzhi; Fan, Ronghui; Wang, Benfeng; Gao, Wenjie

    2014-10-09

    Partial or total flap necrosis after flap transplantation is sometimes clinically encountered in reconstructive surgery, often as a result of a period of hypoxia that exceeds the tolerance of the flap tissue. In this study, we determine whether tanshinone IIA (TSA) pretreatment can protect flap tissue against hypoxic injury and improve its viability. Primary epithelial cells isolated from the dorsal skin of mice were pretreated with TSA for two weeks. Cell counting kit-8 and Trypan Blue assays were carried out to examine the proliferation of TSA-pretreated cells after exposure to cobalt chloride. Then, Polymerase chain reaction and Western blot analysis were used to determine the expression of β-catenin, GSK-3β, SOX2, and OCT4 in TSA-treated cells. In vivo, after mice were pretreated with TSA for two weeks, a reproducible ischemic flap model was implemented, and the area of surviving tissue in the transplanted flaps was measured. Immunohistochemistry was also conducted to examine the related biomarkers mentioned above. Results show that epidermal cells, pretreated with TSA, showed enhanced resistance to hypoxia. Activation of the Wnt signaling pathway in TSA-pretreated cells was characterized by the upregulation of β-catenin and the downregulation of GSK-3β. The expression of SOX2 and OCT4 controlled by Wnt signaling were also found higher in TSA pretreated epithelial cells. In the reproducible ischaemic flap model, pretreatment with TSA enhanced resistance to hypoxia and increased the area of surviving tissue in transplanted flaps. The expression of Wnt signaling pathway components, stem-cell related biomarkers, and CD34, which are involved in the regeneration of blood vessels, was also upregulated in TSA-pretreated flap tissue. The results show that TSA pretreatment protects free flaps against hypoxic injury and increases the area of surviving tissue by activating Wnt signaling and upregulating stem cell-related biomarkers.

  14. FTY720 in combination with cyclosporine--an analysis of skin allograft survival and renal function.

    PubMed

    Silva, Francieli Ruiz; Silva, Lea Bueno Lucas; Cury, Patricia Maluf; Burdmann, Emmanuel Almeida; Bueno, Valquiria

    2006-12-20

    Acute and chronic nephrotoxicity caused by CsA continuous administration impair kidney allograft survival. Several clinical and experimental protocols have shown benefits to the kidney after decreasing CsA dose, withdrawing the drug or delaying its introduction after transplantation. FTY720 is a new compound that has immunosuppressive characteristics and increase allograft survival in animal models without causing the side effects of calcineurin inhibitors (CNIs). FTY720 described mechanism of action that consists to alter the lymphocyte migration pattern without impairment of the immune system response against pathogens. In our mice model, FTY720 administered alone or in combination with CsA during 21 days increased skin allograft survival in a fully mismatched strain combination and did not cause significant changes in renal function. Moreover, renal structure was normal in all groups suggesting that at low doses (10 mg/kg/day) CsA can be associated during short-term period to other immunosuppressive drugs, i.e. FTY720 without affecting the kidney. Combination of immunosuppressive compounds with FTY720 and/or delayed introduction of low cyclosporine dose could prevent graft rejection and avoid nephrotoxicity.

  15. [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].

    PubMed

    Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C

    2016-11-17

    The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision.

  16. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    PubMed

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  17. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap

    PubMed Central

    Francis, Ashish; Baynosa, Richard C.

    2017-01-01

    Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia–reperfusion (IR). Traumatic avulsions and amputated composite tissues—compromised tissue—may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects. Recent Advances: Hyperbaric oxygen (HBO) has demonstrated utility in the salvage of compromised grafts/flaps. It can increase the likelihood and effective size of composite graft survival, improve skin graft outcomes, and enhance flap survival. Mechanisms underlying these beneficial effects include increased oxygenation, improved fibroblast function, neovascularization, and amelioration of IR injury. Critical Issues: Common strategies for the compromised graft or flap include local wound care, surgical debridement, and repeated reconstruction. These modalities are associated with added costs, time, need for reoperation, morbidity, and psychosocial effects. Preservation of the amputated/avulsed tissues minimizes morbidity and maximizes the reconstructive outcome by salvaging the compromised tissue and obviating additional surgery. HBO is often overlooked as a potential tool that can limit these issues. Future Directions: Animal studies demonstrate a benefit of HBO in the treatment of compromised tissues. Clinical studies support these findings, but are limited to case reports and series. Further research is needed to provide multicenter prospective clinical studies and cost analyses comparing HBO to other adjunctive therapies in the treatment of compromised grafts/flaps. PMID:28116225

  18. Syndactyly correction using a venous flap with the plantar cutaneous venous arch.

    PubMed

    Sakamoto, Natsuki; Matsumura, Hajime; Komiya, Takako; Imai, Ryutaro; Niyaz, Ahmatjan; Watanabe, Katsueki

    2014-01-01

    A combination of skin grafts and local flaps is widely used in the reconstruction of syndactyly of the toes. Covering the skin defect without skin grafts on the unilateral side of the toe is preferred, and for this purpose, a rotated flap from the plantar area is typically used. However, the flap can become ischemic or congested in some cases. To avoid this, we elevated a plantar flap with the plantar cutaneous venous arch using a triangular venous flap and covered the lateral side of the web in 7 cases of syndactyly. The dorsal flap was used to create the new web, and the opposite lateral side was reconstructed using a skin graft. The flap circulation was stable, the pedicle of the flap was narrow, and the flap relocation was simple. No flap in any patient showed any evidence of congestion or ischemia. Follow-up demonstrated that the new web was patent in all cases, with no evidence of contraction.

  19. Keratinocytes and fibroblasts in a human skin equivalent model enhance melanocyte survival and melanin synthesis after ultraviolet irradiation.

    PubMed

    Archambault, M; Yaar, M; Gilchrest, B A

    1995-05-01

    To investigate paracrine effects of fibroblasts and keratinocytes on melanocyte behavior after ultraviolet (UV) irradiation, we compared an in vitro skin equivalent model with melanocyte cultures. Human melanocytes were maintained alone in monolayer cultures or on dermal equivalents with or without keratinocytes and were irradiated daily with solar-simulated light. After seven daily UV irradiations, monolayer melanocytes displayed dose-dependent increases in cellular damage. In contrast, melanocytes on dermal equivalents survived strikingly better. Moreover, UV-irradiated skin equivalent melanocytes became highly dendritic as compared with sham-irradiated cells, closely mimicking their morphology in UV-irradiated skin. In addition, in skin equivalents melanocytes migrated from the center to the periphery of the keratinocyte layer after UV irradiation. Melanin production per culture, as measured by 14C-dihydroxyphenylalanine incorporation, was consistently higher in skin equivalent melanocytes than in monolayer melanocytes from the same donor, and it was highest in melanocytes from skin equivalents containing both keratinocytes and fibroblasts. Our data strongly suggest that fibroblasts and keratinocytes modulate melanocyte function in skin. The skin equivalent is a valuable model for investigating paracrine effects on melanocytes after UV irradiation.

  20. Vertical trapezius musculocutaneous flap: a retrospective study.

    PubMed

    Papadopoulos, Othon N; Chrisostomidis, Chrisostomos I; Georgiou, Panagis N; Frangoulis, Marios B; Zapantis-Fragos, Menelaos K; Champsas, Grigorios G

    2005-01-01

    From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.

  1. A minimally invasive modified reverse sural adipofascial flap for treating posttraumatic distal tibial and calcaneal osteomyelitis.

    PubMed

    Yang, Chenglin; Geng, Shuo; Fu, Chunjiang; Sun, Jiabing; Bi, Zhenggang

    2013-12-01

    Our aim was to report a modified reverse sural adipofascial flap for treating posttraumatic distal tibial or calcaneal osteomyelitis. We retrospectively reviewed the records of 15 patients with posttraumatic distal tibial or calcaneal osteomyelitis treated with modified reverse sural adipofascial flaps between 2005 and 2010. The flap was raised through 2 short incisions in the posterior aspect of the lower leg. The raw surface of the flap was covered with a full-thickness skin graft. Donor sites were closed primarily. Lower Extremity Functional Scale (LEFS) scores and 2-point discrimination (TPD) were recorded preoperatively and postoperatively. There were 12 males and 3 females, with an average age of 39 years (range = 18-55 years). Twelve lesions were in the distal tibia and 3 in the calcaneus. The flap ranged in size from 11 × 5 cm to 16 × 7 cm. All flaps survived, and skin grafts healed without complications. Recipient sites had an anatomic contour, and all patients were able to ambulate without the assistance of special shoes or orthoses. No infections recurred, and no ulcers of the grafted skin occurred with the regular wearing of shoes. The follow-up duration was 18.7 ± 6.8 months (range = 12-36 months). The mean LEFS score increased from 22.4 ± 8.3 preoperatively to 53.0 ± 11.2 postoperatively (P = .001). TPD markedly recovered at 24 months postoperatively. The modified reverse sural adipofascial flap provides good outcomes in treating distal tibial and calcaneal osteomyelitis with minimal donor site morbidity.

  2. Composite vascularized skin/bone graft model: a viable source for vascularized bone marrow transplantation.

    PubMed

    Siemionow, Maria; Ulusal, Betul G; Ozmen, Selahattin; Ulusal, Ali E; Ozer, Kagan

    2004-01-01

    In this study, we introduce a new model for vascularized skin and bone marrow transplantation. Twenty-five Lewis (RT1(1)) rats were studied. Anatomic dissection studies were performed in 5 animals. In the experimental group, 10 isograft transplantations were performed between Lewis rats. Combined groin skin and femoral bone flaps were transplanted based on the femoral artery and vein. Transplants were evaluated on a daily basis. All flaps survived without problems over 100 days posttransplant. The skin component remained pink and pliable, and grew new hair. Histological examination of the femoral bone (except the femoral head) revealed active hematopoiesis with a viable compact and cancellous bone components on day 100 posttransplant. This model can be applied to tolerance induction studies across the major Histocompatibility (MHC) barrier, where bone will serve as donor of stem and progenitor cells, and the skin flap will serve as a monitor of graft rejection.

  3. Adipose Tissue-Derived Mesenchymal Stem Cells Increase Skin Allograft Survival and Inhibit Th-17 Immune Response

    PubMed Central

    Larocca, Rafael Assumpção; Moraes-Vieira, Pedro Manoel; Bassi, Ênio José; Semedo, Patrícia; de Almeida, Danilo Candido; da Silva, Marina Burgos; Thornley, Thomas; Pacheco-Silva, Alvaro; Câmara, Niels Olsen Saraiva

    2013-01-01

    Adipose tissue-derived mesenchymal stem cells (ADSC) exhibit immunosuppressive capabilities both in vitro and in vivo. Their use for therapy in the transplant field is attractive as they could render the use of immunosuppressive drugs unnecessary. The aim of this study was to investigate the effect of ADSC therapy on prolonging skin allograft survival. Animals that were treated with a single injection of donor allogeneic ADSC one day after transplantation showed an increase in donor skin graft survival by approximately one week. This improvement was associated with preserved histological morphology, an expansion of CD4+ regulatory T cells (Treg) in draining lymph nodes, as well as heightened IL-10 expression and down-regulated IL-17 expression. In vitro, ADSC inhibit naïve CD4+ T cell proliferation and constrain Th-1 and Th-17 polarization. In summary, infusion of ADSC one day post-transplantation dramatically increases skin allograft survival by inhibiting the Th-17 pathogenic immune response and enhancing the protective Treg immune response. Finally, these data suggest that ADSC therapy will open new opportunities for promoting drug-free allograft survival in clinical transplantation. PMID:24124557

  4. Heating pad burns in anesthetic skin.

    PubMed

    Stevenson, T R; Hammond, D C; Keip, D; Argenta, L C

    1985-07-01

    Patients requiring reconstruction by muscle or musculocutaneous flaps often have an associated area of skin anesthesia. This skin is susceptible to trauma because of its insensibility. This study reports 3 cases in which patients sustained deep partial-thickness burns of anesthetic skin following flap reconstruction. All burns healed by reepithelialization. Following flap reconstruction, patients should be warned regarding the use of heating pads. Burns of this type represent a preventable complication of flap reconstruction.

  5. Captopril Increases Survival after Whole-Body Ionizing Irradiation but Decreases Survival when Combined with Skin-Burn Trauma in Mice.

    PubMed

    Islam, Aminul; Bolduc, David L; Zhai, Min; Kiang, Juliann G; Swift, Joshua M

    2015-09-01

    Past and recent radiation events have involved a high incidence of radiation combined injury where victims often succumb to serious infections as a consequence of bacterial translocation and subsequent sepsis. The risk of infection is exacerbated in radiation combined skin-burn injury (RCI), which increase vulnerability. Furthermore, no suitable countermeasures for radiation combined skin-burn injury have been established. In this study, we evaluated captopril as a potential countermeasure to radiation combined skin-burn injury. Captopril is an FDA-approved angiotensin-converting enzyme inhibitor that was previously reported to stimulate hematopoietic recovery after exposure to ionizing radiation. Female B6D2F1/J mice were whole-body bilateral (60)Co gamma-photon irradiated (dose rate of 0.4 Gy/min) with 9.5 Gy (LD70/30 for RCI), followed by nonlethal dorsal skin-burn injury under anesthesia (approximately 15% total-body surface-area burn). Mice were provided with acidified drinking water with or without dissolved captopril (0.55 g/l) for 30 days immediately after injury and were administered topical gentamicin (0.1% cream; day 1-10) and oral levofloxacin (90-100 mg/kg; day 3-16). Surviving mice were euthanized on day 30 after analyses of water consumption, body weight and survival. Our data demonstrate that, while treatment with captopril did mitigate mortality induced by radiation injury (RI) alone (55% captopril vs. 80% vehicle; n = 20, P < 0.05), it also resulted in decreased survival after radiation combined skin-burn injury (22% captopril vs. 41% vehicle; n = 22, P < 0.05). Moreover, captopril administration via drinking water produced an uneven dosage pattern among the different injury groups ranging from 74 ± 5.4 to 115 ± 2.2 mg/kg/day. Captopril treatment also did not counteract the negative alterations in hematology, splenocytes or bone marrow cellularity after either radiation injury or radiation combined skin-burn injury. These data suggest that

  6. Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study

    PubMed Central

    Karayel, Hikmet; Kaya, Burak; Caydere, Muzaffer; Terzioğlu, Ahmet; Aslan, Gürcan

    2015-01-01

    BACKGROUND: There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps. OBJECTIVE: To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A. METHODS: Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically. RESULTS: The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P<0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A. CONCLUSION: Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke. PMID:26361625

  7. Temporoparietal-occipital flap for facial reconstruction.

    PubMed

    Moretti, E; Garcia, F G

    2001-04-01

    Eight patients with an extensive facial defect of the masseter region were reconstructed with a temporoparietal- occipital rotation flap. This flap is vascularized by both the arteria auricularis posterior and the arteria occipitalis lateralis. These vessels have been sufficient to ensure viability of the entire flap. It is elevated and easily transposed to the masseter region because of the distensibility obtained from the posterior neck. This approach avoided the need for an unsightly skin graft at the site while providing tissue with hair follicles that blend well with the surrounding hair. This large flap offers cosmetic advantages over other techniques for coverage of facial defects in men.

  8. Outcome and complications of 540 microvascular free flaps: the Hamburg experience.

    PubMed

    Pohlenz, Philipp; Blessmann, Marco; Blake, Felix; Li, Lei; Schmelzle, Rainer; Heiland, Max

    2007-03-01

    The aim of this study was to retrospectively analyze surgical outcome and complications of 540 free flap procedures performed at the Department of Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf during 1987-2005. A total of 532 patients were reconstructed with 540 flaps: 32% were latissimus dorsi flaps, 23% were radial forearm flaps, 21% were iliac crest flaps, 10% were fibula flaps, 6% were jejunal flaps, and 8% were other flaps. Thrombosis of one of the vessels and hematoma were the most frequent causes of failure in microvascular free tissue transfer. A total free flap failure occurred in 34 (6.2%) and a partial flap failure in 42 (7.7%) patients. The most reliable flap in regard to survival was the radial forearm flap. The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck.

  9. Outcome of modified turn in flaps for the lining with primary cartilage support in nasal reconstruction.

    PubMed

    Bashir, Muhammad Mustehsan; Khan, Bilal Ahmad; Abbas, Muhammad; Khan, Farid Ahmad

    2013-03-01

    Turning in adjacent skin from the residual nose to line a full-thickness defect is still a controversial option. Text books continue to perpetuate that such flaps are poorly vascularized and may not survive if longer than 1.5 cm. The rationale of our study was to challenge the traditional thoughts about the turn-in flaps for the lining and describe our modified technique of raising these flaps so that well-vascularized thin tissue can be provided for the lining. The study was conducted at the Department of Plastic Surgery, KEMU, Lahore, from January 2007 to March 2011. Eighteen patients were included. They had posttraumatic full-thickness nasal defect of variable extent, involving the lower third of the nose. In the first stage of reconstruction, the epithelialized portion and 5-mm portion of normal adjoining skin were dermabraded. The residual skin of nasal dorsum, side walls, and alae was turned in to form inner lining of 2 nostrils. These flaps were based on healthy dermabraded skin to ensure adequate blood supply. Residual septal and conchal cartilages were used for primary support. Standard ipsilateral paramedian forehead flap with slight oblique design was used for resurfacing. Final assessment of airway patency and alar rim contour was made by the patient at 6 months as satisfactory, just satisfactory, and not satisfactory. There were 12 female and 6 male patients. There was necrosis of distal portion of the forehead flap in 1 case. Partial graft loss at the donor site with bone exposure was noted in another case. There was partial dehiscence and necrosis of turndown flap in 3cases. Mean flap size was 2.05 ± 0.28 cm. As regards airway patency, 12 patients were satisfied, 4 patients were just satisfied, and 2 patients were unsatisfied. When asked about alar rim contour, 3 patients said it to be satisfactory, 9 patients found it just satisfactory, and 6 patients declared it unsatisfactory. Nasal turndown flaps provide reliable tissue for the lining and allow

  10. Complications of free radial forearm flap transfers for head and neck reconstruction.

    PubMed

    Chen, Chun-Ming; Lin, Gau-Tyan; Fu, Yin-Chih; Shieh, Tien-Yu; Huang, I-Yueh; Shen, Yee-Shyong; Chen, Chung-Ho

    2005-06-01

    Free tissue transfer using microvascular anastomosis has been established as an accepted maxillofacial reconstructive procedure. The free radial forearm flap (FRFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Since 1992, we have carried out 38 FRFF transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. We present our clinical experience with head and neck reconstruction using the FRFF and the morbidity of the donor sites. Of the 38 FRFFs, 35 FRFFs were performed successfully. The survival rate of FRFF was 92%. Donor site complications included partial loss of skin graft in 4 donor sites (11%), abnormal sensations in 10 (26%), poor appearance in 3 (8%), and reduced grip strength in 4 (11%). Therefore, we believe that, because of the reliability, functional characteristics, and low donor site morbidity, the FRFF is a useful and versatile flap for reconstruction of head and neck defects.

  11. In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

    PubMed Central

    Edmunds, Marie-Claire; Wigmore, Stephen; Kluth, David

    2013-01-01

    Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury. PMID:23770929

  12. Experimental comparison of bone revascularization by musculocutaneous and cutaneous flaps

    SciTech Connect

    Fisher, J.; Wood, M.B.

    1987-01-01

    Revascularization, one of the major components of bone healing, was examined in an experimental model. The radioactive microsphere technique demonstrated that after 4 weeks beneath a musculocutaneous flap, isolated bone segments had significant blood flow, whereas bone beneath a cutaneous flap did not. The muscle flap bone had a blood flow approximately half that of normal control bone. The muscle of the musculocutaneous flap had a blood flow three times that of the skin of the cutaneous flap. The bipedicle cutaneous flap used was designed to have a healthy blood supply, and at 4 weeks it had a blood flow twice that of control skin. Despite this, there was essentially no demonstrable blood flow in the cutaneous flap bone segments at 4 weeks. Only 3 of 17 bone segments underneath cutaneous flaps showed medullary vascularization, whereas 10 of 11 muscle flap bones did. All bone segments underneath muscle flaps showed osteoblasts and osteoclasts at 4 weeks; neither were seen in the cutaneous bone segments. The process of revascularization occurred through an intact cortex and penetrated into the cancellous bone. Because the bone segments were surrounded by an impervious barrier except for one cortical surface, the cellular activity seen is attributed to revascularization by the overlying flap. In this model, a muscle flap was superior to a cutaneous flap in revascularizing isolated bone segments at 4 weeks. This was documented by blood flow measured by the radioactive microsphere technique and by bone histology.

  13. Preputial flaps to correct buried penis.

    PubMed

    Chu, Chih-Chun; Chen, Yi-Hsin; Diau, Guan-Yeu; Loh, Ih-Wei; Chen, Ke-Chi

    2007-11-01

    The authors developed a preputial skin flap technique to correct the buried penis which was simple and practical. This simple procedure can be applied to most boys with buried penis. In the last 3 years, we have seen 12 boys with buried penis and have been treated by using preputial flaps. The mean age is about 5.1 (from 3 to 12). By making a longitudinal incision on the ventral side of penis, the tightness of the foreskin is released and leave a diamond-shaped skin defect. It allows the penile shaft to extend out. A circumferential incision is made about 5 mm proximal to the coronal sulcus. Pedicled preputial flaps are obtained leaving optimal penile skin on the dorsal side. The preputial skin flaps are rotated onto the ventral side and tailored to cover the defect. All patients are followed for at least 3 months. Edema and swelling on the flaps are common, but improves with time. None of our patients need a second operation. The preputial flaps technique is a simple technique which allows surgeons to deal with most cases of buried penis by tailoring the flaps providing good cosmetic and functional results.

  14. Viability of the skin paddle does not predict the functional outcome in free muscle transfers with a second ischemic event: a report of three cases.

    PubMed

    Dodakundi, Chaitanya; Doi, Kazuteru; Hattori, Yasunori; Sakamoto, Soutetsu; Fujihara, Yuki; Takagi, Takehiko; Fukuda, Makoto

    2012-05-01

    Conventional skin flap monitoring is one of the widely used methods to assess postoperative circulation in innervated free muscle transfer (IFMT). However, following reexploration for vascular compromise and reestablishing circulation, functional recovery of the muscle despite surviving skin flap is not clear. The purpose of this article is to report three such cases and determine the reliability of viable skin flap in an IFMT with a second ischemic event. Long-term functional results were assessed in terms of reinnervation time, elbow range of motion, strength of elbow flexion, finger function in terms of total active motion, and power lifting with hook grip. These IFMTs developed complete or partial necrosis of the muscle and could not obtain satisfactory function. The conventional monitoring of the skin flap did not promptly reflect vascularity of IFMT, and a surviving skin flap after reexploration for compromised vascularity does not guarantee complete survival of the muscle. There is a need for earlier and rapid detection of vascular compromise in IFMTs.

  15. Predictive model for survival and growth of Salmonella typhimurium DT104 on chicken skin during temperature abuse.

    PubMed

    Oscar, T P

    2009-02-01

    To better predict risk of Salmonella infection from chicken subjected to temperature abuse, a study was undertaken to develop a predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin with native flora. For model development, chicken skin portions (2.14 cm2) were inoculated with 0.85 log of Salmonella Typhimurium DT104 (ATCC 700408) and then stored at 5 to 50 degrees C for 8 h. Kinetic data from the storage trials were fit to a primary model to determine lag time (lamda), specific growth rate (micrro), and the 95% prediction interval (PI). Secondary models for lamda, mu, and PI as a function of storage temperature were developed and then combined with the primary model to create a tertiary model. Performance of the tertiary model was evaluated against dependent data, independent data for interpolation, and independent data for extrapolation to kosher chicken skin by using an acceptable prediction zone from -1 (fail-safe) to 0.5 (fail-dangerous) log per skin portion. Survival of Salmonella Typhimurium DT104 on chicken skin was observed during 8 h of storage at 5 to 20 degrees C and at 50 degrees C, whereas growth was observed from 25 to 45 degrees C and was optimal at 40 degrees C with a lamda of 2.5 h and a mu of 1.1 log/h. Variation of pathogen growth, as assessed by PI, increased in a nonlinear manner as a function of temperature and was greater for growth conditions than no-growth conditions. The percentage of acceptable prediction errors was 82.6% for dependent data, 83.7% for independent data for interpolation, and 81.6% for independent data for extrapolation to kosher skin, which all exceeded the performance criterion of 70% acceptable predictions. Thus, it was concluded that the tertiary model provided valid predictions for survival and growth of Salmonella Typhimurium DT104 from a low initial dose on both nonkosher and kosher chicken skin with native flora.

  16. Arterialized Venous Bone Flaps: An Experimental Investigation

    PubMed Central

    Borumandi, Farzad; Higgins, James P.; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander

    2016-01-01

    In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705

  17. Flap prefabrication and stem cell-assisted tissue expansion: how we acquire a monoblock flap for full face resurfacing.

    PubMed

    Li, Qingfeng; Zan, Tao; Li, Haizhou; Zhou, Shuangbai; Gu, Bin; Liu, Kai; Xie, Feng; Xie, Yun

    2014-01-01

    Total face skin and soft-tissue defects remain one of the biggest challenges in reconstructive surgery. Reconstruction of the entire face with uniform coverage and delicate features is difficult to achieve. To avoid the patchwork result seen in multiple flaps and skin grafts, 1 monoblock flap that has similar color, texture, and thickness might be an ideal option to minimize the incisional scars and several surgical procedures but is unavailable with current approaches because of the lack of sufficient matched tissue and the unreliable blood supply for such a large flap. To acquire a monoblock flap for full face reconstruction, we combine the prefabricated flaps, skin overexpansion, and bone marrow mononuclear stem cell transplantation for total facial resurfacing. In this article, we present our experience from our case series that provides universally matched skin and near-normal facial contour. It is a reliable and an excellent reconstructive option for massive facial skin defect.

  18. The Bmi-1 polycomb protein antagonizes the (-)-epigallocatechin-3-gallate-dependent suppression of skin cancer cell survival.

    PubMed

    Balasubramanian, Sivaprakasam; Adhikary, Gautam; Eckert, Richard L

    2010-03-01

    The polycomb group (PcG) proteins are epigenetic regulators of gene expression that enhance cell survival. This regulation is achieved via action of two multiprotein PcG complexes--PRC2 (EED) and PRC1 [B-cell-specific Moloney murine leukemia virus integration site 1 (Bmi-1)]. These complexes modulate gene expression by increasing histone methylation and reducing acetylation--leading to a closed chromatin conformation. Activity of these proteins is associated with increased cell proliferation and survival. We show increased expression of key PcG proteins in immortalized keratinocytes and skin cancer cell lines. We examine the role of two key PcG proteins, Bmi-1 and enhancer of zeste homolog 2 (Ezh2), and the impact of the active agent in green tea, (-)-epigallocatechin-3-gallate (EGCG), on the function of these regulators. EGCG treatment of SCC-13 cells reduces Bmi-1 and Ezh2 level and this is associated with reduced cell survival. The reduction in survival is associated with a global reduction in histone H3 lysine 27 trimethylation, a hallmark of PRC2 complex action. This change in PcG protein expression is associated with reduced expression of key proteins that enhance progression through the cell cycle [cyclin-dependent kinase (cdk)1, cdk2, cdk4, cyclin D1, cyclin E, cyclin A and cyclin B1] and increased expression of proteins that inhibit cell cycle progression (p21 and p27). Apoptosis is also enhanced, as evidenced by increased caspase 9, 8 and 3 cleavage and increased poly(adenosine diphosphate ribose) polymerase cleavage. EGCG treatment also increases Bax and suppresses Bcl-xL expression. Vector-mediated enhanced Bmi-1 expression reverses these EGCG-dependent changes. These findings suggest that green tea polyphenols reduce skin tumor cell survival by influencing PcG-mediated epigenetic regulatory mechanisms.

  19. Dose-survival relationship for epithelial cells of human skin after multifraction irradiation: evaluation by a quantitative method in vivo

    SciTech Connect

    Arcangeli, G.; Mauro, F.; Nervi, C.; Withers, H.R.

    1980-07-01

    The dose-survival relationship for normal epithelial cells after single and fractionated radiation exposures has been established by Withers for the mouse, but it is not available for humans according to a strict criterion for survival of single cell reproductive integrity. In an attempt to obtain such a quantitative estimation, 2 patients requiring radical radiation therapy to the chest wall were treated according to particular Multiple Daily Fractionation (MDF) protocols: i) 250 + 150 + 150 rad/day, 4 hr interval, 5 days/week; and ii) 150 + 150 + 150 + 150 rad/day, 3.5 hr interval, 5 days/week. In both cases, different strips of skin received different total doses: 6300, 6850, and 7150 rad, and 6300, 6750, and 7200 rad, respectively. In case (i), moist desquamation appeared and thereafter repopulating colonies of epithelium could be recognized and counted. Using these counts a survival curve having a D/sub o/ value of 490 +- 150 rad was estimated according to the formula proposed by Withers. In case (ii), no moist desquamation was reached at the doses delivered. The difference observed may imply that the initial region of the survival curve deviates appreciably from exponential between doses of 150 and 250 rad. If such is the case, a /sub 1/D/sub o/ value of 490 rad may represent an underestimate. These results are discussed from the point of view of both the shape of the survival curve and the effectiveness of nonconventional fractionation courses.

  20. Fibular free flap reconstruction of the "true" lateral mandibular defect.

    PubMed

    Anthony, J P; Foster, R D; Kaplan, M J; Singer, M I; Pogrel, M A

    1997-02-01

    The purpose of this study was to determine the role of the fibular free flap in reconstructing lateral segmental defects of the mandible. Over the past 5 1/2 years, 17 consecutive patients underwent reconstruction of their lateral mandible with the fibular free flap. Patients included 12 men and 5 women, the mean age was 54 years (range, 29-76 years), and the mean length of the mandibular defect was 6.3 cm (range, 2.5-9 cm). The majority of patients with tumors (54%) were treated for recurrence and 92% received radiation to the operative field. The mean operative time to perform the microsurgery and bone plating was 4 hours. Postoperative morbidity occurred in 3 patients (18%) (plate fracture, malocclusion, orocutaneous fistula). Five patients (29%) required leg donor site skin grafting. Donor site morbidity included a minor cellulitis, a transient neuropraxia, and one case of leg swelling. None required additional surgery for donor complications. Thus far, 71% of the patients have received dental rehabilitation and 35% had osseointegrated implants placed in their bone flap. Eighty-two percent of the patients achieved both good or excellent aesthetic and functional results. Sixteen patients (94%) tolerate at least a soft diet and 65% are on a regular diet. Five patients developed tumor recurrence an average of 9 months postoperatively with a mean survival of 21 months. This study demonstrates that the fibular free flap is highly reliable for reconstructing the lateral mandible in a single stage, with low overall morbidity, and provides for excellent dental and speech rehabilitation. For most patients, the fibular free flap should be considered for lateral mandibular reconstruction even in those patients with a limited life expectancy.

  1. Reconstruction of lateral forefoot using reversed medial plantar flap with free anterolateral thigh flap.

    PubMed

    Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

    2014-01-01

    Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects.

  2. Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.

    PubMed

    Jing-Chun, Zhao; Kai, Shi; Jia-Ao, Yu; Chun-Jing, Xian; Lai-Jin, Lu; Chun-Hui, Xie

    2015-01-01

    The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects.

  3. Fibular osteoadiposal flap for treatment of tibial adamantinoma: a case report.

    PubMed

    Namba, Yuzaburo; Kimata, Yoshihiro; Koshima, Isao; Sugihara, Shinsuke; Sato, Tohru

    2006-08-01

    We treated a case with left tibial adamantinoma by use of a contralateral fibular osteoadiposal flap. The donor site of conventional fibular osteocutaneous flap must be covered with a skin graft because if we close the donor skin defect directly, compartment syndrome might occur. We were able to close the donor skin defect because this combined type flap included only a small monitoring skin paddle. We present herein the utility of the osteoadiposal flap and show the value of a skin-sparing approach with a minimal aesthetic defect.

  4. Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application.

    PubMed

    Koshima, I; Hosoda, M; Inagawa, K; Moriguchi, T; Orita, Y

    1996-11-01

    The medial thigh flap is a perforator-based flap nourished with septocutaneous or muscle perforators originating from the femoral vessels. To date, 8 patients have been repaired with this flap and extended or connected flaps including this flap: 4 patients with lower leg defects and 4 patients with intraoral and neck defects. The advantages of this flap are (1) several pedicle perforators exist for this flap, which makes possible duplicated vascular anastomoses to establish reliable circulation of the transferred flap; (2) the flap can be extended or connected to other neighboring flaps in the anterior thigh, so that extensively wide defects can be closed in one stage; (3) the great saphenous vein can be simultaneously used as a vein graft or for venous drainage for the flap; (4) the anterior branch of the femoral nerve can be used for sensory potential; and (5) there is minimum morbidity of the donor defect and a large dominant vessel for the leg can be preserved. The suitable indications for this flap are defects after removal of skin cancer in the foot or lower leg and wide defects after resection of head and neck cancer, which can be reconstructed with the flap connected to neighboring skin flaps. The disadvantages of this flap are that it has a small, short vascular pedicle and the bulkiness of the flap's fatty tissue often requires thinning.

  5. Validation of a predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin for extrapolation to a previous history of frozen storage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin was evaluated for its ability to predict survival and growth of the same organism after frozen storage for 6 days at -20 C. Experimental methods used to collect data for model development were the same as tho...

  6. Skew flap for staged below-knee amputation in sepsis.

    PubMed

    Matthews, Christopher O; Williams, Ian M; Lewis, Peter; McLain, A David; Twine, Christopher P

    2016-04-01

    Skew flap amputation was first described in the 1980s but was never as popular as the long posterior flap amputation. This report describes a staged below-knee amputation in sepsis, with pus throughout the leg and a lack of skin coverage. One benefit of skew flaps never previously published is the fact that the suture line is not directly over the tibia. Therefore, an open wound or incomplete skin coverage is not as important as in long posterior flaps where it often leads to bone exposure and revision amputation. These benefits were utilized in this case leading to stump healing.

  7. A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

    PubMed Central

    Casal, Diogo; Pais, Diogo; Iria, Inês; Mota-Silva, Eduarda; Almeida, Maria-Angélica; Alves, Sara; Pen, Cláudia; Farinho, Ana; Mascarenhas-Lemos, Luís; Ferreira-Silva, José; Ferraz-Oliveira, Mário; Vassilenko, Valentina; Videira, Paula A.; Gory O'Neill, João

    2017-01-01

    Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training. PMID:28117814

  8. Choice of Flap Affects Fistula Rate after Salvage Laryngopharyngectomy

    PubMed Central

    Kao, Huang-Kai; Abdelrahman, Mohamed; Chang, Kai-Ping; Wu, Chao-Min; Hung, Shao-Yu; Shyu, Victor Bong-Hang

    2015-01-01

    Due to the significant morbidity and mortality associated with pharyngocutaneous fistula in pharyngoesophageal reconstruction following cancer resection, the purpose of this retrospective study is to examine the selection of tubed skin flaps that impact anastomotic integrity. The flaps evaluated included radial forearm flap versus anterolateral thigh flap, and fasciocutaneous anterolateral thigh flap versus chimeric anterolateral thigh flap. The outcome of interest is the incidence of pharyngocutaneous fistula. The radial forearm group had a significantly higher rate of fistula than the anterolateral thigh group (56.6% vs. 30.2%, p = 0.03). No significant difference in the incidence of fistula was demonstrated between fasciocutaneous and chimeric anterolateral thigh flap (36.8% vs. 25%, p = 0.51). The anastomotic integrity in pharyngoesopharyngeal reconstruction is affected by choice of skin flaps. Anterolateral thigh flap appears to be a viable option for pharyngoesophageal reconstruction. The more technical demand of the anterolateral thigh flap must be weighed against an easily harvested radial forearm flap. PMID:25776941

  9. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    PubMed

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.

  10. Numerical analysis of the V-Y shaped advancement flap.

    PubMed

    Remache, D; Chambert, J; Pauchot, J; Jacquet, E

    2015-10-01

    The V-Y advancement flap is a usual technique for the closure of skin defects. A triangular flap is incised adjacent to a skin defect of rectangular shape. As the flap is advanced to close the initial defect, two smaller defects in the shape of a parallelogram are formed with respect to a reflection symmetry. The height of the defects depends on the apex angle of the flap and the closure efforts are related to the defects height. Andrades et al. 2005 have performed a geometrical analysis of the V-Y flap technique in order to reach a compromise between the flap size and the defects width. However, the geometrical approach does not consider the mechanical properties of the skin. The present analysis based on the finite element method is proposed as a complement to the geometrical one. This analysis aims to highlight the major role of the skin elasticity for a full analysis of the V-Y advancement flap. Furthermore, the study of this technique shows that closing at the flap apex seems mechanically the most interesting step. Thus different strategies of defect closure at the flap apex stemming from surgeon's know-how have been tested by numerical simulations.

  11. Survival of skin graft between transgenic cloned dogs and non-transgenic cloned dogs.

    PubMed

    Kim, Geon A; Oh, Hyun Ju; Kim, Min Jung; Jo, Young Kwang; Choi, Jin; Park, Jung Eun; Park, Eun Jung; Lim, Sang Hyun; Yoon, Byung Il; Kang, Sung Keun; Jang, Goo; Lee, Byeong Chun

    2014-01-01

    Whereas it has been assumed that genetically modified tissues or cells derived from somatic cell nuclear transfer (SCNT) should be accepted by a host of the same species, their immune compatibility has not been extensively explored. To identify acceptance of SCNT-derived cells or tissues, skin grafts were performed between cloned dogs that were identical except for their mitochondrial DNA (mtDNA) haplotypes and foreign gene. We showed here that differences in mtDNA haplotypes and genetic modification did not elicit immune responses in these dogs: 1) skin tissues from genetically-modified cloned dogs were successfully transplanted into genetically-modified cloned dogs with different mtDNA haplotype under three successive grafts over 63 days; and 2) non-transgenic cloned tissues were accepted into transgenic cloned syngeneic recipients with different mtDNA haplotypes and vice versa under two successive grafts over 63 days. In addition, expression of the inserted gene was maintained, being functional without eliciting graft rejection. In conclusion, these results show that transplanting genetically-modified tissues into normal, syngeneic or genetically-modified recipient dogs with different mtDNA haplotypes do not elicit skin graft rejection or affect expression of the inserted gene. Therefore, therapeutically valuable tissue derived from SCNT with genetic modification might be used safely in clinical applications for patients with diseased tissues.

  12. Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy.

    PubMed

    Zhang, Senlin; Chen, Wei; Cao, Gang; Dong, Zhen

    2015-09-01

    This study investigated the tongue function and donor-site morbidity of patients with malignant tumors who had undergone immediate flap reconstruction surgery. Twenty-seven patients who had undergone immediate reconstruction after hemiglossectomy were observed. Twelve patients were reconstructed using the pedicled supraclavicular artery island flap (PSAIF) and 15 patients using the free radial forearm flap (FRFF). Flap survival, speech and swallowing function, and donor-site morbidity at the 6-month follow-up were evaluated. All the flaps were successfully transferred. No obvious complications were found in either the transferred flaps or donor regions. Age, sex, defect extent, speech and swallowing function were comparable between the 2 groups. Donor-site complications were less frequent with PSAIF reconstruction than FRFF reconstruction. The PSAIF is reliable and well suited for hemiglossectomy defect. It has few significant complications, and allows preservation of oral function.

  13. Bilobed flaps for nonhealing ulcer treatment.

    PubMed

    Yetkin, Haluk; Kanatli, Ulunay; Oztürk, Akif Muhtar; Ozalay, Metin

    2003-09-01

    Healing of round ulcers may be difficult particularly in the plantar area. Rigidity and thickness of the plantar skin do not allow fusiform excision and primary suturing. The bilobed flap is a simple reconstructive technique principally used to repair substantial defects in the facial region. The authors' experience with this local flap in the foot is presented with good short-term results. Between 1995 and 1998, five female and seven male neuropathic foot patients with round plantar ulcers were treated with bilobed flaps. The average age of the patients was 50 (range, 15-76). The average size of the ulcers was 1.6 cm (1-3.2 cm). Debridement and orthotic insoles were used at least for 3 months before considering bilobed flaps. Seven patients were diagnosed as type II diabetes mellitus, four patients had cerebral palsy, and another patient had meningomyelocele. The minimal follow-up period was 1 year (average, 19.5 months). The only complication was wound dehiscence at the lateral side of the heel in a type II diabetic. Subsequently, this complicated ulcer was managed with a sliding flap and skin graft without further problem. The study concluded that nonhealing foot ulcers can be effectively treated with a bilobed skin flap of healthy tissues rotated from nonweightbearing parts of the sole.

  14. Feasibility of Human Skin Grafts on An Isolated But Accessible Vascular Supply on Athymic Rats As a System to Study Percutaneous Penetration and Cutaneous Injury

    DTIC Science & Technology

    1986-06-01

    drug delivery and cutaneous toxicology. Heretofore, to assess percutaneous absorption of a topically applied agent in human subjects, investigators...vascular characteristics (8). Our current work involves the validation of the flap model for transdermal flux, drug disposition, and skin metabolism...reported to enhance the effectiveness of ALS and cyclosporine in prolonging the survival of allografts (44), the preliminary data from two rats

  15. Effect of boar seminal plasma immunosuppressive factor on NK cell activity and skin graft survival.

    PubMed

    Veselsky, L; Holan, V; Soucek, J; Stanek, R; Hoskova, M

    1992-01-01

    The B 10 strain of mice was used to test the effect of the boar seminal vesicle immunosuppressive factor on the female mouse response to the male-specific transplantation antigen. Influence of this factor on human natural killer (NK) cell activity was also studied. No inhibitory effect of the immunosuppressive factor on graft survival was apparent during a time of more than 200 days, nor did the factor suppress NK cell activity.

  16. Clinical Experiences with the Scapular Fascial Free Flap

    PubMed Central

    Park, Il Ho; Chang, Yong Joon; Kim, Jae Hyun

    2016-01-01

    Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from 3×12 to 13×23 cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation. PMID:27689051

  17. Free flap rescue using an extracorporeal perfusion device.

    PubMed

    Fichter, Andreas M; Ritschl, Lucas M; Rau, Andrea; Schwarzer, Claudia; von Bomhard, Achim; Wagenpfeil, Stefan; Wolff, Klaus-Dietrich; Mücke, Thomas

    2016-12-01

    The warm ischaemia time of microvascular free flaps is limited. Incalculable events, such as lack of adequate recipient vessels or intraoperative medical emergencies, can lead to prolonged ischaemia and potentially to flap loss. In this study, critically perfused ischaemic or congested flaps were temporarily perfused with an extracorporeal perfusion system until anastomosis could be commenced. Temporary extracorporeal perfusion was performed in 8 radial forearm flaps for 147 ± 52 (range 77-237) minutes. Flap perfusion was assessed using Indocyanine Green fluorescence angiography and combined laser Doppler flowmetry and remission spectroscopy. Results were compared with those of 30 patients who underwent conventional reconstruction with radial forearm flaps. Flap survival, flap microcirculation, postoperative complications, and hospital stay did not differ between groups. We report successful free flap transfer after short-term extracorporeal perfusion for up to 4 h in 8 patient cases. Temporary extracorporeal free flap perfusion reduces the warm ischaemia time in emergency situations and can help to prevent flap failure in critically perfused or congested flaps. The trial is registered with ClinicalTrials.gov, number NCT02449525.

  18. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    SciTech Connect

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-08-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

  19. Superthin Abdominal Wall Glove-Like Flap Combined With Vacuum-Assisted Closure Therapy for Soft Tissue Reconstruction in Severely Burned Hands or With Infection.

    PubMed

    Wang, Fei; Liu, Sheng; Qiu, Le; Ma, Ben; Wang, Jian; Wang, Yong-Jie; Peszel, April; Chen, Xu-Lin

    2015-12-01

    Severe burn and infection to hands always involves the deep structures, such as tendons, joints, and bones. These wounds cannot be closed immediately and therefore creates a high risk for complication. We presented 9 cases with deep dermal burns to the dorsal of the hand (6 electrical burns and 3 thermal crush injuries) with wound infections in 2 cases. The vacuum-assisted closure system was used continuously until the flap reconstruction was performed. A random pattern and superthin abdominal wall skin flap-like glove was designed. The flap was transferred to the defected portion of the dorsum of the hand and resected from the abdominal wall about 3 weeks later. The flaps in 8 of the patients treated by this technique survived completely and partial necrosis of the distal flap occurred in 1 patient. The defect resolved after operative treatment and the function of the hands and fingers were successfully salvaged. All patients resulted in having a satisfactory aesthetic outcome with no or minor discomfort at the abdominal donor area. Integration of the vacuum-assisted closure system and the superthin abdominal wall glove-like flap reconstruction appeared to be successful and should be considered in patients with severely burned hands.

  20. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    PubMed

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  1. The Internal Pudendal Artery Perforator Thigh Flap: A New Freestyle Pedicle Flap for the Ischial Region

    PubMed Central

    Goishi, Keiichi; Abe, Yoshiro; Takaku, Mitsuru; Seike, Takuya; Harada, Hiroshi; Nakanishi, Hideki

    2014-01-01

    Background: Recurrence and complication rates of pressure sores are highest in the ischial region, and other donor sites are needed for recurrent pressure sores. The potential of a new freestyle pedicle flap for ischial lesions, an internal pudendal artery perforator (iPap) thigh flap, was examined through anatomical and theoretical analyses and a case series using computed tomography angiography. Methods: The skin flap was designed in the thigh region based on an iPap. The skin perforators were marked with a Doppler probe. One patient underwent computed tomography angiography with fistulography to identify the damage to or effects on the pedicle vessels of the flap. Debridement of ischial lesions and flap elevation were performed in the jackknife position. Results: The iPap thigh flaps were performed in 5 patients, 4 with ischial pressure sores and 1 with calcinosis cutis of the ischial region. The width and length of the flaps ranged from 5 to 8 cm (mean, 6.6 cm) and 10 to 17 cm (mean, 12.6 cm), respectively. Three patients underwent partial osteotomy of the ischial bone. No complications, including flap necrosis or wound dehiscence of the donor and reconstructed sites, were observed. Conclusions: The perforator vessels of the internal pudendal artery are very close to the ischial tuberosity. Blood flow to the flap is reliable when careful debridement of the pressure sore is performed. The iPap thigh flap is a new option for soft-tissue defects in the ischial region, including ischial pressure sores. PMID:25289335

  2. Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report.

    PubMed

    Scaglioni, Mario F; Chen, Yen-Chou; Yang, Johnson Chia-Shen

    2015-10-01

    Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction.

  3. [Expanded pedicled forearm flap for reconstruction of multiple finger amputations].

    PubMed

    Alvarez Jorge, A; Martelo Villar, F

    2000-05-01

    Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.

  4. Environmental fluctuations and host skin bacteria shift survival advantage between frogs and their fungal pathogen.

    PubMed

    Longo, Ana V; Zamudio, Kelly R

    2017-02-01

    Fluctuating environments can modulate host-pathogen interactions by providing a temporary advantage to one of the interacting organisms. However, we know very little about how environmental conditions facilitate beneficial interactions between hosts and their microbial communities, resulting in individual persistence with a particular pathogen. Here, we experimentally infected Eleutherodactylus coqui frogs with the fungal pathogen Batrachochytrium dendrobatidis (Bd) under environmental conditions known to confer the survival advantage to the host during the warm-wet season, or alternatively to the pathogen during the cool-dry season. We used 16S rRNA amplicon sequencing to quantify changes in bacterial richness and phylogenetic diversity, and identified operational taxonomic units (OTUs) that became overrepresented or suppressed as a consequence of Bd infection. During the warm-wet season, frogs limited Bd infections, recruited putatively beneficial bacteria and returned to pre-infection levels of richness and phylogenetic diversity. In contrast, during the cool-dry season, Bd infections kept increasing through time, and bacterial diversity remained constant. Our findings confirm that infection outcome not only depends on abiotic factors, but also on biotic interactions between hosts and their associated bacterial communities.

  5. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects.

    PubMed

    Posch, N A S; Mureau, M A M; Flood, S J; Hofer, S O P

    2005-12-01

    Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL-ALT perforator flap would offer adequate tissue volume combining maximal freedom in planning with minimal donor site morbidity. From November 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. true MC flap; II. muscle flap with a skin island on one perforator, which could be rotated up to 180 degrees ; III. chimera skin perforator flap with muscle being harvested on a separate branch from the source vessel or on a side branch of the skin perforator. Mean skin size of the MC-ALT flaps was 131 cm2. Mean muscle part size of the MC-ALT flaps was 268 cm3. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colour mismatch was seen in 6 of 8 patients, when skin was used in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2 of 11 patients after 6 months. Patients were satisfied with the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfied patients had received their flap for external facial skin reconstruction. Donor site morbidity was minimal. The combined free partial VL with ALT perforator flap proved valuable as a (chimera type) MC flap with maximal

  6. Soft-tissue coverage of complex dorsal hand and finger defects using the turnover adipofascial flap.

    PubMed

    Deal, D Nicole; Barnwell, Jonathan; Li, Zhongyu

    2011-02-01

    Complex hand wounds with exposed tendon or bone often require free tissue transfer. We report results in 13 patients with complex dorsal hand or digital wounds who underwent soft-tissue reconstruction using a turnover adipofascial flap and skin grafting over a 35-month period. The mean patient age was 44 years. Mechanism of injury included the following: three gunshot, four degloving, one table saw, three chain saw, one thumb avulsion, and one crush. Flap sizes varied from 2 × 4 to 10 × 18 cm, involving the dorsum of the hand in four patients, thumb in two patients, index finger in one patient, long finger in three patients, long and ring fingers in one patient, and web space in two patients. Skin graft survival was 100% in 12 patients. One patient died of sepsis from unrelated medical conditions. All fractures were healed at follow-up, and there were no donor site complications. The adipofascial flap is a good alternative to free tissue transfer for the coverage of complex dorsal hand and finger soft-tissue defects and is associated with technical ease, good cosmetic results, and minimal donor site morbidity.

  7. [Hueston's flap in distal digital amputations. Apropos of 43 cases].

    PubMed

    Dallassera, M; Foucher, G

    1996-06-01

    John Hueston described an advancement rotation flap, sacrificing the innervation of the advanced skin. René Souquet proposed a modification of the technique to retain the sensitivity of the advanced skin. We reviewed 43 such flaps to compare the long term results with a median follow-up of 3 years. The mean 2PD was 6.8 mm for the classical technique and 5.9 mm for the modified flaps. The Semmes-Weinstein test was identical to the controlateral side in 77% and 92% of cases, respectively. These discrepencies were not statistically significant.

  8. Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty.

    PubMed

    D'Arpa, Salvatore; Colebunders, Britt; Stillaert, Filip; Monstrey, Stan

    2017-01-01

    The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity because it avoids the well-known scars of the radial forearm flap. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Preexpansion of the ALT flap allows primary donor site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT donor site, but also the skin graft donor site scar. Preoperative perforator location by means of computed tomography angiography allows safe expander placement through 2 small remote incisions.

  9. Dermal microvasculature and tissue selective thinning techniques (ultrasound and water-jet) of short-time expanded skin in dogs.

    PubMed

    Siegert, R; Danter, J; Jurk, V; Eggers, R; Krüger, S

    1998-01-01

    Certain reconstructive procedures, like auricular reconstructions, require thin and well-vascularized skin. The aims of this study were to analyze if the increased survival of expanded skin flaps was due to morphologic changes of the dermis, if thinning of short-time expanded skin was possible without harm to the microcirculation and if tissue selective cutting methods could be used to resect subcutaneous fat without damaging its vessels. Eighty-two 200-ml expanders were implanted into the trunk regions of 26 beagles and filled immediately with sterile saline. In the first series of experiments, the expansion was terminated after intervals of 0.5-5 weeks and dermal vessels were analyzed morphometrically. In the second series the expanded flaps were raised after 2 weeks and thinned solely surgically or with the additional use of an ultrasonic knife or with cutting by water jet. In contrast to sham flaps, the expanded skin showed only very few areas of necrosis and these were located superficially in most cases. The relative volume of the dermal vessels and their quantity showed a significant increase after the expansion. Additionally, the subcutaneous tissue could be thinned down to 0.4 mm with the water-jet-cutter. Findings demonstrated that the method used could create a well-vascularized skin flap of minimal thickness that could be very helpful for special reconstructive procedures.

  10. High-fat diet exacerbates inflammation and cell survival signals in the skin of ultraviolet B-irradiated C57BL/6 mice

    SciTech Connect

    Meeran, Syed M.; Singh, Tripti; Nagy, Tim R.; Katiyar, Santosh K.

    2009-12-15

    Inflammation induced by chronic exposure to ultraviolet (UV) radiation has been implicated in various skin diseases. We formulated the hypothesis that a high-fat diet may influence the UV-induced inflammatory responses in the skin. C57BL/6 mice were fed a high-fat diet or control diet and exposed to UVB radiation (120 mJ/cm{sup 2}) three times/week for 10 weeks. The mice were then sacrificed and skin and plasma samples collected for analysis of biomarkers of inflammatory responses using immunohistochemistry, western blotting, ELISA and real-time PCR. We found that the levels of inflammatory biomarkers were increased in the UVB-exposed skin of the mice fed the high-fat diet than the UVB-exposed skin of the mice fed the control diet. The levels of inflammatory biomarkers of early responses to UVB exposure (e.g., myeloperoxidase, cyclooxygenase-2, prostaglandin-E{sub 2}), proinflammatory cytokines (i.e., tumor necrosis factor-alpha, interleukin-1beta, interleukin-6), and proliferating cell nuclear antigen and cell survival signals (phosphatidylinositol-3-kinase and p-Akt-Ser{sup 473}) were higher in high-fat-diet-fed mouse skin than control-diet-fed mouse skin. The plasma levels of insulin growth factor-1 were greater in the UVB-irradiated mice fed the high-fat diet than the UVB-irradiated mice fed the control diet, whereas the levels of plasma adiponectin were significantly lower. This pronounced exacerbation of the UVB-induced inflammatory responses in the skin of mice fed a high-fat diet suggests that high-fat diet may increase susceptibility to inflammation-associated skin diseases, including the risk of skin cancer.

  11. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    PubMed

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.

  12. Lateral Arm Free Flap With Preservation of the Posterior Antebrachial Cutaneous Nerve.

    PubMed

    Ki, Sae Hwi

    2016-05-01

    The lateral arm free flap offers many advantages in reconstruction of soft tissue defect and reconstruction of extremities. However, this free flap is associated with sensory loss at the posterior forearm due to injury of the posterior antebrachial cutaneous nerve (PABCN).The PABCN-sparing lateral arm free flaps were performed in 19 patients with various soft tissue defects of the extremity, and the outcomes of free flap reconstructions using this modification are evaluated. All flaps survived without partial necrosis. Three patients experienced transient sensory loss in the posterior area of the forearm after flap harvest.In this study, lateral arm free flaps can be elevated without necessarily sacrificing the PABCN. This nerve-sparing modification decreases the donor-site morbidity of lateral arm free flaps and further increases the overall usefulness of this flap in soft tissue reconstructions of the extremities.

  13. The survival of human skin stored by refrigeration at 4 degrees C in McCoy's 5A medium: does oxygenation of the medium improve storage time?

    PubMed

    DeBono, R; Rao, G S; Berry, R B

    1998-07-01

    To establish the viable storage time of human skin stored by refrigeration at 4 degrees C in McCoy's 5A medium and to establish whether oxygenating the medium improves the viable storage time, the following experiment was conducted. Eighty discs of human split-thickness skin graft, each 3 mm in diameter, were stored in 40 sterile sealable containers under four different conditions: in 0.9% saline, in McCoy's 5A medium, in oxygenated McCoy's 5A medium, and in carbon dioxide supplemented McCoy's 5A medium. Skin graft viability was assessed using tissue culture. Skin stored in saline was viable for only 1 week, whereas skin stored in McCoy's 5A medium and in oxygenated McCoy's 5A medium was viable for 4 weeks. Skin stored in carbon dioxide supplemented McCoy's 5A solution did not even survive the first week. These findings show that McCoy's 5A medium allows at least 4 weeks of viable human skin storage by refrigeration at 4 degrees C. Furthermore, oxygenating the medium does not seem to improve the viable storage time, and carbon dioxide supplementation is detrimental. The advantages of skin storage by refrigeration and the implications of the above findings are discussed. A clinical case in which split-thickness skin was stored for approximately 5 weeks and still resulted in good graft take is quoted as an example of our experience with the use of McCoy's 5A medium.

  14. The medial sural artery perforator free flap.

    PubMed

    Cavadas, P C; Sanz-Giménez-Rico, J R; Gutierrez-de la Cámara, A; Navarro-Monzonís, A; Soler-Nomdedeu, S; Martínez-Soriano, F

    2001-11-01

    The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

  15. Skin banking: treatment option for native skin necrosis following skin-sparing mastectomy and previous breast irradiation.

    PubMed

    Reichl, Heike; Hladik, Michaela; Wechselberger, Gottfried

    2011-05-01

    Skin flap necrosis, as well as positive resection margins in the context of skin-sparing mastectomy and immediate breast reconstruction, may require reoperation, potentially associated with tissue loss, and thereby impair the aesthetic result. Skin banking has recently been described as a method for handling skin flaps of uncertain viability. Here, we describe the advantages of skin banking in previously irradiated patients with breast cancer recurrence, which underwent skin-sparing mastectomy and immediate breast reconstruction. Aside from its utility in the management of skin necrosis, we present this method as an option to conserve the native breast shape in patients with questionable total resection during surgery.

  16. Donor-site Morbidity of Medial and Lateral Thigh-based Flaps: A Comparative Study

    PubMed Central

    Purnell, Chad A.; Lewis, Kevin C.; Mioton, Lauren M.; Hanwright, Philip J.; Galiano, Robert D.; Dumanian, Gregory A.; Alghoul, Mohammed S.

    2016-01-01

    Background: Free and pedicled medial and lateral thigh-based flaps are common reconstructive procedures. However, there have been no comparative studies of morbidity between medial and lateral donor sites. Methods: We conducted an Enterprise Data Warehouse-based review of all the senior authors’ (R.D.G., G.A.D., and M.S.A.) thigh-based free and pedicled flaps. Patient demographic data, donor-site complications, drain duration, and number of postoperative visits were collected and compared. Complications were also compared between fasciocutaneous flaps and muscle or myocutaneous flaps, and skin grafted donor sites. Results: We analyzed 352 flap donor sites, with 155 medial and 197 lateral. Two hundred seventeen (217) flaps were pedicled. Flap types included 127 gracilis, 27 rectus femoris, 134 anterolateral thigh, and 36 vastus lateralis-only flaps. There were no significant differences in complications between medial (17.4%) and lateral thigh (21.3%) donor sites, although lateral thigh flaps had a mean of 1 additional postoperative visit. Rates of wound dehiscence/healing issues were significantly higher in both gracilis myocutaneous flaps (25.9%) and flaps requiring a skin grafted donor site (31.2%). Postoperative therapeutic anticoagulation was the only significant risk factor for a donor-site complication. Flap complications resulted in increased drain duration and postoperative office visits. Conclusions: Donor-site morbidity is similar in both lateral and medial thigh-based flaps. The inclusion of muscle in the flap from either donor site does not seem to increase complications, but the inclusion of a skin paddle with gracilis muscle, or a skin grafted lateral thigh donor site, results in increased wound healing complications. PMID:27975004

  17. Changes in the blood biochemistry following experimental flap ischaemia.

    PubMed

    Knight, K R; Gumley, G J; Rogers, I W; O'Brien, B M

    1988-05-01

    The purpose of this study was to elucidate tissue changes occurring within an ischaemic flap by monitoring the blood biochemistry, and to evaluate these changes in relation to ultimate flap viability. A rabbit epigastric free flap was made ischaemic for 4 days at 6 degrees C, then revascularized by anastomosis of its femoral artery and vein. An identical free flap immediately revascularized in another group of rabbits served as a control. The viability of the free flap, as well as various biochemical parameters studied by drawing blood from a catheter in the ear vein, were observed daily. Immediately after the revascularization of ischaemic flaps, there was a 16-fold increase in the plasma levels of creatine kinase (CK) and a smaller but significant 1.5-fold to 2.0-fold increase in lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). In flaps which ultimately failed by 7 days post-ischaemia, the plasma levels of CK, LDH and AST peaked at day 2 post-ischaemia at 68, 13 and 8 times normal respectively, whereas in flaps which survived, the levels of these enzymes recovered to normal by day 3 post-ischaemia. These enzymic changes are probably due to a combination of ischaemic changes in the flap vasculature, ischaemic changes in the flap muscle, and inflammatory changes in the surrounding abdominal tissue. The plasma levels of CK at any time post-ischaemia, and particularly in the first 24 h, were significantly higher in ischaemic flaps which failed compared with those which survived. This parameter is therefore proposed as a possible means of predicting potential flap failure after ischaemic insult, in time to make appropriate surgical intervention.

  18. The scapular, parascapular, and latissimus dorsi flap as a single osteomyocutaneous flap for repair of complex oral defects.

    PubMed

    Janus, Jeffrey R; Carlson, Matthew L; Moore, Eric J

    2012-01-01

    Complex composite defects of the oral cavity are often created due to en bloc resection of malignant tumors. These defects can involve bone, soft tissue, oral mucosa, and external skin, posing a reconstructive challenge to the microvascular surgeon. Though advances have been made in free tissue transfer via piggybacking techniques and double free-flaps, increases in operative time and morbidity remain limiting factors. Likewise, advancements in single composite flaps (e.g., double-skin paddle fibular free-flap) allow for a single donor site, but limit workable tissue. This report describes our experience with the scapular, parascapular, and latissimus dorsi (SPLD) as a combined single unit osteomyocutaneous flap for composite reconstruction of complex oral defects. A case example is subsequently reviewed for clinical correlation. This is an operative techniques article describing the use of the SPLD single multi-tissue flap for repair of complex oral defects. Cadaveric dissection was performed for instructional purposes. Case example was given for clinical correlation. Relevant history, anatomy, procedural details, and possible complications are presented and subsequently correlated to the case example. A SPLD free-flap as a single multi-tissue flap is a viable and beneficial option for reconstruction of complex oral defects. It provides the volume of tissue necessary to fill composite defects and exists as an alternative to multi-flap procedures, which carry a longer operative time and multiple donor site morbidity.

  19. Mesenchymal stem cells increase skin graft survival time and up-regulate PD-L1 expression in splenocytes of mice.

    PubMed

    Moravej, Ali; Geramizadeh, Bita; Azarpira, Negar; Zarnani, Amir-Hassan; Yaghobi, Ramin; Kalani, Mehdi; Khosravi, Maryam; Kouhpayeh, Amin; Karimi, Mohammad-Hossein

    2017-02-01

    Recently, mesenchymal stem cells (MSCs) have gained considerable interests as hopeful therapeutic cells in transplantation due to their immunoregulatory functions. But exact mechanisms underlying MSCs immunoregulatory function is not fully understood. Herein, in addition to investigate the ability of MSCs to prolong graft survival time, the effects of them on the expression of PD-L1 and IDO immunomodulatory molecules in splenocytes of skin graft recipient mice was clarified. To achieve this goal, full-thickness skins were transplanted from C57BL/6 to BALB/c mice. MSCs were isolated from bone marrow of BALB/c mice and injected to the recipient mice. Skin graft survival was monitored daily to determine graft rejection time. On days 2, 5 and 10 post skin transplantation, serum cytokine levels and expression of PD-L1 and IDO mRNA and protein in the splenocytes of recipient mice were evaluated. The results showed that administration of MSCs prolonged skin graft survival time from 11 to 14 days. On days 2 and 5 post transplantation, splenocytes PD-L1 expression and IL-10 serum level in MSCs treated mice were higher than those in the controls, while IL-2 and IFN-γ levels were lower. Rejection in MSCs treated mice was accompanied by an increase in IL-2 and IFN-γ, and decrease in PD-L1 expression and IL-10 level. No difference in the expression of IDO between MSCs treated mice and controls was observed. In conclusion, we found that one of the mechanisms underlying MSCs immunomodulatory function could be up-regulating PD-L1 expression.

  20. Reconstruction of the chin using an expanded deltopectoral flap following multiple recurrences of oral cancer

    PubMed Central

    Balakrishnan, Chenicheri; Hackenson, David; Balakrishnan, Anila; Elliott, David; Careaga, Daniel

    2012-01-01

    An important alternative to free tissue transfer in patients requiring correction of soft tissue chin defects are local and regional flaps, such as the pectoralis major myocutaneous flap and deltopectoral flap. With predictable vascular supply, potential for large size, and good aesthetic match for facial and cervical skin, the deltopectoral flap can offer the reconstructive surgeon additional options in patients who lack vessels suitable for free tissue transfer. The use of an expanded deltopectoral flap for a staged reconstruction of the chin in a patient with cancer recurrences, concomitant resections, radiation and multiple reconstructions is reported. PMID:23997595

  1. Osteocutaneous radial forearm free flap in subtotal nasal reconstruction

    PubMed Central

    Moore, Alexander Michael; Montgomery, Jenny; McMahon, Jeremy; Sheikh, Saghir

    2014-01-01

    A 66-year-old man presented with a large squamous cell carcinoma of the right nasal vestibule. He underwent partial rhinectomy and medial maxillectomy followed by staged reconstruction. Reconstruction of a full-thickness nasal defect requires repair of three distinct layers: the skin–soft tissue envelope, subsurface framework and intranasal lining. We report the first use in the UK of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. The skin of the radial forearm free flap was tubed to recreate the nasal lining and the radial bone reconstructed the dorsal contour of the nose. A full-thickness paramedian forehead flap supplied external coverage. The osteocutaneous radial forearm free flap and forehead flap is a viable option for large nasal defects requiring reconstruction of framework, nasal lining and external covering. PMID:25427933

  2. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap.

    PubMed

    Tang, Chen-Ling; Wu, Yi-Chia; Lai, Ching-Hung; Lai, Chung-Sheng; Lin, Chih-Lung; Lin, Sin-Daw; Chang, Kao-Ping

    2012-10-01

    The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.

  3. Trends in net survival from skin malignant melanoma in six European Latin countries: results from the SUDCAN population-based study.

    PubMed

    Galceran, Jaume; Uhry, Zoé; Marcos-Gragera, Rafael; Borràs, Joan

    2017-01-01

    In Europe as a whole, survival from skin malignant melanoma (SMM) has increased constantly since the 1980s. The aim of the SUDCAN collaborative study was to compare the trends in the 5-year net survival from SMM and in related excess mortality rate between six European Latin countries (Belgium, France, Italy, Portugal, Spain, and Switzerland). The data were extracted from the EUROCARE-5 database (end of follow-up: 01 January 2009). First, the net survival was studied over the 2000-2004 period using the Pohar-Perme estimator. For trend analyses, the study period was specific to each country. The results are reported from 1992 to 2004 in France, Italy, Spain, and Switzerland and from 2000 to 2004 in Belgium and Portugal. The analyses were carried out using a flexible excess rate modeling. Over the 2000-2004 period, the 5-year net survival from SMM ranged from 79 (Portugal) to 90% (Switzerland). In all countries, net survival was higher in women versus men and in young versus old age groups. From 1992 to 2004, the 5-year net survival increased the most in the countries with the lowest survivals in 1992 (+9% in Italy and Spain vs. +2% in Switzerland or +4% in France). The differences between countries decreased between 1992 and 2004. Although survival increased to a lower or higher extent in all countries during the period studied, significant differences in net survival from SMM persisted among the six countries studied. Health policies should mainly enhance early diagnosis by increasing public awareness and with screening campaigns. Furthermore, new immunotherapies, which will be approved soon hopefully, should also be used to improve the outcomes of SMM treatment.

  4. Upregulation of PIM2 by Underexpression of MicroRNA-135-5p Improves Survival Rates of Skin Allografts by Suppressing Apoptosis of Fibroblast Cells

    PubMed Central

    Zhang, Hongtu

    2017-01-01

    Background It has been reported that miR-135-5p is involved with many diseases. In this study, we aimed at define the relationship between miR-135-5p level and burn patient survival after skin transplantation. Material/Methods Expression of miR-135-5p and PIM2 was measured using real-time PCR and Western blot analysis in the skin samples collected from burn patients who received skin graft or in the fibroblast cells transfected with miR-135-5p mimics or inhibitors. The regulatory association between miR-135-5p and PIM2 was verified using bioinformatics analysis and luciferase assay. Results The expression level of miR-135-5p was determined in 60 tissue samples divided into 2 groups based on the presence of rejection (long survival n=30, and short survival n=30). We found that miR-135-5p was substantially downregulated in the long survival group. We then searched the miRNA database online with the “seed sequence” located within the 3′-UTR of the target gene, and then validated PIM2 to be the direct gene via luciferase reporter assay system. We also established the negative regulatory relationship between miR-135-5p and PIM2 via studying the relative luciferase activity. We also conducted real-time PCR and Western blot analysis to study the mRNA and protein expression level of PIM2 among different groups (long survival n=30, short survival n=30) or cells treated with scramble control, miR-135-5p mimics, PIM2 siRNA, and miR-135-5p inhibitors, indicating the negative regulatory relationship between MiR-135-5p and PIM2. We also conducted experiments to investigate the influence of miR-135-5p and PIM2 on viability and apoptosis of cells. The results showed miR-135-5p reduced the viability of cells, while PIM2 negatively interfered with the viability of cells, and miR-135-5p inhibited apoptosis and PIM2 suppressed apoptosis. Conclusions MiR-135-5p is involved with the prognosis of burn patients after skin transplantation. PIM2 is a virtual target of miR-135-5p, and

  5. Leptin deficiency-induced obesity exacerbates ultraviolet B radiation-induced cyclooxygenase-2 expression and cell survival signals in ultraviolet B-irradiated mouse skin

    SciTech Connect

    Sharma, Som D.; Katiyar, Santosh K.

    2010-05-01

    Obesity has been implicated in several inflammatory diseases and in different types of cancer. Chronic inflammation induced by exposure to ultraviolet (UV) radiation has been implicated in various skin diseases, including melanoma and nonmelanoma skin cancers. As the relationship between obesity and susceptibility to UV radiation-caused inflammation is not clearly understood, we assessed the role of obesity on UVB-induced inflammation, and mediators of this inflammatory response, using the genetically obese (leptin-deficient) mouse model. Leptin-deficient obese (ob/ob) mice and wild-type counterparts (C57/BL6 mice) were exposed to UVB radiation (120 mJ/cm{sup 2}) on alternate days for 1 month. The mice were then euthanized and skin samples collected for analysis of biomarkers of inflammatory responses using immunohistochemistry, western blotting, ELISA and real-time PCR. Here, we report that the levels of inflammatory responses were higher in the UVB-exposed skin of the ob/ob obese mice than those in the UVB-exposed skin of the wild-type non-obese mice. The levels of UVB-induced cyclooxygenase-2 expression, prostaglandin-E{sub 2} production, proinflammatory cytokines (i.e., tumor necrosis factor-alpha, interleukin-1beta, interleukin-6), and proliferating cell nuclear antigen and cell survival signals (phosphatidylinositol-3-kinase and p-Akt-Ser{sup 473}) were higher in the skin of the ob/ob obese mice than the those in skin of their wild-type non-obese counterparts. Compared with the wild-type non-obese mice, the leptin-deficient obese mice also exhibited greater activation of NF-kappaB/p65 and fewer apoptotic cells in the UVB-irradiated skin. Our study suggests for the first time that obesity in mice is associated with greater susceptibility to UVB-induced inflammatory responses and, therefore, obesity may increase susceptibility to UVB-induced inflammation-associated skin diseases, including the risk of skin cancer.

  6. Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle

    PubMed Central

    Liu, Lifeng; Cao, Xuexin; Zou, Lin; Li, Zongyu; Cao, Xuecheng; Cai, Jinfang

    2013-01-01

    The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps. PMID:24376731

  7. Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience

    PubMed Central

    Ismail, H.; Elshobaky, A.

    2016-01-01

    Summary Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques, including chimeric flaps, supercharged flap, pre-expanded flaps, “superthin” flaps and perforator flaps. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Between January 2013 and March 2015, 20 patients suffering from postburn neck contracture underwent reconstruction with 20 unilateral supraclavicular artery perforator flaps. Nineteen patients had post-burn neck contractures (9 cases type Іc, 10 cases type Пc) while only one had post-burn granulation tissue in the neck. We harvested fifteen flaps from the right side and five from the left. Size of the reconstructed defect ranged from 23x10 to14x6, and flap size varied from 25/11 to 16/7cm. Period of follow up ranged from 27-2months (average 12.3). Nineteen flaps survived well (95% survival rate): only one was lost due to iatrogenic extensive dissection over the pedicle. Five cases showed distal superficial epidermolysis, and 2 cases showed 2 cm complete distal necrosis. All patients were managed conservatively. Our results coincide with other literature results confirming the efficacy and rich vascularity of this flap. In all cases with distal partial necrosis, flaps were 23 cm or more. We recommend that supraclavicular flaps of more than 22 cm in length are not harvested immediately and that flaps are expanded before harvesting. Expanding the supraclavicular flap increases its surface area and decreases donor site morbidity. PMID:28149252

  8. Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience.

    PubMed

    Ismail, H; Elshobaky, A

    2016-09-30

    Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques, including chimeric flaps, supercharged flap, pre-expanded flaps, "superthin" flaps and perforator flaps. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Between January 2013 and March 2015, 20 patients suffering from postburn neck contracture underwent reconstruction with 20 unilateral supraclavicular artery perforator flaps. Nineteen patients had post-burn neck contractures (9 cases type Іc, 10 cases type Пc) while only one had post-burn granulation tissue in the neck. We harvested fifteen flaps from the right side and five from the left. Size of the reconstructed defect ranged from 23x10 to14x6, and flap size varied from 25/11 to 16/7cm. Period of follow up ranged from 27-2months (average 12.3). Nineteen flaps survived well (95% survival rate): only one was lost due to iatrogenic extensive dissection over the pedicle. Five cases showed distal superficial epidermolysis, and 2 cases showed 2 cm complete distal necrosis. All patients were managed conservatively. Our results coincide with other literature results confirming the efficacy and rich vascularity of this flap. In all cases with distal partial necrosis, flaps were 23 cm or more. We recommend that supraclavicular flaps of more than 22 cm in length are not harvested immediately and that flaps are expanded before harvesting. Expanding the supraclavicular flap increases its surface area and decreases donor site morbidity.

  9. Autologous breast reconstruction with the extended latissimus dorsi flap.

    PubMed

    Chang, David W; Youssef, Adel; Cha, Sumi; Reece, Gregory P

    2002-09-01

    The extended latissimus dorsi myocutaneous flap can provide autogenous tissue replacement of breast volume without an implant. Nevertheless, experience with the extended latissimus dorsi flap for breast reconstruction is relatively limited. In this study, the authors evaluated their experience with the extended latissimus dorsi flap for breast reconstruction to better understand its indications, limitations, complications, and clinical outcomes. All patients who underwent breast reconstruction with extended latissimus dorsi flaps at the authors' institution between January of 1990 and December of 2000 were reviewed. During the study period, 75 extended latissimus dorsi flap breast reconstructions were performed in 67 patients. Bilateral breast reconstructions were performed in eight patients, and 59 patients underwent unilateral breast reconstruction. There were 45 immediate and 30 delayed reconstructions. Mean patient age was 51.5 years. Mean body mass index was 31.8 kg/m2. Flap complications developed in 21 of 75 flaps (28.0 percent), and donor-site complications developed in 29 of 75 donor sites (38.7 percent). Mastectomy skin flap necrosis (17.3 percent) and donor-site seroma (25.3 percent) were found to be the most common complications. There were no flap losses. Patients aged 65 years or older had higher odds of developing flap complications compared with those 45 years or younger (p = 0.03). Patients with size D reconstructed breasts had significantly higher odds of flap complications compared with those with size A or B reconstructed breasts (p = 0.05). Obesity (body mass index greater than or equal to 30 kg/m2) was associated with a 2.15-fold increase in the odds of developing donor-site complications compared with patients with a body mass index less than 30 kg/m2 (p = 0.01). No other studied factors had a significant relationship with flap or donor-site complications. In most patients, the extended latissimus dorsi flap alone, without an implant, can

  10. Complex lower face reconstruction using a combined technique of Estlander flap and subscapular artery system free flaps.

    PubMed

    Hamahata, Atsumori; Saitou, Takashi; Beppu, Takeshi; Shirakura, Satoshi; Hatanaka, Akio; Yamaki, Takashi; Sakurai, Hiroyuki

    2013-12-01

    When advanced mandibular carcinoma is resected, the defect may include lip and oral commissure. Free flap insertion is commonly used to reconstruct the lip defect. Although improvements in the oral reconstructive method via free flap use have been reported, functional and aesthetic results of the oral sphincter remain limited. This case report describes two individuals presenting with massive lower face defects, including a lower lip defect and a mandibular bone defect. Reconstruction was accomplished using the Estlander flap and free subscapular system of flaps. In both cases, the free subscapular artery system flap was elevated from the mandibular bone defect and other mucosal defect. The lower lip and oral commissure defect was reconstructed via Estlander flap. Free flaps survived 100% and both cases healed without complication. Patients regained good oral sphincter function with no reports of drooling. Thus, in cases involving massive lower face resection, including that of the lower lip and mandibular bone, this method of reconstruction when combined with lip-switch flap and subscapular artery system flap can prove to be useful.

  11. The sternocleidomastoid perforator flap.

    PubMed

    Avery, C M E

    2011-10-01

    The conventional pedicled sternocleidomastoid (SCM) flap has a poor arc of rotation, limited volume and precarious vascularity. This report describes a new technique for raising a SCM flap based on the perforating vessels of the superior thyroid vascular pedicle. The upper and lower attachments of the sternocleidomastoid muscle are divided. Four medically and/or surgically compromised patients have successfully undergone reconstruction of hemiglossectomy (1), partial glossectomy (1) and rim of mandible (2) defects for malignancy. The arc of rotation of the SCM flap is greatly increased and the potential applications for the flap expanded.

  12. Compound or Specially Designed Flaps in the Lower Extremities.

    PubMed

    Battiston, Bruno; Ciclamini, Davide; Tang, Jin Bo

    2017-04-01

    Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular.

  13. Free Flap Salvage after Recurrent Venous Thrombosis by Means of Large-Scale Treatment with Medical Leeches

    PubMed Central

    Fujiki, Masahide; Arikawa, Masaki; Kagaya, Yu; Miyamoto, Shimpei

    2016-01-01

    Summary: An anterolateral thigh flap was salvaged using 110 medical leeches in the absence of an available vein for reanastomosis. After surgical construction of the flap for full-thickness thoracic wall reconstruction, the patient developed complete venous occlusion. Specifically, the anastomotic vein developed complete occlusion, and the internal jugular vein had a thrombus. In addition, because the lung was posterior to the flap, the angiogenic area of the flap was very small. When the medical leeches were first applied, the flap showed prominent venous congestion. However, the congestion began to resolve by day 6 of leech use, leading to complete survival of the flap. PMID:28293509

  14. Complement component 3 deficiency prolongs MHC-II disparate skin allograft survival by increasing the CD4+ CD25+ regulatory T cells population

    PubMed Central

    Zheng, Quan-you; Liang, Shen-ju; Li, Gui-qing; Lv, Yan-bo; Li, You; Tang, Ming; Zhang, Kun; Xu, Gui-lian; Zhang, Ke-qin

    2016-01-01

    Recent reports suggest that complement system contributes to allograft rejection. However, its underlying mechanism is poorly understood. Herein, we investigate the role of complement component 3 (C3) in a single MHC-II molecule mismatched murine model of allograft rejection using C3 deficient mice (C3−/−) as skin graft donors or recipients. Compared with C3+/+ B6 allografts, C3−/− B6 grafts dramatically prolonged survival in MHC-II molecule mismatched H-2bm12 B6 recipients, indicating that C3 plays a critical role in allograft rejection. Compared with C3+/+ allografts, both Th17 cell infiltration and Th1/Th17 associated cytokine mRNA levels were clearly reduced in C3−/− allografts. Moreover, C3−/− allografts caused attenuated Th1/Th17 responses, but increased CD4+CD25+Foxp3+ regulatory T (Treg) cell expression markedly in local intragraft and H-2bm12 recipients. Depletion of Treg cells by anti-CD25 monoclonal antibody (mAb) negated the survival advantages conferred by C3 deficiency. Our results indicate for the first time that C3 deficiency can prolong MHC-II molecule mismatched skin allograft survival, which is further confirmed to be associated with increased CD4+ CD25+ Treg cell population expansion and attenuated Th1/Th17 response. PMID:27641978

  15. Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography.

    PubMed

    Nagata, Tetsuji; Masumoto, Kazuma; Uchiyama, Yoshiyuki; Watanabe, Yoshiko; Azuma, Ryuichi; Morimoto, Yuji; Katou, Fuminori

    2014-10-01

    In head and neck surgery, free-flap reconstruction using a microvascular anastomosis is an indispensable option after tumor ablation. Because the success of free-flap reconstruction is enhanced by rapid identification and salvage of failing flaps, postoperative monitoring of free flaps is essential. We describe a new technique using indocyanine green (ICG) near-infrared angiography and pinprick testing to monitor intraoral free flaps. A solution of ICG (Diagnogreen, 5 ml) was intravenously injected, and scanning was performed with a near-infrared video camera system. Thirty seconds after ICG injection, a pinprick test was performed by placing a 24-gage needle through the dermis to the subcutaneous fat of the flap. Pinprick testing during ICG fluorescence imaging was performed in 30 patients. Flap perfusion was confirmed in all patients, and all flaps survived postoperatively. ICG fluorescence imaging demonstrated that flap perfusion was maintained.

  16. Laparoscopic Free Omental Flap for Craniofacial Reconstruction: A Video Article Demonstrating Operative Technique and Surgical Applications.

    PubMed

    McIntyre, Benjamin C; Lobb, David; Navarro, Fernando; Nottingham, James

    2017-03-01

    The omental flap is a well described pedicled flap for surgical reconstruction of multiple body locations. As a laparoscopically harvested free flap, the omentum offers a minimally invasive solution to many reconstructive problems including extremity and head and neck wounds. This video article highlights the operative technique involved in flap harvest and inset for a cranial defect. An illustrative case involving a 23-year-old female's traumatic scalp degloving injury that was resurfaced by free omental flap and split-thickness skin graft is presented. This patient had stable long-term wound coverage for a very severe injury. Through video media we demonstrate that the laparoscopically harvested free omental flap is a minimally invasive, 2-team operation that provides soft tissue coverage of severe, remote wounds. This video demonstrates a safe operative technique and nuances specific to laparoscopic harvest of this flap.

  17. Recurrent squamous cell carcinoma of the scalp treated with serial free flaps: A case report.

    PubMed

    Ikander, Peder; Sørensen, Jens Ahm

    2015-09-01

    Reconstruction of large full thickness scalp defects is always a challenge. Many different techniques can be used, but larger defects often call for a free tissue transfer. The purpose of this report is to present one successful way of treating multiple large scalp defects. A 61-year-old man was seen with recurrent squamous cell carcinoma of the scalp. The lesions were of full thickness, about 10-15 cm in diameter and included the calvarial bone and the dura layer. The reconstruction process included split-thickness skin grafting, local flaps, and three free microvascular flaps; two latissimus dorsi flaps and one anterolateral thigh flap. No total flap loss was seen, but partial flap necrosis called for secondarily reconstruction. The final result was cosmetically acceptable and the patient is of good health. In conclusion, serial free microvascular flaps may be used with good results when dealing with large difficult and recurrent scalp defects.

  18. Complex technique of large sural flap: an alternative option for free flap in large defect of the traumatized foot.

    PubMed

    Mohammadkhah, Naser; Motamed, Sadrollah; Hosseini, Seyed Nejat; Hallajmofrad, Hamid Reza; Abdolzadeh, Madjid; Afzali Borujeni, Lotfallah; Mousavinasab, Seyednouraddin

    2011-01-01

    The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.

  19. Reconstruction of weightbearing forefoot defects with digital artery flaps.

    PubMed

    Liu, Lifeng; Cao, Xuecheng; Cai, Jinfang

    2015-01-01

    Reconstruction of a defect of the weightbearing forefoot region remains a challenging problem owing to the limited alternatives available. The digital artery flap can be used for coverage of defects in the weightbearing forefoot. The present study reports our results using a digital artery flap for reconstruction of soft tissue defects of the weightbearing forefoot in 8 patients. The mean patient age was 35 ± 11.3 years. The etiology of the soft tissue defects included 4 (50%) traumatic events, 2 (25%) dysfunctional scars, and 2 (25%) neuropathic ulcerations. The mean postoperative follow-up duration was 22 ± 11.1 months (range 12 months to 4 years). All 8 flaps survived successfully. The complications included 1 case of delayed healing of a neuropathic ulceration. The digital artery flap is a good alternative for soft tissue defects of the weightbearing forefoot. The surgical techniques for harvesting the flaps are easy to manage.

  20. Peroneal artery perforator chimeric flap: changing the perspective in free fibula flap use in complex oromandibular reconstruction.

    PubMed

    Daya, Mahendra

    2008-08-01

    The fibula osteoseptocutaneous flap has undergone multiple refinements since its first description in oromandibular reconstruction. There is now a better understanding of the blood supply to the skin of the lateral aspect of the leg. Multiple free skin paddles can be harvested freestyle from the lateral aspect of the leg. The size of the flaps that can be harvested has not been clearly defined. A case report of a complex oromandibular reconstruction following a shotgun injury to the face demonstrates a way of maximizing the skin harvest. An osteoseptocutaneous fibula flap was used for the replacement of the mandible and the internal lining of the oral cavity. A larger lateral leg flap based on a musculocutaneous perforator of the peroneal artery was used for the external and full-thickness lower-lip defect. The latter flap by definition is a peroneal artery perforator flap, which to the best of my knowledge is terminology that has not been used in the English literature. The main purpose of this article is to review the blood supply of the lateral leg and how this can be utilized to reach the goals of a complex oromandibular and total lower-lip reconstruction.

  1. Modified Free Latissimus Dorsi Musculocutaneous Flap in the Reconstruction of Extensive Postoncologic Defects in the Head and Neck Region

    PubMed Central

    Zhu, Guiquan; Li, Chunhua; Chen, Jin; Cai, Yongcong; Li, Ling; Wang, Zhaohui

    2015-01-01

    Abstract Oncological resection of advanced carcinoma in the head and neck region results in vast defects. The free latissimus dorsi musculocutaneous flap (FLDMF) is one of the most commonly used flaps for the repair of complex head and neck defects. We tried to modify FLDMF to multiple segments or combine it with acellular dermis to fit through-and-through defects in the oral-facial region during the last decade. A retrospective review of patients with FLDMF reconstruction between 2004 and 2012 was undertaken. Demographics, histology, surgical management, disease control and overall survival, complications, radiotherapy, aesthetic outcome, as well as economic results were analyzed. The majority of the patients (66.7%) had recurrent tumors, and the rest of the patients had primary tumor with stage IV. Fourteen patients (38.9%) had a history of prior radiation therapy, whereas 27.8% of the patients had postoperative radiation therapy. The areas of the defects vary from 52 cm2 to 180 cm2 (mean, 86.4 cm2). The flap failed in 1 of the 37 patients. The complications at the recipient site include hematoma (n = 6, 16.7%), venous insufficiency (n = 4, 11.1%), infection (n = 3, 8.3), and partial flap necrosis (n = 2, 5.5%). The donor-site complications include delayed healing, necrosis of skin graft, and limited shoulder function. The 5-year overall survival rate was 39.1%, and the 5-year disease-free survival rate was 22.1%. In conclusion, the FLDMF could be modified to fit vast defects where voluminous tissue is needed to be transferred in the head and neck region. PMID:25723665

  2. Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications

    PubMed Central

    Liu, Muyuan; Liu, Weiwei; Yang, Xihong; Guo, Haipeng; Peng, Hanwei

    2017-01-01

    The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps. PMID:28387356

  3. Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications.

    PubMed

    Liu, Muyuan; Liu, Weiwei; Yang, Xihong; Guo, Haipeng; Peng, Hanwei

    2017-04-07

    The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.

  4. Hemipelvectomy for Buttock Tumors Utilizing an Anterior Myocutaneous Flap of Quadriceps Femoris Muscle

    PubMed Central

    Sugarbaker, Paul H.; Chretien, Paul A.

    1983-01-01

    Hemipelvectomy utilizing an anterior myocutaneous flap is indicated for aggressive tumors of the buttock and proximal portion of the posterior thigh. A large operative defect created posteriorly by amputation of the lower extremity, hemipelvis, and buttock is covered by a myocutaneous flap of quadriceps femoris muscle and overlying skin and subcutaneous tissue. The superficial femoral artery is preserved to sustain the myocutaneous flap. ImagesFig. 2A,B,C.Fig. 2A,B,C. PMID:6848048

  5. A study of the blown flap/jet flap analogy

    NASA Technical Reports Server (NTRS)

    Hough, G. R.

    1979-01-01

    A study of the blown flap/jet flap analogy has been undertaken. Analytical predictions were made using both improved lifting line and optimized vortex lattice models for the jet flap. Results were compared with experimental data for three propulsive lift systems; the jet augmented flap, the externally blown flap, and the upper surface blown flap. Force increments due to changes in geometry and jet parameters were well approximated in most cases, although the absolute values of the aerodynamic forces were usually underestimated. The relatively simple jet-flap models gave performance predictions of accuracy comparable to more complex analyses.

  6. An anatomic and clinical study of the adductor magnus tendon-descending genicular artery bone flap.

    PubMed

    Huang, Dong; Wang, Hai-Wen; Xu, Da-Chuan; Wang, Hong-Gang; Wu, Wei-Zhi; Zhang, Hui-Ru

    2011-01-01

    The composite tissue flap of the descending genicular vessels with the adductor magnus tendon is a newly developed, reliable method to repair the Achilles tendon and relevant skin defects. The aim of this study was to evaluate the anatomy of the adductor magnus tendon-descending genicular artery bone flap, and the feasibility and value for the repair of the Achilles tendon and relevant skin defects. There were 34 adult specimens used for the anatomy of this flap. The descending genicular artery originates 10.5 ± 1.6 cm above the adductor tubercle, with a diameter of 1.8 ± 0.6 mm and a length of 1.2 ± 0.5 cm. Its articular branch is distributed in the adductor magnus tendon and the medial condyle of the femur. The saphenous branch has a diameter of 1.1 ± 0.3 mm and is distributed in the skin of the upper medial calf. A total of 16 cases of trauma-induced Achilles tendon damage and calcaneus and skin defects were repaired with the vascularized adductor magnus tendon bone flap, including the reconstruction of Achilles tendon insertion and repair of relevant skin defects. All of the composite tissue flaps were viable, the skin sensation of the flaps was recovered, and all patients walked with a normal gait. Our results suggested that the adductor magnus tendon-descending genicular artery bone flap is an alternative method to repair composite tissue defects of the Achilles tendon.

  7. Arsenic transformation predisposes human skin keratinocytes to UV-induced DNA damage yet enhances their survival apparently by diminishing oxidant response

    SciTech Connect

    Sun Yang; Kojima, Chikara; Chignell, Colin; Mason, Ronald; Waalkes, Michael P.

    2011-09-15

    Inorganic arsenic and UV, both human skin carcinogens, may act together as skin co-carcinogens. We find human skin keratinocytes (HaCaT cells) are malignantly transformed by low-level arsenite (100 nM, 30 weeks; termed As-TM cells) and with transformation concurrently undergo full adaptation to arsenic toxicity involving reduced apoptosis and oxidative stress response to high arsenite concentrations. Oxidative DNA damage (ODD) is a possible mechanism in arsenic carcinogenesis and a hallmark of UV-induced skin cancer. In the current work, inorganic arsenite exposure (100 nM) did not induce ODD during the 30 weeks required for malignant transformation. Although acute UV-treatment (UVA, 25 J/cm{sup 2}) increased ODD in passage-matched control cells, once transformed by arsenic to As-TM cells, acute UV actually further increased ODD (> 50%). Despite enhanced ODD, As-TM cells were resistant to UV-induced apoptosis. The response of apoptotic factors and oxidative stress genes was strongly mitigated in As-TM cells after UV exposure including increased Bcl2/Bax ratio and reduced Caspase-3, Nrf2, and Keap1 expression. Several Nrf2-related genes (HO-1, GCLs, SOD) showed diminished responses in As-TM cells after UV exposure consistent with reduced oxidant stress response. UV-exposed As-TM cells showed increased expression of cyclin D1 (proliferation gene) and decreased p16 (tumor suppressor). UV exposure enhanced the malignant phenotype of As-TM cells. Thus, the co-carcinogenicity between UV and arsenic in skin cancer might involve adaptation to chronic arsenic exposure generally mitigating the oxidative stress response, allowing apoptotic by-pass after UV and enhanced cell survival even in the face of increased UV-induced oxidative stress and increased ODD. - Highlights: > Arsenic transformation adapted to UV-induced apoptosis. > Arsenic transformation diminished oxidant response. > Arsenic transformation enhanced UV-induced DNA damage.

  8. PRFM enhance wound healing process in skin graft.

    PubMed

    Reksodiputro, Mirta; Widodo, Dini; Bashiruddin, Jenny; Siregar, Nurjati; Malik, Safarina

    2014-12-01

    Facial plastic and reconstructive surgery often used skin graft on defects that cannot be covered primarily by a local flap. However, wound healing using skin graft is slow, most of the time the graft is contractured and the take of graft is not optimal. Platelet rich fibrin matrix (PRFM) is a new generation of concentrated platelets that produce natural fibrin and reported to speed up the healing process. Application of PRFM in the skin graft implants is expected to increase the survival of the graft. We used porcine as animal models to elucidate the effect of autologous PRFM on wound healing in full-thickness (FTSG) and split-thickness (STSG) skin grafts. Survival level of the skin graft was determined by using ImageJ software based on the formation of collagen type 1 and graft take. We observed that the use of PRFM in FTSG and STSG increased type 1 collagen formation. We also found that PRFM addition in STSG gave the best skin graft take.

  9. Divided and Sliding Superficial Temporal Artery Flap for Primary Donor-site Closure

    PubMed Central

    Sugio, Yuta; Seike, Shien; Hosokawa, Ko

    2016-01-01

    Summary: Superficial temporal artery (STA) flaps are often used for reconstruction of hair-bearing areas. However, primary closure of the donor site is not easy when the size of the necessary skin island is relatively large. In such cases, skin grafts are needed at the donor site, resulting in baldness. We have solved this issue by applying the divided and sliding flap technique, which was first reported for primary donor-site closure of a latissimus dorsi musculocutaneous flap. We applied this technique to the hair-bearing STA flap, where primary donor-site closure is extremely beneficial for preventing baldness consequent to skin grafting. The STA flap was divided into 3, and creation of large flap was possible. Therefore, we concluded that the divided and sliding STA flap could at least partially solve the donor-site problem. Although further investigation is necessary to validate the maximum possible flap size, this technique may be applicable to at least small defects that are common after skin cancer ablation or trauma. PMID:27975020

  10. Effects of Tissue Component Volumes on Vascular Resistance in Free Flaps.

    PubMed

    Ono, Masashi; Takanari, Keisuke; Toriyama, Kazuhiro; Yagi, Shunjiro; Ebisawa, Katsumi; Sawamura, Hisashi; Kambe, Miki; Murotani, Kenta; Kamei, Yuzuru

    2017-01-01

    Background A successful free flap transfer is achieved, in part, by having a thorough understanding of vascular anatomy and blood flow dynamics. We previously reported that vascular resistance differs by type of free flap. To test the hypothesis that the difference reflects the proportion of tissue components within free flaps, we calculated blood flow and vascular resistance for free flaps in which we determined the volume of each tissue component. Methods Measurements and calculations were made for 40 free flap transfers performed at our hospital: 7 radial forearm flaps, 14 anterolateral thigh flaps, and 19 rectus abdominis myocutaneous flaps. Results The vascular resistance of free flaps was inversely related to the volume of each tissue component. Univariate regression analysis revealed that muscle volume correlated most closely with resistance (r = 0.881), followed by skin (r = 0.622), and fat (r = 0.577). Multiple regression analysis confirmed the relationship between combined muscle and fat volume and resistance (R(2) = 0.865). Conclusions A strong inverse correlation exists between vascular resistance and combined muscle and fat tissue volume in flaps. It may be helpful to consider these relationships when making decisions regarding choice of free flap and recipient vessels.

  11. Hemato - Immunological and biochemical parameters, skin antibacterial activity, and survival in rainbow trout (Oncorhynchus mykiss) following the diet supplemented with Mentha piperita against Yersinia ruckeri.

    PubMed

    Adel, Milad; Pourgholam, Reza; Zorriehzahra, Jalil; Ghiasi, Maryam

    2016-08-01

    This study was aimed to assess the potential effects of Mentha piperita on the hemato - immunological and biochemical parameters, skin antibacterial activity and protection against Yersinia ruckeri infection in rainbow trout Oncorhynchus mykiss. Fish were divided into 4 groups before being fed diets supplemented with 0, 1, 2 and 3% of Mentha piperita (MP) plant extract for 8 weeks. Dose-dependent increases immune (both in skin mucus and blood serum) and hematological parameters (number of red and white cells, hematocrit and hemoglobin contents), as well as in respiratory burst activity, total protein, albumin, and neutrophil levels in fish fed supplemented diets compared to the control fish. Furthermore, dietary MP plant extract supplements have no significant effect on blood biochemical parameters and enzymatic activities of liver determined in serum of rainbow trout. After 8 weeks the cessation of feeding with MP plant extract, survival rates of 54.4%, 63.6% and 75.2% were recorded in groups which received 1, 2 and 3% of MP plant extract of feed, respectively, compared to 34.6% survivals in the control. This study underlying several positive effects of dietary administration of MP plant extract to farmed fish.

  12. Increasing options in autologous microsurgical breast reconstruction: four free flaps for ‘stacked’ bilateral breast reconstruction

    PubMed Central

    Patel, Nakul Gamanlal; Ramakrishnan, Venkat V.

    2016-01-01

    For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of ‘stacked’ bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791

  13. Free flaps in orbital exenteration: a safe and effective method for reconstruction.

    PubMed

    López, Fernando; Suárez, Carlos; Carnero, Susana; Martín, Clara; Camporro, Daniel; Llorente, José L

    2013-05-01

    The aim of this study was to investigate the course of reconstructive treatment and outcomes with use of free flaps after orbital exenteration for malignancy. Charts of patients who had free flap reconstruction after orbital exenteration were retrospectively reviewed and the surgical technique was evaluated. Demographics, histology, surgical management, complications, locoregional control, and survival were analyzed. We performed 22 flaps in 21 patients. Reconstruction was undertaken mainly with anterolateral thigh (56 %), radial forearm (22 %), or parascapular (22 %) free flaps. Complications occurred in 33 % of patients and the flap's success rate was 91 %. The 5-year locoregional control and survival rates were 42 and 37 %, respectively. Free tissue transfer is a reliable, safe, and effective method for repair of defects of the orbit and periorbital structures resulting from oncologic resection. The anterolateral thigh flap is a versatile option to reconstruct the many orbital defects encountered.

  14. Myocutaneous flap (V-Y design) from the nasal bridge for medial canthal reconstruction.

    PubMed

    Moretti, E A; Gomez Garcia, F

    1998-07-01

    Repair of soft tissue loss of the medial canthal area is usually accomplished by using skin grafts or frontal flaps based on the glabellar vessels. However, skin grafts can provoke scar tissue contracture, or skin color chromatic changes (hypopigmentation or hyperpigmentation). On the other hand, frontal flaps are sometimes thicker than normal skin and lead to unsatisfactory aesthetic results. To avoid these disadvantages, the authors designed an alternative method for reconstruction of defects of the medical canthal area. The authors suggest using a myocutaneous flap (V-Y design) from the nasal bridge to repair soft tissue defects no larger than 2 cm in diameter (surface < 4 cm2) in the medial canthal area. The pedicle of this flap is based on supratrochlear and dorsal nasal vessels. This technique has proved safe and reliable and has led to good functional and cosmetic results.

  15. "Mini paddle" for monitoring the fibular free flap in mandibular reconstruction.

    PubMed

    Al Qattan, M M; Boyd, J B

    1994-01-01

    The use of a "mini" skin paddle to monitor the fibular free flap for mandibular reconstruction is described. The paddle is easy to inset, can be excised later under local anesthesia, and yet is adequate for postoperative monitoring.

  16. Survival at refrigeration and freezing temperatures of Campylobacter coli and Campylobacter jejuni on chicken skin applied as axenic and mixed inoculums.

    PubMed

    El-Shibiny, Ayman; Connerton, Phillippa; Connerton, Ian

    2009-05-31

    Campylobacter is considered to be the most common cause of bacterial diarrhoeal illness in the developed world. Many cases are thought to be acquired from consumption of undercooked poultry. The aim of this study was to compare the effect of the rate of cooling on the survival, at 4 degrees C and -20 degrees C, of Campylobacter coli and Campylobacter jejuni strains, inoculated on chicken skin from axenic culture or as mixed inoculums. Strains chilled in a domestic refrigerator varied in their tolerance to storage at 4 degrees C. Statistically significant differences between strains applied as axenic or mixed inoculums were observed for specific strain combinations using two-way ANOVA, including the enhanced survival of antibiotic resistant C. coli 99/367 at 4 degrees C. The use of rapid cooling (at -20 degrees C/min) enhanced the survival of all the Campylobacter strains chilled to 4 degrees C compared to standard refrigeration. Freezing to -20 degrees C reduced viable counts by 2.2-2.6 log10 CFU/cm(2) in 24 h. Rapid cooling to -20 degrees C (at -30 degrees C/min) enhanced the survival of C. coli 99/367 compared to freezing in a domestic freezer. Statistically significant interaction terms between specific strains were observed in mixed inoculums chilled to -20 degrees C by freezing in a domestic freezer and by rapid chilling to -20 degrees C. Rapid chilling of poultry, particularly for 4 degrees C storage may enhance survival of Campylobacter and although this is an issue that affects meat quality, it should be considered by poultry processors.

  17. [Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap].

    PubMed

    Moullot, P; Philandrianos, C; Gonnelli, D; Casanova, D

    2014-10-01

    Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.

  18. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    PubMed Central

    Liu, Yuan Fang; Vuong, Christopher; Walker, Paul Charles; Peterson, Nathaniel Ray; Inman, Jared Christian; Filho, Pedro Alcantara Andrade; Lee, Steve Choon-Sung

    2016-01-01

    Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free. PMID:27092284

  19. Flapping of Insectile Wings

    NASA Astrophysics Data System (ADS)

    Huang, Yangyang; Kanso, Eva

    2015-11-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. Yet the effects of muscle stiffness on the performance of insect wings remain unclear. Here, we construct an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring and submerged in an oscillatory flow. The wing system is free to rotate and flap. We first explore the extent to which the flyer can withstand roll perturbations, then study its flapping behavior and performance as a function of spring stiffness. We find an optimal range of spring stiffness that results in large flapping amplitudes, high force generation and good storage of elastic energy. We conclude by conjecturing that insects may select and adjust the muscle spring stiffness to achieve desired movement. These findings may have significant implications on the design principles of wings in micro air-vehicles.

  20. Control of Flap Vortices

    NASA Technical Reports Server (NTRS)

    Greenblatt, David

    2005-01-01

    A wind tunnel investigation was carried out on a semi-span wing model to assess the feasibility of controlling vortices emanating from outboard flaps and tip-flaps by actively varying the degree of boundary layer separation. Separation was varied by means of perturbations produced from segmented zero-efflux oscillatory blowing slots, while estimates of span loadings and vortex sheet strengths were obtained by integrating wing surface pressures. These estimates were used as input to inviscid rollup relations as a means of predicting changes to the vortex characteristics resulting from the perturbations. Surveys of flow in the wake of the outboard and tip-flaps were made using a seven-hole probe, from which the vortex characteristics were directly deduced. Varying the degree of separation had a marked effect on vortex location, strength, tangential velocity, axial velocity and size for both outboard and tip-flaps. Qualitative changes in vortex characteristics were well predicted by the inviscid rollup relations, while the failure to account for viscosity was presumed to be the main reason for observed discrepancies. Introducing perturbations near the outboard flap-edges or on the tip-flap exerted significant control over vortices while producing negligible lift excursions.

  1. The role of fabricated chimeric free flaps in reconstruction of devastating hand and forearm injuries.

    PubMed

    Giessler, Goetz A; Schmidt, Andreas B; Germann, Guenter; Pelzer, Michael

    2011-11-01

    Devastating hand and forearm injuries almost exclusively need free flap transfer if reconstruction is attempted. Early active and passive motion is only possible with aggressive, early, and comprehensive reconstruction. Despite recent advances in compound flaps, in selected cases it might be wise to harvest several smaller flaps and microsurgically combine them to one "chain-linked" flap "system." Four microsurgically fabricated chimeric free flaps were used in four patients for complex hand and forearm injuries. The combinations were sensate anterolateral thigh (ALT) flap plus sensate extended lateral arm flap (2x), ALT plus free fibula, and ALT plus functional musculocutaneous gracilis muscle. All flaps survived completely. Functional rehabilitation was possible immediately after flap transfer. There were no donor-site complications except two widened scars. The microsurgical fabrication of chimeric free flaps, as well established in head and neck reconstruction, can be successfully adapted to massive hand injuries as well. Individual placement of selected tissue components, early comprehensive reconstruction, and reduction of the number of operations are beneficial in cases that need more than one free flap.

  2. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients.

    PubMed

    Song, Jin Woo; Ben-Nakhi, Muneera; Hong, Joon Pio

    2012-11-01

    Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.

  3. Supraclavicular Artery Flap for Head and Neck Oncologic Reconstruction: An Emerging Alternative

    PubMed Central

    Shenoy, Ashok; Patil, Vijayraj S.; Prithvi, B. S.; Chavan, P.; Halkud, Rajshekar

    2013-01-01

    Aim. Head and Neck oncologic resections often leave complex defects which are challenging to reconstruct. The need of the hour is a versatile flap which has the advantages of both a regional flap (viz. reliable and easy to harvest) and a free flap (thin, pliable with good colour match). In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Materials and Method. The flap was used as a pedicled fasciocutanous and was based on the transverse supraclavicular artery. We assessed this reconstructive option for complications as well as its and functional out comes. Results. Eleven cases underwent supraclavicular artery flap between 20011-2012 of which 5 were males and 6 females. Mean defect size was 5 cm × 6 cm. Nine donor sites were closed primarily and 1 required split skin grafting. We encountered one complete flap loss which was attributed to a band of constricting skin bridge over the vascular pedicle in a defect involving lateral third of midface. Two patient developed pharyngeocutaneous fistula (without flap loss) out of 3 patients who underwent augmentation pharyngoplasty post Near total laryngectomy. Conclusion. Supra clavicular artery flap is a thin versatile, reliable, easy to harvest, with good cosmetic and functional outcome at both ends (recipient and donor) for reconstructing head and neck oncologic defects. PMID:24490064

  4. Use of the versatile sternocleidomastoid flap in oral and maxillofacial surgery: our experience.

    PubMed

    Wei, Dong; Liu, Jian-hua; Zhao, Wen-quan; Zhu, Hui-yong; Li, Zhi-yong; Wang, Hui-ming

    2013-12-01

    Our aim was to evaluate the reliability of sternocleidomastoid (SCM) flaps in the reconstruction of defects after oral and maxillofacial resections, and summarise the ways in which morbidity can be reduced. We retrospectively enrolled 65 patients who had malignant tumours resected, and assessed the postoperative viability of the SCM flap. All complications were recorded during a follow up period of 1-64 months. We also investigated the relation between recurrence in regional lymph nodes and their preoperative histological state. The conventional SCM flap, the split SCM flap with only the sternal head, and the SCM flap with a half-thickness clavicular graft, were used to repair different defects. No flaps necrosed completely, and in only 5 cases was there partial loss of the skin paddle. The skin paddle avulsed in 2 cases 2 patients developed wound infections. Only 9 patients developed complications (14%, 9/65). Use of the split SCM flap overcomes the problem of bulk. The combination of the SCM flap and clavicular bone enables early dental implantation. The SCM flap is convenient, reliable, and technically easy for the reconstruction of intraoral or mandibular tissue loss. Preservation of the branch of the superior thyroid artery and precise surgical technique contribute to a higher success rate.

  5. Bare serratus anterior free flap in the reconstruction of the partial pharyngoesophageal defect.

    PubMed

    Ugurlu, Kemal; Karsidag, Tamer; Akcal, Arzu; Karsidag, Semra; Yazar, Memet; Seven, Hüseyin

    2011-05-01

    Reconstruction of defects of the cervical esophagus is a challenge in head and neck surgery. Several methods have been used: flaps with local tissues, pharyngogastric anastomosis, deltopectoral skin flaps, skin muscle transplant from the pectoralis major, and microvascularized free skin fascial and small intestine flaps. A 81-year-old patient who has a partial pharyngoesophageal defect after resection of laryngeal carcinoma underwent reconstruction with bare serratus anterior fascial free flap. The subscapular artery and vein were anastomosed to the superior thyroid artery and vein. The patient's postoperative recovery went uneventfully. In the endoscopic examination, the defect was completely covered with native mucosa 8 weeks after surgery, and also, there were no stricture and fistula tract in the reconstructed area.Serratus fascial flap is a thin and pliable flap with good and reliable vascularity; it can be used in the reconstruction of partial cervical esophageal defect with its long pedicle. Serratus fascial flap can provide significant epithelialization that cannot be differentiated from native esophagus. We propose that serratus fascial free flap is an important alternative in esophageal reconstructions because it creates minimal donor-site morbidity and it can easily adapt to the defect.

  6. Ciprofloxacin Enhances Stress Erythropoiesis in Spleen and Increases Survival after Whole-Body Irradiation Combined with Skin-Wound Trauma

    DTIC Science & Technology

    2014-02-28

    and clearly distinguished red pulp from white pulp (Figure 4A and B bottom panels). It has been reported that red pulp macrophages (RPMs) digest ...the recommendations and guidelines of the American Veterinary Medical Association. For the survival study, we observed animals every 2 hours during work...resonance system . Calibration of the dose rate with alanine was directly traceable to the National Institute of Standards and Technology and the National

  7. Free radial forearm flap versatility for the head and neck and lower extremity

    SciTech Connect

    Chicarilli, Z.N.; Ariyan, S.; Cuono, C.B.

    1986-07-01

    Microsurgical techniques have developed numerous territories suitable for free tissue transfer. However, the demand for thin cutaneous resurfacing limits the choice of flaps available to the reconstructive microsurgeon. The radial forearm flap is a thin, axial, fasciocutaneous flap, offering pliable cutaneous resurfacing, with or without sensation. We have used 15 flaps to reconstruct defects in the head and neck and lower extremity resulting from burns, blunt and avulsive trauma, radiation necrosis, and tumor ablation. Two flaps (15 percent) developed venous congestion and were salvaged by reoperation. One retrograde flap (7.5 percent) developed partial necrosis from arterial insufficiency. Neural re-innervation was successful in two out of three patients in whom it was attempted. Two patients (15%) sustained minor donor site skin graft loss that healed secondarily. In our series of predominantly older patients the donor sites have been relatively inconspicuous at one year follow-up. A functional restoration was achieved in all patients.

  8. Bilateral Pedicled Superficial Inferior Epigastric Artery Flap in the Treatment of Hidradenitis Suppurativa

    PubMed Central

    Hoang, Don; Saber, Sepideh; Patel, Ketan; Carey, Joseph

    2016-01-01

    Summary: The authors present a new technique in surgically treating hidradenitis suppurativa (HS), a debilitating skin condition. In HS, surgical treatment is often the best option because of the high recurrence rates despite extensive medical treatment. A commonly successful surgical method is using skin flaps after excision of the affected area. A superficial inferior epigastric artery flap is demonstrated here as a new alternative approach to treating a case of extensive HS of the groin. By using the pedicled superficial inferior epigastric artery flap for groin reconstruction, inguinal HS can be widely excised and reconstructed with minimal donor-site morbidity and a good aesthetic outcome. PMID:27622101

  9. Free jejunal flaps can be monitored by use of microdialysis.

    PubMed

    Sorensen, Hanne Birke

    2008-08-01

    When new combinations of preoperative treatments of carcinoma of the esophagus are implemented, surgical morbidity and mortality become even more important risk factors. This study investigated whether the risk of postoperative complications caused by ischemia in the reconstructed esophagus can be reduced using microdialysis as monitoring method. This is a retrospective study of 14 patients undergoing resection of carcinoma in the upper part of the esophagus and reconstruction with a free jejunal flap. The metabolism in all 14 jejunal transfers was monitored by use of microdialysis. The data were analyzed looking for reliable parameters detecting critical ischemia. Critical ischemia was suspected in two cases. Both of these cases were surgically revised, ischemia in the jejunal flap was verified, and the jejunal flaps were revascularized. All 14 jejunal flaps survived. Using the concentration of glucose in the microdialysate, it was possible to detect the two cases of critical ischemia. Yet, the most reliable parameter seemed to be the retrospectively calculated lactate:glucose ratio; in both the ischemic flaps, the lactate:glucose ratio exceeded more than 1000% the maximum values found in all the nonischemic flaps. Microdialysis is a promising monitoring method for surveillance of free jejunal flaps.

  10. Blowing Flap Experiment: PIV Measurements

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.; Bremmer, David M.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the flap vortex system. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  11. A standardized model for predicting flap failure using indocyanine green dye

    NASA Astrophysics Data System (ADS)

    Zimmermann, Terence M.; Moore, Lindsay S.; Warram, Jason M.; Greene, Benjamin J.; Nakhmani, Arie; Korb, Melissa L.; Rosenthal, Eben L.

    2016-03-01

    Techniques that provide a non-invasive method for evaluation of intraoperative skin flap perfusion are currently available but underutilized. We hypothesize that intraoperative vascular imaging can be used to reliably assess skin flap perfusion and elucidate areas of future necrosis by means of a standardized critical perfusion threshold. Five animal groups (negative controls, n=4; positive controls, n=5; chemotherapy group, n=5; radiation group, n=5; chemoradiation group, n=5) underwent pre-flap treatments two weeks prior to undergoing random pattern dorsal fasciocutaneous flaps with a length to width ratio of 2:1 (3 x 1.5 cm). Flap perfusion was assessed via laser-assisted indocyanine green dye angiography and compared to standard clinical assessment for predictive accuracy of flap necrosis. For estimating flap-failure, clinical prediction achieved a sensitivity of 79.3% and a specificity of 90.5%. When average flap perfusion was more than three standard deviations below the average flap perfusion for the negative control group at the time of the flap procedure (144.3+/-17.05 absolute perfusion units), laser-assisted indocyanine green dye angiography achieved a sensitivity of 81.1% and a specificity of 97.3%. When absolute perfusion units were seven standard deviations below the average flap perfusion for the negative control group, specificity of necrosis prediction was 100%. Quantitative absolute perfusion units can improve specificity for intraoperative prediction of viable tissue. Using this strategy, a positive predictive threshold of flap failure can be standardized for clinical use.

  12. The Trapezius Muscle Flap: A Viable Alternative for Posterior Scalp and Neck Reconstruction

    PubMed Central

    Yang, Hee Jun; Kim, Yang Woo; Lee, Sang Gu

    2016-01-01

    Background The trapezius muscle flap is not usually the first reconstructive option for skin and soft tissue defects in the posterior neck and scalp due to surgeons' unfamiliarity with the surgical anatomy and developments in free tissue transfer techniques. The goals of this study were to describe the clinical use of trapezius flaps in posterior neck and scalp reconstruction, and to investigate the vascular anatomy of trapezius flaps in Asians in order to obtain information facilitating the safe design and elevation of flaps in which most of the muscle is preserved. Methods A retrospective chart review was performed of 10 patients who underwent trapezius muscle flap for posterior neck and scalp defects. We also performed an anatomical study of 16 flaps harvested from 8 preserved Asian adult cadavers and evaluated the main landmarks relevant for trapezius muscle flap. Results In the anatomical study, the mean vertical height from the inferior angle of the scapula to the point at which the superficial cervical artery penetrated the trapezius was 4.31±2.14 cm. The mean vertical height of the trapezius muscle flap pivot point was 9.53±2.08 cm from the external occipital protuberance. Among the 10 flaps, partial necrosis on the overlaid skin graft occurred in 1 patient and postoperative seroma occurred in another patient. Conclusions Vascular variations in the trapezius muscle flap are uncommon in Asians, but when present, such variations appear to have little impact on harvesting the flap or on its circulation. The trapezius muscle flap is a viable alternative for posterior neck and scalp reconstruction. PMID:27896183

  13. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps.

    PubMed

    Guerra, Aldo Benjamin; Gill, Paul Singh; Trahan, Chris G; Ruiz, Bernardo; Lund, Kerstin M; Delaune, Christie L; Thibodeaux, Brett A; Metzinger, Stephen Eric

    2005-02-01

    Muscle and musculocutaneous flaps have been used reliably in reconstruction of soft-tissue defects for many years. Previous experimental studies have shown musculocutaneous flaps to be superior to the random pattern and fasciocutaneous flaps in the management of infected wounds. Over the past decade, perforator flaps have gained acceptance as alternative methods of reconstruction in the clinical setting that can decrease donor-site morbidity and hospital stay, and increase patient satisfaction. The authors theorized that perforator flaps may be able to handle infected wounds better than random pattern and fasciocutaneous flaps because their blood supply is essentially the same as many of their musculocutaneous counterparts. The goal of this study was to compare the S1 perforator-based skin flap and latissimus dorsi musculocutaneous flap in the dorsal flank of the rabbit with the introduction of bacteria to simulate both superficial and deep wound infection. Measurements of oxygen tension and regional perfusion index were performed on both types of flaps to ascertain their viability and capacity to heal. The authors found no statistical significance between latissimus dorsi musculocutaneous and S1 perforator flaps in the rabbit with respect to superficial and deep wound infections. The regional perfusion index was calculated for postoperative days 1, 2, and 4. No statistically significant difference between the two flaps using the regional perfusion index could be identified. Additionally, regional perfusion for both types of flaps was greater than 0.6, indicating that their capacity to heal wounds is similar.

  14. The saphenous neurovascular free flap.

    PubMed

    Acland, R D; Schusterman, M; Godina, M; Eder, E; Taylor, G I; Carlisle, I

    1981-06-01

    A new neurovascular free-flap donor area on the medial side of the knee is described. The flap is supplied by the saphenous artery, a branch of the descending genicular artery. It is drained both by the long saphenous vein and by the saphenous venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve above the knee and the saphenous nerve below the knee. The flap is thin, has a long vascular pedicle (up to 15 cm) and a dependable nerve supply, and can be made quite large. The principal disadvantage is the donor wound, which requires grafting in most cases. We describe the anatomy of the saphenous flap, the method of raising it, and our early clinical experience with it both as a free flap and as a pedicled flap. Potential uses of the saphenous flap and its broader significance in relation to flaps on the lower extremity are briefly discussed.

  15. Externally blown flap impingement noise

    NASA Technical Reports Server (NTRS)

    Lasagna, P. L.; Putnam, T. W.

    1972-01-01

    Tests of the noise produced by the impingement of the jet exhaust on the wing and flap for an externally blown flap system were conducted with a CF700 turbofan engine and an F-111B wing panel. The noise produced with a daisy nozzle installed on the engine was greater than that produced by a conical nozzle at the same thrust. The presence of the wing next to the test nozzles increased the noise, as did increasing the flap deflection angle. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested. Tests showed that the single-slotted flap deflected 60 deg, produced less noise than the double-slotted flaps. Also, maintaining the maximum distance between the exit nozzle and flap system resulted in a minor reduction in noise.

  16. Ciprofloxacin enhances stress erythropoiesis in spleen and increases survival after whole-body irradiation combined with skin-wound trauma.

    PubMed

    Fukumoto, Risaku; Burns, True M; Kiang, Juliann G

    2014-01-01

    Severe hematopoietic loss is one of the major therapeutic targets after radiation-combined injury (CI), a kind of injury resulting from radiation exposure combined with other traumas. In this study, we tested the use of ciprofloxacin (CIP) as a treatment, because of recently reported immunomodulatory effects against CI that may improve hematopoiesis. The CIP regimen was a daily, oral dose for 3 weeks, with the first dose 2 h after CI. CIP treatment improved 30-day survival in mice at 80% compared to 35% for untreated controls. Study of early changes in hematological parameters identified CI-induced progressive anemia by 10 days that CIP significantly ameliorated. CI induced erythropoietin (EPO) mRNA in kidney and protein in kidney and serum; CIP stimulated EPO mRNA expression. In spleens of CI mice, CIP induced bone morphogenetic protein 4 (BMP4) in macrophages with EPO receptors. Splenocytes from CIP-treated CI mice formed CD71⁺ colony-forming unit-erythroid significantly better than those from controls. Thus, CIP-mediated BMP4-dependent stress erythropoiesis may play a role in improving survival after CI.

  17. The inner prepuce flap for penile scald burns.

    PubMed

    Fuller, Sam M; Roughton, Michelle C; Gottlieb, Lawrence J

    2014-01-01

    Preputial skin has similar color, texture, and composition to the skin of the penile shaft. The inner preputial skin may be transferred as a flap based upon Dartos fascia to resurface full-thickness burns of the penile shaft, providing a gliding and stretchable surface cover unique to the penis. The advantages of using the inner prepuce skin to resurface full-thickness burns of the penile shaft will be elucidated and the technique will be described. A retrospective chart review was performed of three patients whose penile shaft was resurfaced with inner prepuce flaps after tangential excision of their full-thickness scald burns. Patient 1 was a 9-year-old boy who sustained an 8% TBSA scald burn resulting in a full-thickness burn to the dorsum of his penis. Patient 2 was a 3-year-old boy who sustained a 60% TBSA immersion scald burn as a victim of child abuse, resulting in a circumferential penile burn. Patient 3 was an 8- year-old boy who sustained a 3% TBSA grease burn to the dorsum of his penis. The inner surface of the prepuce of the patients was intact. They were treated with an inner preputial flap. Full-thickness scald burns to the penis are unusual and challenging for the patient, family, and burn surgeon. It is advantageous that inner preputial skin is commonly spared. This specialized thin skin is ideal for resurfacing the penile shaft and should be used when available.

  18. Naso-orbital fistula and socket reconstruction with radial artery forearm flap following orbital mucormycosis

    PubMed Central

    Bhatnagar, Ankur; Agarwal, Amit

    2016-01-01

    Invasive mucormycosis is an uncommon cause of orbital exenteration. Reconstruction of an exenterated orbit is a surgical challenge. The loss of eyelids, adnexal structures, and even surrounding skin causes significant facial disfigurement. The goal for reconstruction demands a symmetrical orbital cavity with good prosthetic rehabilitation. Multiple reconstructive options in the form of skin grafts, local flaps, and free flaps are available. However, none of them provide ideal reconstruction. Our patient not only had extensive soft-tissue loss and unstable lining but also a large naso-orbital fistula. Reconstruction for this complex defect was done using an adipofascial radial artery flap which not only closed the fistula but also provided soft-tissue bulk and good skin match. Radial artery forearm flap provides a simple, stable, and good reconstructive option postorbital exenteration. PMID:28356694

  19. Bilobed flap in sole surgery

    SciTech Connect

    Sanchez-Conejo-Mir, J.; Bueno Montes, J.; Moreno Gimenez, J.C.; Camacho-Martinez, F.

    1985-09-01

    The bilobed flap is a simple reconstructive technique principally used to correct substantial defects in the facial region. The authors present their experience with this local flap in the difficult plantar area, with excellent short-term functional results. They describe the special characteristics of the bilobed flap in this zone, and comment on its indications and possible complications.

  20. Systematic Review and Operative Technique of Recalcitrant Pressure Ulcers Using a Fillet Flap Technique

    PubMed Central

    Rao, Venkat K.

    2016-01-01

    Background: The purpose of this article is to describe the indications, operative technique, outcomes, and systematic review of the literature on the reconstruction of patients with end-stage pressure ulcers using a fillet flap technique. In this technique, the femur, tibia, and fibula are removed from the thigh and leg, and the soft tissue is used as a pedicled, or free, myocutaneous flap for reconstruction. Long-term outcomes, salient surgical technique of flap elevation, and design are detailed for patients who had a fillet of leg flap for reconstruction of extensive pressure ulcers. Methods: The indications, surgical technique, and postoperative outcomes of 5 patients who had pedicled fillet flaps are reviewed including patient age, sex, underlying comorbidities, duration of paraplegia, operative technique, and complications. A systematic review of the literature was performed searching PubMed, Cochrane Database, and Medline with the following MeSH terms: pressure ulcer, pressure sore, decubitus ulcer, fillet flap, and fillet flap. Inclusion criteria were use of a fillet technique, article data on the number of reconstructions before fillet flap, complications, and English language. Results: Most of our patients were male 75% (n = 3) with an average age of 47.5 years, had been paralyzed for an average of 16 years, and had few medical comorbidities. Two patients (3 flaps) required hip disarticulation, 1 patient had a bilateral fillet flaps, and 3 patients had resection of tibia/fibula. After following patients for an average of 1.4 years (4 mo to 2 yr), complications were limited to 1 patient who had partial-thickness flap loss at the distal skin flap that healed by secondary intention and 1 patient who had ulcer recurrence because of noncompliance. Four articles met inclusion criteria for systematic review and 3 were excluded. Conclusions: The fillet of leg flap remains a useful and reliable method of reconstructing end-stage pressure ulcers. PMID:27622082

  1. Rotation flaps for coverage after total knee arthroplasty

    PubMed Central

    Pozzobon, Leonardo Rafael; Helito, Camilo Partezani; Guimarães, Tales Mollica; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis

    2013-01-01

    OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series. PMID:24453672

  2. Tissue oxygen tension measurement for monitoring musculocutaneous and cutaneous flaps.

    PubMed

    Hjortdal, V E; Awwad, A M; Gottrup, F; Kirkegaard, L; Gellett, S

    1990-01-01

    In pigs, latissimus dorsi musculocutaneous island flaps and buttock skin island flaps were raised. Subcutaneous (PscO2) and intramuscular oxygen tension (PimO2) were measured using a non-heated needle electrode before, during and after repeated occlusion of the supplying artery or the draining vein. During arterial and venous occlusion, the tissue oxygen tension in the musculocutaneous flap dropped rapidly. A plateau was reached after 15 min. After arterial occlusion the mean value was 20 mmHg (SEM = +/- 5 mmHg, N = 6) in the subcutis and 16 mmHg in the muscle (SEM = +/- 4 mmHg, N = 10). After venous occlusion the mean value was 11 mmHg (SEM = +/- 3 mmHg, N = 6) in the subcutis. In the skin flap the drop of PscO2 was slower, and after 30 min of arterial occlusion the mean value was 29 mmHg (SEM = +/- 9 mmHg, N = 6). This study has shown that tissue oxygen tension measurement can be used as a sensitive indicator of acute impairment of the supplying vessels in island flaps. The method seems to have potential for monitoring free tissue transfers. A comparable decrease in PscO2 was found for arterial and venous impairment.

  3. Improved Transplanted Stem Cell Survival in a Polymer Gel Supplemented With Tenascin C Accelerates Healing and Reduces Scarring of Murine Skin Wounds.

    PubMed

    Yates, Cecelia C; Nuschke, Austin; Rodrigues, Melanie; Whaley, Diana; Dechant, Jason J; Taylor, Donald P; Wells, Alan

    2017-01-24

    Mesenchymal stem cells (MSCs) remain of great interest in regenerative medicine because of their ability to home to sites of injury, differentiate into a variety of relevant lineages, and modulate inflammation and angiogenesis through paracrine activity. Many studies have found that despite the promise of MSC therapy, cell survival upon implant is highly limited and greatly reduces the therapeutic utility of MSCs. The matrikine tenascin C, a protein expressed often at the edges of a healing wound, contains unique EGF-like repeats that are able to bind EGFR at low affinities and induce downstream prosurvival signaling without inducing receptor internalization. In this study, we utilized tenascin C in a collagen/GAG-based polymer (TPolymer) that has been shown to be beneficial for skin wound healing, incorporating human MSCs into the polymer prior to application to mouse punch biopsy wound beds. We found that the TPolymer was able to promote MSC survival for 21 days in vivo, leading to associated improvements in wound healing such as dermal maturation and collagen content. This was most marked in a model of hypertrophic scarring, in which the scar formation was limited. This approach also reduced the inflammatory response in the wound bed, limiting CD3e+ cell invasion by approximately 50% in the early wound-healing process, while increasing the numbers of endothelial cells during the first week of wound healing as well. Ultimately, this matrikine-based approach to improving MSC survival may be of great use across a variety of cell therapies utilizing matrices as delivery vehicles for cells.

  4. A triceps musculocutaneous flap for chest-wall defects

    SciTech Connect

    Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. )

    1990-09-01

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

  5. Combined Use of an Anterolateral Thigh Flap and Superficial Inferior Epigastric Artery Flap for Reconstruction of an Extensive Abdominal Wall Defect

    PubMed Central

    Kagaya, Yu; Arikawa, Masaki; Kobayashi, Eisuke

    2016-01-01

    Summary: Reconstruction of large abdominal wall defects is challenging. We herein report the successful reconstruction of an extensive abdominal wall defect using a novel combination of flaps after sarcoma resection. A 74-year-old man presented with a dedifferentiated liposarcoma on his abdominal wall. He underwent excision of the tumor, which resulted in an extensive abdominal wall defect. The defect was reconstructed with a pedicled anterolateral thigh flap with an iliotibial tract and a pedicled superficial inferior epigastric artery flap. No skin graft was necessary. The wounds healed successfully, and no herniation occurred. The combination of an anterolateral thigh flap and a superficial inferior epigastric artery flap is a versatile option for reconstruction of extensive abdominal wall defects. PMID:27975026

  6. Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers

    PubMed Central

    Karimi, Ebrahim; Ardestani, Seyyed Hadi Samimi; Jafari, Mehrdad; Hagh, Ali Bagheri

    2016-01-01

    Objectives Free flaps are widely used to reconstruct head and neck defects. Despite the improvement in the surgical techniques and the surgeons’ experiences, flap failures still occur due to thrombotic occlusion after small vessels anastomosis. To reduce the possibility of flap loss as a result of thrombotic occlusion, various anticoagulants have been used. In this study we decided to evaluate a new protocol for anticoagulation therapy and its effect on flap survival and complications. Methods In this interventional study, 30 patients with head and neck cancer underwent surgical defects were reconstructed by microvascular free flap between 2013 and 2014. In the postoperative period patients have taken aspirin (100 mg/day) for 5 days and enoxaparin (40 mg/day subcutaneously) for 3 days. The flap survival was followed for three weeks. Results Given that there was no complete necrosis or loss of flap, the free flap success rate was as much as 100%. The need for re-exploration occurred in 3 patients (10%). Only in one patient the need for re-exploration was due to problem in venous blood flow. Conclusion The aspirin-enoxaparin short-term protocol may be a good choice after free flap transfer in reconstruction of head and neck surgical defects. PMID:27337950

  7. Case Report Reconstruction of Exposed Ilium With Reverse Turnover Latissimus Dorsi Muscle Flap

    PubMed Central

    Hayashida, Kenji; Endo, Yoshie; Kamebuchi, Katsuhiko

    2011-01-01

    Objective: It is difficult to cover a large skin and soft tissue defect with exposure of the ilium. We therefore performed a new reconstruction technique, using a reverse latissimus dorsi muscle flap fed by perforating branches of only the 10th intercostal artery. Methods: A 45-year-old man had a large traumatic defect located on the hip with exposure of the iliac crest. After confirming and preserving perforating branches of the 10th intercostal artery, the latissimus dorsi muscle flap was turned over just proximal to the perforating branch, and a split-thickness skin graft was performed over the flap. Results: The skin graft took place well and there were no circulation problems. Conclusions: This flap covered a larger area on the hip than the musculocutaneous flap. Furthermore, this is easier to perform and is less invasive than a vascularized free flap. Skin and soft tissue defects that expose bones of the lumbar or hip region can be reconstructed with a local flap; however, the deficit is small for this coverage and usually there is little skin and soft tissue to cover the wound defect in the surrounding area. Thus, it is often difficult to deal with large defects. We performed a reconstruction, using a reverse latissimus dorsi flap fed by perforating branches of the 10th intercostal artery for a large skin and soft tissue defect of the hip with exposure of the iliac crest, resulting in a good outcome. This technique is thought to be useful for reconstruction when the ilium is exposed, and we report the case and surgical procedure. PMID:21559059

  8. Reconstruction of through-and-through osteocutaneous defects of the mouth and face with subscapular system flaps.

    PubMed Central

    Kalavrezos, Nicholas; Hardee, Peter S. G. F.; Hutchison, Iain L.

    2005-01-01

    BACKGROUND: Major ablative surgery in the head and neck region may create composite defects involving the oral mucosa, bone and the overlying facial skin. The large surface area and the three-dimensional nature of these defects pose a difficult reconstructive challenge requiring adequate bone and large, positionally versatile skin flaps. PATIENTS AND METHODS: From September 1993 to May 2000, 19 patients with through-and-through osteocutaneous defects of the mouth and face were reconstructed with composite subscapular artery system flaps. The evaluated parameters included: (i) site and dimensions of the tissue defect; (ii) specific flap properties; and (iii) review of the recipient and donor site morbidity. RESULTS: 10 variants of scapular osteocutaneous flaps, eight latissimus dorsi with serratus anterior and rib osteo-myocutaneous flaps, and one combination of an osteocutaneous scapular and myocutaneous latissimus dorsi flap were used to reconstruct composite facial defects with mean dimensions of: skin 54.4 cm(2), mucosa 56.2 cm(2) and bone of 8.2 cm. Ischaemic complications occurred in three patients including one total flap failure and one failure of the bony component in previously irradiated patients. The third flap was successfully salvaged. No significant long-term donor site morbidity was noted. CONCLUSION: Composite flaps based on the subscapular artery system are a versatile reconstructive modality for large through-and-through defects of the mouth and face. PMID:15720908

  9. Multiple-digit resurfacing using a thin latissimus dorsi perforator flap.

    PubMed

    Kim, Sang Wha; Lee, Ho Jun; Kim, Jeong Tae; Kim, Youn Hwan

    2014-01-01

    Traumatic digit defects of high complexity and with inadequate local tissue represent challenging surgical problems. Recently, perforator flaps have been proposed for reconstructing large defects of the hand because of their thinness and pliability and minimal donor site morbidity. Here, we illustrate the use of thin latissimus dorsi perforator flaps for resurfacing multiple defects of distal digits. We describe the cases of seven patients with large defects, including digits, circumferential defects and multiple-digit defects, who underwent reconstruction with thin latissimus dorsi perforator flaps between January 2008 and March 2012. Single-digit resurfacing procedures were excluded. The mean age was 56.3 years and the mean flap size was 160.4 cm(2). All the flaps survived completely. Two patients had minor complications including partial flap loss and scar contracture. The mean follow-up period was 11.7 months. The ideal flap for digit resurfacing should be thin and amenable to moulding, have a long pedicle for microanastomosis and have minimal donor site morbidity. Thin flaps can be harvested by excluding the deep adipose layer, and their high pliability enables resurfacing without multiple debulking procedures. The latissimus dorsi perforator flap may be the best flap for reconstructing complex defects of the digits, such as large, multiple-digit or circumferential defects, which require complete wrapping of volar and dorsal surfaces.

  10. Blown flap noise prediction

    NASA Technical Reports Server (NTRS)

    Reddy, N. N.

    1978-01-01

    Theoretical and experimental developments of flow-surface interaction noise with a particular emphasis on blown-flap noise were reviewed. Several blown-flap noise prediction methods were evaluated by comparing predicted acoustic levels, directivity, and spectra with a recently obtained data base. A prediction method was selected and a detailed step-by-step description of this method was provided to develop a computer module to calculate one-third octave band frequency spectra at any given location in the far-field for under-the-wing and upper surface blown configurations as a function of geometric and operational parameters.

  11. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation

    PubMed Central

    Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction. PMID:28194351

  12. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation.

    PubMed

    Weitgasser, Laurenz; Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

  13. Externally blown flap impingement noise.

    NASA Technical Reports Server (NTRS)

    Putnam, T. W.; Lasagna, P. L.

    1972-01-01

    An investigation of externally blown flap impingement noise was conducted using a full-scale turbofan engine and aircraft wing. The noise produced with a daisy nozzle installed on the engine exhaust system was greater than that produced by a conical nozzle at the same thrust. The daisy nozzle caused the jet velocity to decay about 35 percent at the flap. The presence of the wing next to the conical nozzle increased the noise, as did increasing the flap deflection. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested.

  14. A case report of total breast reconstruction using an inframammary adipofascial flap with an implant

    PubMed Central

    Ogawa, Tomoko; Yamakawa, Tomomi

    2016-01-01

    Introduction Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap. Presentation of case The patient was a 27-year-old female with moderate ptotic breasts, who had ductal carcinoma in situ in the lower outer quadrant of her left breast. After NSM through the inframammary fold (IMF) incision, the subcutaneous fat of the intended inframammary area was undermined, and the tongue shaped adipofascial flap was pulled up in the intended area. After inserting a tissue expander under the major pectoral muscle, this adipofascial flap was reflected back to the inferior portion of the breast area. After modeling the breast mound with this flap, the inframammary skin incision was sutured. Eleven months later, the patient underwent surgery to replace the expander with a permanent implant. Eight months after the replacement with an implant, the cosmetic result is good. Discussion This procedure can be performed through the same skin incision on the IMF as NSM. Total breast reconstruction using the inframammary adipofascial flap with an implant can be an alternative approach to achieving symmetry in some patients. Conclusion This method is useful for breast reconstruction after NSM for young patients with moderate-ptotic breasts. PMID:27107500

  15. Skin Injuries Reduce Survival and Modulate Corticosterone, C-Reactive Protein, Complement Component 3, IgM, and Prostaglandin E2 after Whole-Body Reactor-Produced Mixed Field (n + γ-Photons) Irradiation

    PubMed Central

    Kiang, Juliann G.; Ledney, G. David

    2013-01-01

    Skin injuries such as wounds or burns following whole-body γ-irradiation (radiation combined injury (RCI)) increase mortality more than whole-body γ-irradiation alone. Wound-induced decreases in survival after irradiation are triggered by sustained activation of inducible nitric oxide synthase pathways, persistent alteration of cytokine homeostasis, and increased susceptibility to systemic bacterial infection. Among these factors, radiation-induced increases in interleukin-6 (IL-6) concentrations in serum were amplified by skin wound trauma. Herein, the IL-6-induced stress proteins including C-reactive protein (CRP), complement 3 (C3), immunoglobulin M (IgM), and prostaglandin E2 (PGE2) were evaluated after skin injuries given following a mixed radiation environment that might be found after a nuclear incident. In this report, mice received 3 Gy of reactor-produced mixed field (n + γ-photons) radiations at 0.38 Gy/min followed by nonlethal skin wounding or burning. Both wounds and burns reduced survival and increased CRP, C3, and PGE2 in serum after radiation. Decreased IgM production along with an early rise in corticosterone followed by a subsequent decrease was noted for each RCI situation. These results suggest that RCI-induced alterations of corticosterone, CRP, C3, IgM, and PGE2 cause homeostatic imbalance and may contribute to reduced survival. Agents inhibiting these responses may prove to be therapeutic for RCI and improve related survival. PMID:24175013

  16. General regression neural network and Monte Carlo simulation model for survival and growth of Salmonella on raw chicken skin as a function of serotype, temperature and time for use in risk assessment

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A general regression neural network and Monte Carlo simulation model for predicting survival and growth of Salmonella on raw chicken skin as a function of serotype (Typhimurium, Kentucky, Hadar), temperature (5 to 50C) and time (0 to 8 h) was developed. Poultry isolates of Salmonella with natural r...

  17. [Anatomical rationale for elevating revascularized ulnar forearm fasciocutaneous flap for head and neck reconstruction].

    PubMed

    Verbo, E V; Petrosyan, A A; Gileva, K S

    2015-01-01

    In this paper we studied in detail features of the blood supply to the tissues of the forearm of the pools ulnar and radial arteries, the technique of line access and the formation of skin-fascial ulnar flap by using a layered dissection with contrast vessels on non fixed human cadavers. Blood supply of the forearm carried out by branches radial and ulnar arteries, which allows to create in this area radial flap and ulnar flap loo. The size of the skin-fascial ulnar flap can reach 3-10 cm in length, 2-6 cm in width, the length of vessel pedicle of the transplant can reach 12 cm. The research studied the characteristics of blood supply of the forearm and the comparative evaluation of tissue perfusion of the radial and ulnar arteries; proved localization forming ulnar flap. Studies have shown that revascularised skin-fascial ulnar flap may be can be an alternative donor material for elimination of soft tissue defects with less traumatization donor area and reduce upper limb function compared with radial flap.

  18. New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

    PubMed Central

    Al Karmouty, Ahmed F.

    2016-01-01

    Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap. PMID:27777799

  19. Noise Reduction of Aircraft Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V. (Inventor); Brooks, Thomas F. (Inventor)

    2009-01-01

    A reduction in noise radiating from a side of a deployed aircraft flap is achieved by locating a slot adjacent the side of the flap, and then forcing air out through the slot with a suitable mechanism. One, two or even three or more slots are possible, where the slot is located at one;or more locations selected from a group of locations comprising a top surface of the flap, a bottom surface of the flap, an intersection of the top and side surface of the flap, an intersection of the bottom and side surfaces of the flap, and a side surface of the flap. In at least one embodiment the slot is substantially rectangular. A device for adjusting a rate of the air forced out through the slot can also be provided.

  20. Turned in fasciocutaneous island flap from face and neck based on subdermal microcirculation for reconstruction of the oral cavity following cancer surgery

    PubMed Central

    Gajiwala, Kalpesh Jayantkumar

    2016-01-01

    Background: The skin and soft tissues of the face and neck have a rich plexus of dermal-subdermal vessels, which creates the possibility of raising a fasciocutaneous flap based on this vascular supply. A turned in fasciocutaneous island flap (TIFCIF) from an adjacent area of the defect can provide a simple substitute to many complex reconstructive procedures. Materials and Methods: Fifteen patients underwent wide excision for oral cancer and upper neck dissection, maintaining bone framework, between August 2010 and June 2014. The reconstruction was done with a ’turned in fasciocutaneous island flap’ (TIFCIF) from the upper neck-lower face based on subdermal superficial adipofascial microvascular network instead of a specific known feeder vessel. The upper cervical flap, the donor site, when raised during the initial incision and the upper neck dissection, was cut off from the facial artery, the submental artery, the superior thyroid and the transverse cervical arteries. The microcirculation depended largely on the rich vascular plexus formed of the branches of the superficial temporal and the maxillary arteries. The donor site was primarily closed in Fourteen of the Fifteen patients. Eight patients received post-surgery irradiation. Results: All the flaps survived and healed and withstood radiation well. Two patients had flap dehiscence from suture line, of which one needed reattachment while other a minor one healed by itself and one patient had occasional drooling. There was no difficulty in eating or swallowing. Conclusions: A random patterned TIFCIF based on superficial subdermal adipofascial microcirculation, formed of a rich vascular plexus in the face and neck region can provide a simple alternative for intraoral reconstruction. PMID:28216817

  1. Hand Allograft Saved by an Ultrathin Groin Flap

    PubMed Central

    Château, Joseph; Gazarian, Aram; Boucher, Fabien; Badet, Lionel; Braye, Fabienne; Saint-Cyr, Michel

    2016-01-01

    Summary: We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery. To our knowledge, this is the only case of an upper extremity allotransplant salvaged by a pedicled flap. PMID:27757334

  2. [Use of vascularized free flaps for reconstruction of oncological defects in the head and neck].

    PubMed

    Roman, L D; Karpenko, A V; Sidgatullin, R R; Belova, E N; Chumanikhina, N S; Dzhalilov, D N

    2012-01-01

    The aim of the study is to assess our results with free flap transfer. Since October, 2005 till December, 2011 51 operations were performed. Mucosa of upper digestive tract was reconstructed in 40 cases, soft tissues and skin of the head and neck region-in 11 cases. Reconstruction was primary in all but 2 cases. 18 first cases were performed with 2,5x and 4x binocular loupes magnification. Operating microscope was used in another 33 cases. 37 radial forearm fasciocutaneous flaps, 5 latissimus dorsi musculocutaneous flaps, 7 anterolateral thigh flaps, 1 scapular osteocutaneous were used with the single case of visceral flap--jejunal free flap. Death in early postoperative period occurred once. Complete flap loss occurred six times. Five radial and one latissimus dorsi free flaps were lost. Arterial thrombosis is considered as a primary cause of failure in one case, venous thrombosis-in two cases. Severe postoperative infection was considered as a primary cause of failure in one case. In remaining 2 cases the cause of flap loss could not be determined exactly. There were three cases of revision surgery with attempts to reperform venous anastomosis, one of them was successful. Overall success rate in this series is 86,3 %. The main cause of such a low rate of success is a lack of experience.

  3. Versatility of the Free Anterolateral Thigh Flap in the Reconstruction of Large Defects of the Weight-Bearing Foot: A Single-Center Experience with 20 Consecutive Cases.

    PubMed

    Pappalardo, Marco; Jeng, Seng-Feng; Sadigh, Parviz L; Shih, Hsiang-Shun

    2016-09-01

    Background Reconstruction of the weight-bearing surface of the foot represents a challenging task. With very little scope to borrow glabrous tissue from adjacent areas means that achieving a "like for like" reconstruction is rarely possible. In this setting, alternative approaches need to be considered. In this article we present our experience with various differing designs of the anterolateral thigh flap (ALT) in the reconstruction of 20 large defects of the weight-bearing sole. Methods Twenty patients with complex soft tissue defects of the weight-bearing sole underwent reconstruction over a 5-year period. Five cases were complicated by osteomyelitis resulting in significant calcaneal defects. The follow-up period ranged from 8 to 48 months and outcomes were assessed by two-point discrimination and protective sensation, observation of gait, and the ability of the patient to return to wearing normal footwear. Results All flaps survived with the exception of two partial skin necrosis. Sensory nerve coaptation was performed in 12/20 cases. One patient underwent second-stage total calcaneal reconstruction with a fibula osteocutaneous flap. Five large defects were reconstructed with the split skin paddle technique to allow for direct donor-site closure. No evidence of postoperative ulceration was noted in any of the patients over the follow-up period and all were satisfied regarding the functional and aesthetic results achieved. Conclusion Complex defects of the weight-bearing sole can be successfully reconstructed using the free ALT flap resulting in very favorable functional outcomes. Even when calcaneal osteomyelitis has set in, excellent outcomes can be achieved.

  4. The impact of Pfannenstiel scars on TRAM flap complications.

    PubMed

    Dayhim, Fariba; Wilkins, Edwin G

    2004-11-01

    For the past two decades, the transverse rectus abdominis musculocutaneous (TRAM) flap has been a mainstay of postmastectomy breast reconstruction. Because the flap depends on musculocutaneous perforating vessels from the rectus muscle for survival, some authors have raised concerns about increased risks of TRAM flap loss in patients with scars from previous abdominal surgeries, particularly those with Pfannenstiel scars. To assess the effects of Pfannenstiel scars on complication rates, we retrospectively evaluated the inpatient and outpatient records of 241 patients undergoing TRAM reconstruction in a single institution over an 11-year period. Of these patients, 51 had previous Pfannenstiel scars. while 190 did not. Controlling for potential confounding variables (body mass index and timing of reconstruction), logistic regressions found no significant differences between the Pfannenstiel and nonPfannenstiel cohorts in the rate of flap loss (15.7% and 20%, respectively; P = 0.376) or in the incidence of postoperative abdominal donor site laxity (17.6% and 12.1%, respectively; P= 0.361). Within the Pfannenstiel group, the type of TRAM reconstruction (ie, pedicle versus free flaps) did not have a significant effect on complication rates. We conclude that previous concerns over the impact of preexisting Pfannenstiel scars on TRAM flap complications are unfounded.

  5. Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap

    PubMed Central

    Watanabe, Hidekata; Masumoto, Kazuyuki; Kikuchi, Mamoru; Satake, Yoshiyasu; Yanai, Tetsu; Harada, Yoshimi; Ishihara, Yasuhiro; Yasuta, Masato

    2016-01-01

    Background: The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. Methods: Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. Results: The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. Conclusion: Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity. PMID:27200258

  6. Serratus anterior composite flaps for reconstruction of large-area oral and maxillofacial defects: a new neuromuscular flap.

    PubMed

    Tang, Wei; Long, Jie; Feng, Fan; Guo, Lijuan; Gao, Chao; Tian, Weidong

    2009-11-01

    Large area defects in the maxillofacial field are difficult to restore with sufficient esthetic and functional outcome. This study was to assess the feasibility of using serratus anterior composite flaps for reconstruction of large-area oral and maxillofacial tissue defects and to determine subsequent effects on neuromuscular function. Six patients with severe maxillofacial deformities were treated with serratus anterior composite flaps. The neurovascularized pedicle of each flap retained the long thoracic nerve to supply motor innervation. The long thoracic nerve was anastomosed with a branch of the facial nerve. The remaining fine branches of the facial nerve were separated interfascicularly and intrafascicularly, and then implanted within the border of the serratus anterior muscle. Transplanted flaps survived in all patients without vascular crisis. At the 12-month follow-up examinations, patients were able to close their eyes, wrinkle their forehead, and blow through pursed lips using the reconstructed mimetic muscles. The free serratus anterior composite flap has different digitations of the serratus anterior and motor nerve innervations, which is an attractive choice for reconstruction of large defects of oral and maxillofacial tissue. The nerve anastomosis and facial nerve replantation technique may protect the pedicle from atrophy of the transferred flap. Facial motion can be animated by neurotization or reinnervation in-growth in the neurotized slips of the serratus.

  7. Microdissected Prefabricated Flap: An Evolution in Flap Prefabrication

    PubMed Central

    2016-01-01

    When traditional flap techniques are not feasible, we apply flap prefabrication, which is more complicated and sophisticated but supplies large and thin flaps. There are some disadvantages to the technique that require improvement, such as venous congestion after flap transfer, which requires months for neoangiogenesis and necessitates a vascular carrier. Here, the author presents a new technique, called as ‘microdissected prefabricated flap,’ to successfully produce a safe, large, and thin flap. This technique is based on the microdissection of the perforators to the greatest extent possible, spreading them out into the subdermal level and using them as a carrier. The details and the application of this technique are presented and reported. PMID:27896196

  8. Primary one-stage reconstruction of cheek defect after a shotgun blast to the face: use of the latissimus dorsi musculocutaneous free flap for soft-tissue repair and facial reanimation.

    PubMed

    Safak, T; Akyürek, M

    2001-10-01

    The authors describe a case of a shotgun blast injury to the face in which early definitive repair of both facial soft tissues and facial reanimation was accomplished in one stage using a free flap. The trauma occurred 2 days before presentation via a hunting rifle fired at a short range. On examination, a 8 x 5-cm cheek defect was evident, involving the full thickness of the perioral facial mimetic muscles as well. A free latissimus dorsi musculocutaneous flap was transferred to the defect, with the thoracodorsal nerve coapted to an ipsilateral, severed buccal branch of the facial nerve. Postoperatively, the flap survived completely, with its skin paddle excised subsequently in two stages. Good muscle movement was obtained, providing resting symmetry and a pleasant smile. Other than soft-tissue and bony defects resulting from shotgun injuries, ablation of the facial nerve or facial mimetic muscles may be an important component of the defect that needs further consideration. The authors conclude that the current technique of one-stage, early definitive repair of soft tissues and facial reanimation in such cases of facial shotgun blast injury offers the advantages of achieving both goals with one flap and accomplishing the procedure primarily in one stage.

  9. Platysma myocutaneous flap for reconstruction of intraoral defects following excision of oral sub mucous fibrosis: A report of 10 cases

    PubMed Central

    Ramanujam, Sathyanarayanan; Venkatachalam, Suresh; Subramaniyan, Monica; Subramaniyan, Deepika

    2015-01-01

    Various surgical procedures are available for treating oral submucous fibrosis, but all of them have their inherent drawbacks. The superiorly based platysma myocutaneous flap is a common reconstruction option for intraoral defects followed after excision of fibrous bands in oral submucous fibrosis. The superiorly based flap has an excellent blood supply, but less efficient venous drainage when compared with posteriorly based flap. We present our results of using a superiorly based flap in the treatment of oral submucous fibrosis. Of 10 patients eight had no postoperative complications, one patient developed partial skin loss and other developed venous congestion which was managed conservatively. PMID:26538949

  10. The flap by flap dissection in terminal ballistic applied to less lethal weapons.

    PubMed

    de Freminville, Humbert; Rongieras, Fréderic; Prat, Nicolas; Voiglio, Eric J

    2011-06-01

    Medical examiners often have to solve questions such as firing distance and bullet trajectory for lethal weapons. Knowledge in the field of terminal ballistics has increased during the last 30 years and layer by layer dissection reveals superficial wounds that can be linked with the permanent cavity. At the end of the 1990s, terminal ballistics also focused on less lethal weapons and their wounds. Here, 2 different less lethal weapons with single bullets were tested on nonembalmed and undressed cadavers (N = 26) at different ranges and speeds. We have developed a technique for dissection which we call flap by flap dissection that reveals the advantage of the bullet-skin-bone entity, the absence of wounds linking its components and range of less lethal weapons.

  11. One plus one: Two free flaps from same donor thigh for simultaneous coverage of two different defects

    PubMed Central

    Bandi, Susmitha; Koteswara Rao, Rayidi Venkata; Reddy, Damalacheruvu Mukunda

    2016-01-01

    Introduction: Primary microvascular reconstruction of multiple defects is challenging particularly if it has to be simultaneous. In trauma cases, harvesting two independent free flaps from different sites is very time-consuming and adds to morbidity. To eliminate these disadvantages, we sought to find out a reliable alternative method of harvesting two independent free flaps based on the descending branch of circumflex femoral artery, i.e., one anterolateral thigh (ALT) flap and one rectus femoris muscle flap. Aim: To study the feasibility of transferring two free flaps, i.e., ALT and rectus femoris muscle flap simultaneously from the same thigh for coverage of two different limb defects. Materials and Methods: From 2003 to 2012, five patients with two defects each were managed with a total of ten flaps harvested from five donor sites based on independent pedicles of descending branch of lateral circumflex femoral artery and used to cover severe injuries of extremities. Three cases had both lower limb defects and two cases had one upper limb and one lower limb defect. In each case, one ALT flap and one rectus femoris muscle flap were used for coverage. Results: All reconstructive procedures were completed without any major complications. All flaps survived well. There were no re-explorations and no complications related to donor sites. Conclusion: We conclude that our approach of simultaneous harvest of ALT and rectus femoris muscle from the same thigh offers two flaps for two different defects in terms of economy of donor site and operating time. PMID:27833281

  12. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction.

    PubMed

    Choi, Dong Hoon; Goh, Terence; Cho, Jae Young; Hong, Joon Pio

    2014-11-01

    Distant free flaps have become a routine option for reconstruction of large, complicated facial soft tissue defects. The challenge is to find a flap that is pliable to provide good contour and function. The purpose of this paper was to evaluate the use of superficial circumflex iliac artery perforator (SCIP) flaps for facial defects. From November 2010 to June 2013, facial reconstruction was performed on 6 patients (age range, 15-79 years). The harvesting technique was modified to elevate above the deep fat, and the pedicles were taken above or just below the deep fascia. The mean size of the flap was 75.6 cm2, with a thickness of 7 mm; the mean pedicle length was 4.9 cm; and the mean artery caliber was 0.7 mm. The supermicrosurgery technique was used successfully in all 6 cases. Donor sites were all closed primarily. The mean follow-up was 16.7 months. All flaps survived without flap loss, and the donor sites healed without complications including lymphorrhea. The patients were satisfied with contour and function after reconstruction. The result of these 6 cases suggested that the SCIP flap can be a reliable flap for moderate-sized to large defects in the face. The use of new instrumentation and supermicrosurgical techniques allows use of the SCIP flap reliably while providing patients with a good contour, function, and minimal donor site morbidity.

  13. The Versatile Modiolus Perforator Flap

    PubMed Central

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    Background: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap successfully for several indications, and it is our first choice for perioral reconstruction. PMID:27257591

  14. Intracranial microvascular free flaps.

    PubMed

    Levine, Steven; Garfein, Evan S; Weiner, Howard; Yaremchuk, Michael J; Saadeh, Pierre B; Gurtner, Geoffrey; Levine, Jamie P; Warren, Stephen M

    2009-02-01

    Large acquired intracranial defects can result from trauma or surgery. When reoperation is required because of infection or tumor recurrence, management of the intracranial dead space can be challenging. By providing well-vascularized bulky tissue, intracranial microvascular free flaps offer potential solutions to these life-threatening complications. A multi-institutional retrospective chart and radiographic review was performed of all patients who underwent microvascular free-flap surgery for salvage treatment of postoperative intracranial infections between 1998 and 2006. A total of six patients were identified with large intracranial defects and postoperative intracranial infections. Four patients had parenchymal resections for tumor or seizure and two patients had posttraumatic encephalomalacia. All patients underwent operative debridement and intracranial free-flap reconstruction using the latissimus dorsi muscle (N=2), rectus abdominis muscle (N=2), or omentum (N=2). All patients had titanium (N=4) or Medpor (N=2) cranioplasties. We concluded that surgery or trauma can result in significant intracranial dead space. Treatment of postoperative intracranial infection can be challenging. Vascularized free tissue transfer not only fills the void, but also provides a delivery system for immune cells, antibodies, and systemically administered antibiotics. The early use of this technique when intracranial dead space and infection coexist is beneficial.

  15. Flexion contractures of fingers: contracture elimination with trapeze-flap plasty.

    PubMed

    Grishkevich, V M

    2011-02-01

    Scar flexion contracture of fingers is one of the most serious consequences of hand burns and patient disability after burn. Many kinds of reconstructive techniques are currently used and new procedures are being investigated. The author presents a new method of finger contracture reconstruction developed in the process of burn reconstructive operations on hands of over a thousand patients. Finger flexion contractures are caused by a semilunar fold, both sheets of which are scars. The sheets have a surface deficiency in length, which causes a contracture, and excess of skin in width, which allows contracture elimination with local flaps. The length deficiency extends from the crest of the fold to the joint rotation axis and has a trapezoid form. To compensate for skin deficiency and to address the contracture, it is necessary to convert both fold sheets into trapezoid flaps by radial incisions. Because the fold is of semilunar (crescent) shape, the flaps accept a trapezoid form. One or several pairs of the flaps are mobilized with the split fat layer from the fold's crest to the joint rotation axis level. The oppositely transposed flaps fully or partially cover the wound in the proximal interphalangeal (PIP) zone first. The remaining smaller wounds are covered with full-thickness skin grafts. The flaps have a reliable blood circulation; partial flap loss is an exception. The flap's surface does not decrease, the skin grafts shrink insufficiently, and the distant results, as a rule, are good. Two hundred and seventy-five patients were operated upon. Scar contractures were satisfactorily addressed in all patients. Incomplete extension was found in 46 patients; this was caused by interphalangeal joint injuries (ligaments, capsule, cartilage), ankylosis or boutonniere deformity.

  16. Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.

    PubMed

    Wolff, Klaus-Dietrich; Fichter, Andreas; Braun, Christian; Bauer, Florian; Humbs, Martin

    2014-10-01

    Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons.

  17. Soft tissue reconstruction with omental free flap in complex upper extremity injuries: report of 13 cases.

    PubMed

    Iglesias, Martin; Butrón, Patricia; León-López, Daniela Alejandra; García-Mancilla, Sofía; Espino-Gaucin, Israel; Rubio, Alethia

    2014-09-01

    Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.

  18. Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb.

    PubMed

    Checcucci, Giuseppe; Galeano, Mariarosaria; Zucchini, Maura; Zampetti, Pier Giuseppe; Ceruso, Massimo

    2014-05-01

    Reconstruction of distal thumb injuries still remains a challenge for hand surgeons. Surgical treatment includes the use of local, regional, and free flaps. The purpose of this report is to present the results of the use of a sensitive reverse flow first dorsal metacarpal artery (FDMA) flap. The skin flap was designed on the radial side of the proximal phalanx of the index finger based on the ulnar and radial branch of the FDMA and a sensory branch of the superficial radial nerve. This neurovascular flap was used in five patients to cover distal soft-tissue thumb defects. All flaps achieved primary healing except for one patient in whom superficial partial necrosis of the flap occurred, and the defect healed by second intention. All patients maintained the thumb original length and were able to return to their previous daily activities. The reverse flow FDMA flap is a reliable option to cover immediate and delayed defects of distal thumb, offering acceptable functional and cosmetic outcomes in respect to sensibility, durability, and skin-match.

  19. Overview of Local Flaps of the Face for Reconstruction of Cutaneous Malignancies: Single Institutional Experience of Seventy Cases

    PubMed Central

    Rao, Jagdeep K; Shende, Kaustubh Sharad

    2016-01-01

    Context: The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience. PMID:28163451

  20. A novel way to treat skin tears.

    PubMed

    Moradian, Scott; Klapper, Andrew M

    2016-04-01

    Skin tears are one of the most commonly treated wounds in the elderly population. In their most basic form, they are essentially traumatic random pattern flaps. We postulate that the injured blood flow to these skin flaps should be ignored and the tissue should be treated as a skin graft. A case report is presented of an 86-year-old female with an 8 × 3·5 cm skin tear to her right upper extremity after a hip fracture. In addition to conventional wound closure strips re-approximating the tissues, a disposable negative pressure wound therapy device was placed to act as bolster. Upon its removal on day 5, the opposed skin tear tissue was found to be 100% viable. We therefore propose that this update may be an improvement over classical skin tear treatments and should be followed up with a case series.

  1. Reverse saphenous conduit flap in small animals: Clinical applications and outcomes.

    PubMed

    Elliott, Ross C

    2014-08-20

    Due to the lack of skin elasticity defects of the distal hind limb can be a challenge to close. This article assesses a well-described, but completely under-used technique for closure of wounds on the distal tarsus. The technique was used with good success in six cases presenting to the Bryanston Veterinary Hospital with a wide range of underlying pathology ranging from trauma to neoplastic disease of the tarsus. All six cases were treated with a reverse saphenous conduit flap and two of them underwent radiation therapy with no adverse side effects. All cases showed excellent results with a very low degree of flap necrosis that never exceeded 15% of the total flap area. This skin flap provides an excellent treatment method that is reliable in closure of defects of the distal tarsus with few adverse effects. To the author's knowledge there has been only one previously published report on the clinical use of this type of skin flap, even though the flap is well described in most texts.

  2. Free and locoregional flap associations in the reconstruction of extensive head and neck defects.

    PubMed

    Bianchi, B; Ferri, A; Ferrari, S; Copelli, C; Poli, T; Sesenna, E

    2008-08-01

    Head and neck surgical defects after oncological resection of advanced carcinoma involving the oral cavity are often composite and involve bone, mucosa, soft tissues and skin. For the most extensive defects, the simultaneous association of two free flaps is the best choice to improve the function of the preserved structures. This procedure is difficult and involves prolonged surgery, therefore it is only possible in selected patients. In some composite head and neck defects the association of free and locoregional flaps seems to be indicated. This study, discusses the use of free and locoregional flap association, focusing on its aesthetic advantages and functional results. From January 1995 to December 2006, 30 patients received simultaneous locoregional and free flap transfer for closure of post-ablative oral cavity defects. Microvascular tissue transfer included the radial forearm, anterolateral thigh, rectus abdominis, and fibula and iliac crest free flaps. Locoregional flaps included the cervicofacial, cervicopectoral, deltopectoral, pectoralis major, latissimus dorsi and posterior scalp flaps. Based on the good functional and aesthetic outcome and low rate of complications, the association of free and locoregional flaps represents a good reconstructive option for patients with extensive post-oncological composite head and neck defects.

  3. The bipedicled latissimus dorsi myocutaneous free flap: clinical experience with 53 patients.

    PubMed

    Karaaltin, Mehmet Veli; Erdem, Adnan; Canter, Ibrahim; Cavdar, Günay; Baghaki, Semih

    2010-01-01

    The Latissimus dorsi musculocutaneous flap is a valuable workhorse of the microsurgeon, especially in closing large body defects. One of the pitfalls in harvesting the flap, is particularly in its inferior aspect which may be unreliable. Here we report a series of 53 patients who were undergone bipedicled free latissimus dorsi musculocutaneous free flaps for extensive tissue defects. The age of patients were between 5 and 64 and all of them were males. The wound sizes in these patients ranged between 31-35 x 10-12 cm and flap dimensions were between 38-48 x 6-8 cm. Perforator branches of the 10th intercostal vessels were dissected and supercharged to the flaps to reduce the risk of ischemia of the inferior cutaneous extensions. The secondary pedicles were anastomosed to recipient vessels other than the primary pedicles. Recipient areas were consisted of lower extremities. Four patients suffered of early arterial failure in the major pedicle and all revisions were successfully attempted. Neither sign of venous congestion nor arterial insufficiency were observed at the inferior cutaneous extensions of the flaps, and all defects were reconstructed successfully. All donor sites were primarily closed, only two patients suffered from a minor area of superficial epidermal loss at the donor site, without suffering any adjunct complications. In conclusion coverage of large defects can be safely performed with extending the skin paddle of latissimus dorsi flap as a bipedicled free flap.

  4. Reduction of Flap Side Edge Noise - the Blowing Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Brooks, THomas F.

    2005-01-01

    A technique to reduce the noise radiating from a wing-flap side edge is being developed. As an airplane wing with an extended flap is exposed to a subsonic airflow, air is blown outward through thin rectangular chord-wise slots at various locations along the side edges and side surface of the flap to weaken and push away the vortices that originate in that region of the flap and are responsible for important noise emissions. Air is blown through the slots at up to twice the local flow velocity. The blowing is done using one or multiple slots, where a slot is located along the top, bottom or side surface of the flap along the side edge, or also along the intersection of the bottom (or top) and side surfaces.

  5. [Anatomic changes after radical surgery and reconstruction with pedunculated or revascularized flaps in advanced head and neck tumors: computerized tomography and magnetic resonance findings].

    PubMed

    Osti, M F; Scattoni Padovan, F; Ricciardi, D; De Angelis D'Ossat, M; Sbarbati, S; Pirolli, C; Maurizi Enrici, R; Anaveri, G

    1997-04-01

    January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps wer used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The postoperative scar around the flap exhibited soft-tissue density with slight post-contrast enhancement at CT and slightly hypodense on T2-weighted MR images. Post-contrast CT and MRI showed slight scar enhancement with no signal changes in the fatty component. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened layers with both imaging methods. Temporal and latissimus dorsi flaps are made basically of muscular tissue, fatty tissue and occasionally skin (used to repair a mucosal defect): consequently, CT showed a structure with mostly parenchymal density in all cases and MRI depicted intermediate signal intensity. MRI was useful to detect 12 revascularized jejunal or radial flaps thanks to its higher contrast resolution and multiplanar capabilities showing even such thin structures as these flaps. Moreover, MRI permitted to study skull base reconstruction with revascularized (latissimus dorsi) flaps in 5 of our patients.

  6. Anticoagulants and Statins As Pharmacological Agents in Free Flap Surgery: Current Rationale

    PubMed Central

    Pršić, Adnan; Kiwanuka, Elizabeth; Caterson, Stephanie A.

    2015-01-01

    Microvascular free flaps are key components of reconstructive surgery, but despite their common use and usual reliability, flap failures still occur. Many pharmacological agents have been utilized to minimize risk of flap failure caused by thrombosis. However, the challenge of most antithrombotic therapy lies in providing patients with optimal antithrombotic prophylaxis without adverse bleeding effects. There is a limited but growing body of evidence suggesting that the vasoprotective and anti-inflammatory actions of statins can be beneficial for free flap survival. By inhibiting mevalonic acid, the downstream effects of statins include reduction of inflammation, reduced thrombogenicity, and improved vasodilation. This review provides a summary of the pathophysiology of thrombus formation and the current evidence of anticoagulation practices with aspirin, heparin, and dextran. In addition, the potential benefits of statins in the perioperative management of free flaps are highlighted. PMID:26617953

  7. Definition of the gracilis musculocutaneous flap for distant transfer in cats.

    PubMed

    Gregory, C R; Gourley, I M; Snyder, J R; Ilkiw, J

    1992-01-01

    Dissection, injection, and surgical studies in feline cadavers and in anesthetized cats were conducted to determine the feasibility of using the gracilis muscle as the basis for a free musculocutaneous flap. The vascular pedicle of the flap consisted of the femoral artery and vein. Mean length (1.6 +/- 0.2 cm) of the vascular pedicle and mean artery (1.33 +/- 0.19 mm) and vein (2.55 +/- 0.38 mm) diameters were satisfactory for microvascular transfer. Fluorometry revealed overlying cutaneous perfusion in the flaps on the basis of their muscle vascular pedicles. To ensure survival of the flap, the muscular branches of the femoral artery and vein supplying the gracilis muscle had to be carefully preserved during surgical elevation of the flap.

  8. Versatility of nasolabial flaps in oral cavity reconstructions

    PubMed Central

    Cebrián-Carretero, José L.; Morán-Soto, María J.; Burgueño-García, Miguel

    2014-01-01

    Objectives: Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium-sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with very good aesthetic and functional outcomes. Study Design: A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the resective and reconstructive techniques involved, as well as any complications. Results: Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size. All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to 8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence, two hematomas and one orocutaneous fistula, none of which affected the survival of the flap. Conclusions: The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe, and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral defects in edentulous patients with other comorbidities. Key words

  9. Flap reconstruction of the hypopharynx: a defect orientated approach.

    PubMed

    van der Putten, L; Spasiano, R; de Bree, R; Bertino, G; Leemans, C René; Benazzo, M

    2012-10-01

    The present retrospective analysis evaluated the outcomes of different flap reconstructions for several hypopharyngeal defects in 136 patients who underwent hypopharyngeal reconstruction with a free or pedicled flap after excision of pharyngeal or laryngeal carcinoma.Functional and oncological outcome were the main measures. Nine patients had a type I-a hypopharyngeal defect (partial with larynx preserved), 33 type I-b (partial without larynx preserved), 85 type II (circumferential), 5 type III (extensive superior) and 4 vertical hemipharyngolaryngectomy. The flaps used to reconstruct these defects were pectoralis major (n = 34), free radial forearm (n = 25), jejunum (n = 72), pedicled latissimus dorsi (n = 2), sternocleidomastoid (n = 1), lateral thigh (n = 1) and deltopectoral (n = 1). Twelve defects (9%) needed a secondary flap reconstruction. Surgical and medical complications were seen in 29% and 8% of patients, respectively; 18% of patients developed a fistula. No difference in complication rate or admission days was found for pre-operative versus no previous radiotherapy, type of defect or free versus pedicled flap. After 12 months follow-up, 38% of patients had a tracheo-oesophageal voice prosthesis, in 82% a fully oral diet was obtained and the average body weight gain was 0.9 kg. Five-year overall and disease-specific survival rates were 35% and 49%, respectively, while local and regional control rates were 65% and 91%, respectively. Considering these results, a defect orientated approach may be helpful for deciding which flap should be used for reconstruction of the hypopharynx. An algorithm is proposed with similar functional and oncological outcomes for the different groups. The choice of flap should be based on expected morbidity and functional outcome.

  10. Free sensate medial plantar flap for contralateral plantar forefoot reconstruction with flap reinnervation using end-to-side neurorrhaphy: a case report and literature review.

    PubMed

    Lykoudis, Efstathios G; Seretis, Konstantinos; Lykissas, Marios G

    2013-03-01

    Reconstruction of weight-bearing plantar defects remains a challenge due to the unique characteristics of the plantar skin and thus the limited available options. The medial plantar flap, either pedicled or free, represents an ideal option, but its use as sensate flap for forefoot defects has been scarcely reported. We present a case of plantar forefoot reconstruction with a free sensate medial plantar flap, with end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve of the recipient. Last follow-up, at 2 years post-op, verified a very good functional and aesthetic outcome, indicating that the suggested approach may prove the treatment of choice in selected cases of plantar forefoot reconstruction.

  11. Preoperative Angiographic Criteria for Predicting Free-Flap Transfer Outcomes in Patients With Lower-Extremity Peripheral Arterial Disease.

    PubMed

    Park, Sang Woo; Kim, Junhyung; Choi, Jaehoon; Kim, Jun Sik; Lee, Jeong Hwan; Park, Young Sook

    2016-09-29

    Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg. Angiographies with arterial abnormalities were classified into 3 groups: favorable free-flap survival, compromised free-flap survival, and postsurgical pedal ischemia. The study enrolled 50 patients between 2005 and 2013. In 42% of patients, arterial abnormalities were observed by angiography. Age >65 years was the strongest risk factor for development of lower-leg arterial abnormality (P < .001). The anterior tibial and peroneal arteries were significantly more stenotic than other vessels. In the favorable free-flap survival and compromised free-flap survival groups, free-flap transfers were attempted in 7 patients but intraoperatively abandoned in 2 patients, with postoperative failure in 1 patient. In the postsurgical pedal ischemia group, free-flap transfers were attempted in 10 patients but intraoperatively abandoned in 6 patients, with postoperative failure in 3.

  12. Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap.

    PubMed

    Yeo, In Sung; Kim, Se-Hyuk; Park, Myong Chul; Lim, Hyoseob; Kim, Joo Hyoung; Lee, Il Jae

    2014-07-01

    Skull base reconstruction presents a challenging therapeutic problem requiring a multispecialty surgical approach and close cooperation between the neurosurgeon, head and neck surgeon, as well as plastic and reconstructive surgeon during all stages of treatment. The principal goal of skull base reconstruction is to separate the intracranial space from the nasopharyngeal and oropharyngeal cavities, creating support for the brain and providing a water-tight barrier against cerebrospinal fluid leakage and ascending infection. We present a case involving a 58-year-old man with anterior skull base defects (2.5 cm × 3 cm) secondary to the removal of olfactory neuroblastoma. The patient received conventional radiation therapy at 6000 cGy in 30 fractions approximately a month before tumor removal. The patient had radiation therapy before surgery and was planned to have postoperative radiation therapy, which would lead to a higher complication rate of reconstruction. Artificial dura was used for the packing of the dural defect, which was also suspected to increase the complication rate of reconstruction. For these reasons, we chose to apply the dual flap technique, which uses both local pericranial flap and de-epithelized radial forearm free flap for anterior skull base defect to promote wound healing. During 28 months of follow-up after coverage of the anterior skull base defect, the dual flap survived completely, as confirmed through follow-up magnetic resonance imaging. The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and there was minimal donor-site morbidity of the radial forearm free flap. Reconstruction of anterior skull base defects using the dual flap technique is safe, reliable, and associated with low morbidity, and it is ideal for irradiated wounds and low-volume defects.

  13. Skin Dictionary

    MedlinePlus

    ... your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a ... your skin, hair, and nails Skin dictionary Camp Discovery Good Skin Knowledge lesson plans and activities Video library Find a ...

  14. Lateral tarsal artery flap: an option for hypopharyngeal reconstruction in patients with hypopharyngeal carcinomas after surgery

    PubMed Central

    Wang, Chengyuan; Wang, Qiang; Wang, Zengtao; Li, Guojun; Yang, Dazhang

    2015-01-01

    Background: Hypopharyngeal reconstruction following resection of hypopharyngeal carcinoma has utilized local, regional and free tissue transfer flap options. No single surgical technique is currently in use for hypopharyngeal reconstruction that is applicable to all patients. In this article, we introduce the application of the lateral tarsal artery flap (LTA flap) as a reconstructive option following hypopharyngeal oncologic ablation. Methods: From June 2010 to January 2012, four patients of hypopharyngeal carcinomas underwent total laryngectomy and partial pharyngectomy followed by single-stage reconstruction with LTA flaps. After operation, patients were treated with radical radiotherapy within four weeks. All the patients were followed up. Results: All flaps survived, with an average size of 7.5 cm × 5.8 cm (range of 8.0-7.0 cm × 6.0-5.0 cm). There were no complications or contractures during the follow-up. Normal diets were adopted two weeks after operation. The follow-up ranged from 12-20 months (mean: 15 months). There were no distal stenosis or pharyngocutaneous fistula nor were there any donor-site complications. Conclusion: The LTA flap could be a viable option for hypopharyngeal reconstruction following head and neck oncologic resection. It seems that LTA flap would be a promising flap deserving extensively research. PMID:26131060

  15. Pathologic studies of acute rejection of mismatched feline musculocutaneous flaps. Effect of cyclosporine and prednisolone.

    PubMed

    Gregory, C R; Gourley, I M; Ferreira, H; Moore, P F; Imondi, K A; Patz, J D; Gregory, T A; Pedersen, N C

    1991-06-01

    The gracilis musculocutaneous flap was developed as an allograft model to study acute rejection and immunosuppression in the cat. Twelve adult cats received a MLC incompatible flap. Six of the cats received cyclosporine oral solution and prednisolone (0.5 mg/kg/24 hr) for 100 days and six cats were not treated. Trough whole-blood levels of cyclosporine in the treatment group were maintained at approximately 750 ng/ml for 70 days, then 500 ng/ml for the remaining 30 days. Three flaps failed due to technical problems; 5 flaps were studied in the treatment group and 4 in the untreated group. All 5 flaps in the treatment group survived the 100 day treatment period and were rejected 30 +/- 26 days following cessation of treatment. Prior to discontinuation of treatment, with the exception of one cat, inflammatory changes associated with rejection were not observed in biopsy specimen. The flaps in the untreated group survived 13 +/- 1.5 days. Histopathologic examination of the flaps revealed little difference in the appearance of acute rejection and rejection after cessation of therapy. The most prominent lesion was a vasculitis with extensive perivascular lymphohistocytic inflammation. The lymphoid infiltrates consisted predominantly of T cells of both major classes (CD4 and CD8). Full-thickness epidermal necrosis and subsequent bacterial invasion followed vascular compromise.

  16. Correction of syndactyly using a dorsal separated V-Y advancement flap and a volar triangular flap in adults.

    PubMed

    Yildirim, Cengiz; Sentürk, Sadk; Keklikçi, Kenan; Akmaz, Ibrahim

    2011-10-01

    Skin grafts and local flaps are conventional methods of repair for congenital syndactyly, but the results obtained are not always as functional and aesthetic as desired and frequently leave postoperative scars and residual syndactyly. In this article, we describe a new surgical technique for web reconstruction in the correction of simple, incomplete syndactyly. The technique consists of a dorsal separated V-Y advancement flap and a volar triangular flap to cover the newly created web space, thus avoiding skin graft in this space. In all, 15 web spaces in 10 patients were treated using this method. A follow-up period of 6 months to 2 years showed neither recurrence of the deformity nor web creep of any degree. The technique is rapid, safe, easily performed, and reproducible and requires a single surgical procedure. It uses donor tissue identical in color, texture, and thickness, which renders acceptable cosmesis in cases of simple, incomplete syndactyly, therefore, avoiding the use of skin grafts and resulting postoperative scar contracture in the web space.

  17. Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.

    PubMed

    Costa, Dary J; Walen, Scott; Varvares, Mark; Walker, Ronald

    2016-02-01

    Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure.

  18. Double free flaps harvested from one or two donor sites for one or two-staged burn reconstruction: models of sequential-link and independent-link microanastomoses.

    PubMed

    Mardini, Samir; Tsai, Feng-Chou; Yang, Jui-yung

    2004-11-01

    Extensive burn injuries and subsequent scarring result in functional and aesthetic impairments. The use of free flaps in burn reconstructions provides superior outcomes especially when other, more conservative reconstructive methods fail and curtail efforts of relentless rehabilitation. Multiple chronic scar-associated problems and extensive acute burn defects are conventionally resolved by multiple procedures. Thus, two or extensive scar regions are typically reconstructed using two free flaps (double free flaps) in two separate, procedures utilizing two independent donor sites. This leads to a protracted course of repetitive operations, hospitalizations, and rehabilitation, causing a prolonged period of discomfort and disability. The definition of double free flaps is two independent free flaps with two sets of microanastomoses. This paper illustrates, via a case-series, that double free flaps could be performed in one procedure, with both flaps harvested from either one or two donor sites. Two flaps are then utilized to resolve one large or two problem areas at the same time. Revascularization of the flaps is achieved via either a sequential-link or independent-link microanastomoses. The advantages of harvesting double free flaps from one region and using them in one stage to reconstruct one or two defect area include: (1) providing a large area of soft, pliable skin from one region for re-surfacing burn injuries or resolving scar associated problems, (2) decreasing the treatment course and potential disability, (3) decreasing donor site morbidities, (4) increasing maneuverability and conformability of the flap, and (5) affording a better functional and aesthetic outcome.

  19. Leg morbidity and function following fibular free flap harvest.

    PubMed

    Shpitzer, T; Neligan, P; Boyd, B; Gullane, P; Gur, E; Freeman, J

    1997-05-01

    Over a period of 3 years, 50 consecutive free fibular flaps for mandibular reconstruction were performed on 47 patients. In 38 patients (81%) a skin paddle was included with the flap to provide either mucosal lining or skin cover; in 9 patients (19%) bone alone was used. Thirty-one patients (66%) required a skin graft to close the donor defect in the leg. Donor leg morbidity and function were determined by patient questionnaire and by physical examination. Forty-one donor sites in 40 patients were available for long-term follow-up. The follow-up ranged from 4 to 39 months with an average of 17 months. Immediate postoperative infection occurred in the donor site of 1 patient (2%) and required additional surgery. There was no other immediate donor site complications when closure required skin grafting. Eleven patients (27%) had late donor site morbidity, consisting of motor weakness of the great toe in 5 patients, ankle instability and/or stiffness in 3 patients, donor site pain in 1 patient, and edema in 2 patients. All complications were graded as mild in severity by the patient and by the examiner. In this series, although most donor site defects required skin grafting, short- and long-term morbidity was minimal. After a short rehabilitation period, all patients were fully able to engage in all daily and recreational activities.

  20. Flap Edge Noise Reduction Fins

    NASA Technical Reports Server (NTRS)

    Khorrami, Mehdi R. (Inventor); Choudhan, Meelan M. (Inventor)

    2015-01-01

    A flap of the type that is movably connected to an aircraft wing to provide control of an aircraft in flight includes opposite ends, wherein at least a first opposite end includes a plurality of substantially rigid, laterally extending protrusions that are spaced apart to form a plurality of fluidly interconnected passageways. The passageways have openings adjacent to upper and lower sides of the flap, and the passageways include a plurality of bends such that high pressure fluid flows from a high pressure region to a low pressure region to provide a boundary condition that inhibits noise resulting from airflow around the end of the flap.

  1. Dancing girl flap: a new flap suitable for web release.

    PubMed

    Shinya, K

    1999-12-01

    To create a deep web, a flap must be designed to have a high elongation effect in one direction along the mid-lateral line of the finger and also to have a shortening effect in the other direction, crossing at a right angle to the mid-lateral line. The dancing girl flap is a modification of a four-flap Z-plasty with two additional Z-plasties. It has a high elongation effect in one direction (>550%) and a shortening effect in the other direction at a right angle (<33%), creating a deep, U-shaped surface. This new flap can be used to release severe scar contracture with a web, and is most suitable for incomplete syndactyly with webs as high as the proximal interphalangeal joint.

  2. [Oromandibular reconstruction with free peroneal flap and osseointegrated implants].

    PubMed

    Navarro Cuéllar, C; Cuesta Gil, M; Plasencia Delgado, J; Guerra Martínez, B; Acero Sanz, J; López de Atalaya, F J; Ochandiano Caicoya, S; Navarro Vila, C

    2003-01-01

    Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.

  3. Flap monitoring using infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Keller, Alex; Wright, Leigh P.; Elmandjra, Mohamed; Mao, Jian-min

    2006-02-01

    We report results of clinical trials on flap monitoring in 65 plastic surgeries. Hemoglobin oxygen saturation of flap tissue (StO II) was monitored non-invasively by using ODISsey TM tissue oximeter, an infrared spectroscopic device. StO II measurements were conducted both intra-operatively and post-operatively. From the intra-operative measurements, we observed that StO II values dropped when the main blood vessels supplying the flap were clamped in surgery, and that StO II jumped after anastomosis to a value close to its pre-operative value. From post-operative monitoring measurements for the 65 flap cases, each lasted two days or so, we found that the StO II values approach to a level close to the baseline if the surgery was successful, and that the StO II value dropped to a value below 30% if there is a perfusion compromise, such as vascular thrombosis.

  4. Effects of Venous Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model

    PubMed Central

    Zheng, Jun; Xi, Shanshan; Ding, Maochao; Li, Hong; Xu, Wei; Tang, Maolin; Chen, Shixin

    2016-01-01

    Objective To comparatively assess the effects of venous superdrainage and arterial supercharging on dorsal perforator flap survival. Materials and Methods Sixty male Sprague-Dawley rats (450–550g) were randomly divided into three groups (n = 20), including control group (Control) and experimental groups A (venous superdrainage, Exp. A) and B (arterial supercharging, Exp. B). At postoperative day 7, survival areas of the flaps were evaluated and all animals underwent angiography. Laser Doppler was used to evaluate flap perfusion from 0h to 7days after surgery. Histology with hematoxylin and eosin staining was used to count microvessels. Tissue of “Choke vessels”was excised for quantification of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) by western blot assay at 6h and 7days after surgery. Results In the Exp. A group, almost all flaps survived (98.2±1.6%); in the Exp. B and control group, survival areas accounted for 78.8±8.5% and 60.3±7.8%, respectively (P <0.001). In addition, Exp. A animals showed improved anastomosis of choke vessels 2 compared with the Exp. B and Control groups. Furthermore, flap blood flow and partial pressure of oxygen in the Exp. A group were significantly higher compared with values obtained for the Exp. B and Control groups, from 6 hours to 7 days after surgery. More microvessels were found in the Exp. A group (11.65±1.33) than in Exp. B (9.25±0.34) and control (7.25±0.91) animals on POD 7. The relative expression level of HIF-1α and VEGF were significant at 6h and 7days after surgery. Conclusions Venous superdrainage in rat dorsal perforator flap is more effective than arterial supercharging in promoting flap survival, and could effectively alter hemodynamics in the microcirculation and stimulate blood vessel formation. PMID:27513520

  5. Postoperative Quantitative Assessment of Reconstructive Tissue Status in Cutaneous Flap Model using Spatial Frequency Domain Imaging

    PubMed Central

    Yafi, Amr; Vetter, Thomas S; Scholz, Thomas; Patel, Sarin; Saager, Rolf B; Cuccia, David J; Evans, Gregory R; Durkin, Anthony J

    2010-01-01

    Background The purpose of this study is to investigate the capabilities of a novel optical wide-field imaging technology known as Spatial Frequency Domain Imaging (SFDI) to quantitatively assess reconstructive tissue status. Methods Twenty two cutaneous pedicle flaps were created on eleven rats based on the inferior epigastric vessels. After baseline measurement, all flaps underwent vascular ischemia, induced by clamping the supporting vessels for two hours (either arterio-venous or selective venous occlusions) normal saline was injected to the control flap, and hypertonic hyperoncotic saline solution to the experimental flap. Flaps were monitored for two hours after reperfusion. The SFDI system was used for quantitative assessment of flap status over the duration of the experiment. Results All flaps demonstrated a significant decline in oxy-hemoglobin and tissue oxygen saturation in response to occlusion. Total hemoglobin and deoxy-hemoglobin were markedly increased in the selective venous occlusion group. After reperfusion and the solutions were administered, oxy-hemoglobin and tissue oxygen saturation in those flaps that survived gradually returned to the baseline levels. However, flaps for which oxy-hemoglobin and tissue oxygen saturation didn’t show any signs of recovery appeared to be compromised and eventually became necrotic within 24–48 hours in both occlusion groups. Conclusion SFDI technology provides a quantitative, objective method to assess tissue status. This study demonstrates the potential of this optical technology to assess tissue perfusion in a very precise and quantitative way, enabling wide-field visualization of physiological parameters. The results of this study suggest that SFDI may provide a means for prospectively identifying dysfunctional flaps well in advance of failure. PMID:21200206

  6. Full scale upper surface blown flap noise

    NASA Technical Reports Server (NTRS)

    Heidelberg, L. J.; Homyak, L.; Jones, W. L.

    1975-01-01

    A highly noise suppressed TF 34 engine was used to investigate the noise of several powered lift configurations involving upper surface blown (USB) flaps. The configuration variables were nozzle type (i.e. slot and circular with deflector), flap chord length, and flap angle. The results of velocity surveys at both the nozzle exit and the flap trailing edge are also presented and used for correlation of the noise data. Configurations using a long flap design were 4 db quieter than a short flap typical of current trends in USB flap design. The lower noise for the long flap is attributed primarily to the greater velocity decay of the jet at the flap trailing edge. The full-scale data revealed substantially more quadrupole noise in the region near the deflected jet than observed in previous sub-scale tests.

  7. Skin Diseases: Skin Health and Skin Diseases

    MedlinePlus

    Skip Navigation Bar Home Current Issue Past Issues Skin Diseases Skin Health and Skin Diseases Past Issues / Fall 2008 Table of Contents ... acne to wrinkles Did you know that your skin is the largest organ of your body? It ...

  8. Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction.

    PubMed

    Bendon, Charlotte L; Giele, Henk P

    2016-07-01

    Traditionally, in free flap cover of lower limb injuries, every attempt is made to perform anastomoses proximal to the zone of injury. We report on the success of anastomoses within the zone of trauma, at the level of the fracture, avoiding further dissection and exposure. The records of free flap reconstructions for fractures of the lower extremity at a tertiary trauma centre between 2004 and 2010 were retrospectively reviewed. A total of 48 lower limb fractures required free flap reconstruction, performed at 28 days post injury (0-275 days). Anastomoses were proximal (21), distal (5) or within the zone of trauma (22). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between groups. Of the 22 performed within the zone of injury, five returned to theatre but only two for revision of anastomosis and 20 (91%) of these flaps survived. Of the 48 free flaps, arterial anastomoses were end to end in 34 (71%) and end to side in 14 (30%). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between the end-to-end and end-to-side groups. There was a tendency for arterial anastomoses to be performed end to end outside the zone of trauma (23/26) compared to within the zone of trauma (11/22). Our data suggest that free flap anastomoses can be performed safely in the zone of trauma in lower limb injuries.

  9. The Role of Muscle Flaps for Salvage of Failed Perforator Free Flaps

    PubMed Central

    2015-01-01

    Background: Despite the most heroic efforts, sometimes free flaps fail. Perforator free flaps are not invincible and can suffer the same fate. The real challenge is how to decide what is the next best choice for achieving the desired outcome. Methods: Over the past decade, 298 free perforator flaps were used in our institution. Total failure occurred in 16 patients, and partial failure requiring a second free flap occurred in an additional 6 patients for a true success rate of 93%. All failures had some form of secondary vascularized tissue transfer, which included the use of muscle flaps in 9 (41%) different patients. Results: Initial flap salvage after a failed perforator free flap was attempted with 12 perforator and 5 muscle free flaps as well as 1 perforator and 2 muscle local flaps. These were not all successful, with loss of 3 muscle free flaps and 3 perforator flaps. Tertiary free flap coverage was successful in 3 cases using 2 muscle flaps and 1 perforator free flap. Local fasciocutaneous flaps or primary wound closure was used in the remaining individuals. Conclusions: Microsurgical tissue transfers can be the most rewarding and at the same time the most challenging reconstructive endeavor. Persistence in achieving the desired outcome can require multiple steps. Perforator flaps are an important asset to obtain this goal. However, muscle flaps can still be a useful alternative, and the message is that they should not be overlooked as sometimes a viable option. PMID:26893989

  10. Buried free flaps in head and neck reconstruction: higher risk of free flap failure?

    PubMed

    Reiter, M; Harréus, U; Kisser, U; Betz, C S; Baumeister, Ph

    2017-01-01

    Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72 h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8 %) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.

  11. [Significance of abdominal wall CT-angiography in planning DIEA perforator flaps, TRAM flaps and SIEA flaps].

    PubMed

    Fansa, H; Schirmer, S; Frerichs, O; Gehl, H B

    2011-04-01

    Muscle sparing TRAM flaps and DIEA perforator flaps are standard procedures for breast reconstruction. Recently CT-angiography has been established to evaluate perforator vessels pre-operatively. CT-angiography was introduced to our department in July 2009. In a retrospective analysis data of the last 20 patients (altogether 22 flaps) before CT-angiography introduction and the following 20 (also 22 flaps) patients after introduction of CT-angiography were analysed with regard to the ratio of TRAM to DIEP flaps, and the time required to raise the flaps. The same surgeon raised all flaps. As different surgeons performed dissection of the recipient site, anastomoses, and insertion of flaps, and patients received primary (with sentinel or complete lymphadenctomy) or secondary reconstructions, only the time required harvesting the flap was compared. Thus other influences on raising the flap were eliminated. DIEP flaps were harvested with one single perforator. If perfusion or was considered not to be safe via one single perforator a muscle sparing TRAM flap (ms2) was raised. Angiography was performed using a 64-slice multi-detector CT scanner. CT-angiography did not lead to an increased rate of DIEP flaps in relation to ms2-TRAM flaps. Harvesting time of all flap types with CT-angiography on average was 121 min, without CT-angiography 135 min. This was not significantly different. However, separate analysis of DIEP flaps and ms2-TRAM flaps revealed a significant advantage of CT-angiography based harvesting of DIEP flaps of 26 min: with CT-angiography 101 min vs. 127 min without CT-angiography (p<0.028). There were no significant differences for ms2-TRAM flaps. All scans showed course and branching, diameter and size of the inferior epigastric artery. If evident the superficial inferior epigastric artery (SIEA) was marked. Dosage was 292 mGy-606 mGy×cm dependent on body weight. CTDI was 6.8-14.7 mGy. CT-angiography is a reproducible and observer independent procedure

  12. Technique of Dorsal Transversely Oriented Transposition Flap for Web Reconstruction in Toe Syndactyly Surgery.

    PubMed

    Saito, Susumu; Suzuki, Yoshihisa; Suzuki, Shigehiko

    2015-01-01

    In toe desyndactyly, a dorsal or plantar commissural flap, combined with skin grafts, will ensure an acceptable result. However, the parallel unsightly scars in the longitudinal direction on the dorsum of the toes will sometimes fail to satisfy the patient's and/or the parents' aesthetic expectations. To address this issue, we developed a technique using a transversely oriented transposition flap for web reconstruction, which can spare the dorsal interdigital skin maximally to shift the dorsal scars plantarly such that they become inconspicuous. The design of the flap is simple and uncomplicated surgically. Moreover, the donor site morbidity is minimal, owing to the good healing potential of the transverse scars. This technique could be an alternative in web reconstruction of toe desyndactyly, especially in cases with high cosmetic priority.

  13. Reconstruction of the Orbit With a Temporalis Muscle Flap After Orbital Exenteration

    PubMed Central

    Uyar, Yavuz; Yıldırım, Güven; Kuzdere, Mustafa; Arbağ, Hamdi; Jorayev, Chary; Kılıç, Mehmet Vefa; Gümrükçü, Said Serdar

    2015-01-01

    Objectives This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. Methods A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented. Results The study included 13 patients (nine men, four women; age range, 30-82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasons Conclusion The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence. PMID:25729496

  14. Experimental studies of flow separation and stalling on two-dimensional airfoils at low speeds. Phase 2: Studies with Fowler flap extended

    NASA Technical Reports Server (NTRS)

    Seetharam, H. C.; Wentz, W. H., Jr.

    1975-01-01

    Results were given on experimental studies of flow separation and stalling on a two-dimensional GA(W)-1 17 percent thick airfoil with an extended Fowler flap. Experimental velocity profiles obtained from a five tube probe survey with optimum flap gap and overlap setting (flap at 40 deg) are shown at various stations above, below, and behind the airfoil/flap combination for various angles of attack. The typical zones of steady flow, intermittent turbulence, and large scale turbulence were obtained from a hot wire anemometer survey and are depicted graphically for an angle of attack of 12.5 deg. Local skin friction distributions were obtained and are given for various angles of attack. Computer plots of the boundary layer profiles are shown for the case of the flap at 40 deg. Static pressure contours are also given. A GA(W)-2 section model was fabricated with 30 percent Fowler flaps and with pressure tabs.

  15. Prolonged Survival (>48 months) in a Squamous Cell Carcinoma of the Cervix After Late Skin Metastasis (>5 year) to Incision Site: A Case Report.

    PubMed

    Ozmen, Batuhan; Sükür, Yavuz Emre; Atabekoğlu, Cem; Güngör, Mete

    2009-01-01

    Metastasis to the incision site of squamous cervical cancer (SCC) is an extremely rare entity which is strictly related with extremely poor prognosis. The vast majority of the reported cases died in a year due to distant recurrences, whereby skin metastases were predominantly observed close to the primary tumor site. A SCC with skin metastasis which was diagnosed 5 years after the radical surgery and postoperative radiotherapy which involved the midline incision site was reported. Large surgical excision of the metastasis with remaining surgical free margins (>2 cm) and combined chemo-radiotherapy with single agent (cisplatinum) was performed. The patient did not show any recurrences for 4 years follow-up. Apparently, palliative combined chemo-radiotherapy along with large excision seems favorable for controlling symptoms and progression of skin metastasis of squamous cervical cancer.

  16. Free toe pulp flap for finger pulp and volar defect reconstruction

    PubMed Central

    Balan, Jyoshid R.

    2016-01-01

    Background: Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement. Materials and Methods: From June 2015 to April 2016, we performed seven free toe pulp flaps for finger defect reconstruction. All patients were males. Five flaps were done in emergency post-traumatic cases, and two were done in elective set up. The cases included reconstruction of three thumbs, one index and one ring finger in an emergency set up and two ring fingers in the elective. Thumb reconstruction was done with great toe lateral pulp and the other digits reconstructed with second toe pulp flap. Follow-up evaluation included both functional and aesthetic assessment. Results: Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4–8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm2). Three patients had delayed donor site wound healing. Conclusions: The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match. PMID:27833279

  17. Electromagnetic flowmetry--an experimental method for continuous blood flow measurement using a new island flap model.

    PubMed

    Banis, J C; Schwartz, K S; Acland, R D

    1980-10-01

    We describe a reliable experimental method for direct, continuous measurement of the rate of blood flow in an island skin flap, using an electromagnetic flowmeter applied to the artery of the flap. The canine saphenous island flap model, developed as part of this study, is a large (11 x 14 cm) island flap, based solely on the saphenous artery (2 mm in diameter). We describe the anatomy of the flap and the method of raising it. Electromagnetic flowmetry is the only method of blood flow determination that provides immediate, continuous, and quantitative measurement of flow. We describe the principles and pitfalls of the electromagnetic flowmeter and the numerous rules of practice that must be observed to obtain consistent results. A validation study was carried out, in which we simultaneously measured arterial inflow with the flowmeter and venous outflow from the flap using direct collection. This study was based on the assumption that at any point in time the arterial and venous rate of flow were equal. We present the results of the study, which show an extremely close linear relationship between the measured and actual rates of flow. We intend to use this experimental method to study the factors that affect the rate of blood flow in free skin flap transfer.

  18. PIV Measurements on a Blowing Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several blowing flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main-element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the vortex system or accelerated the merging of the side vortex to the flap top surface. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  19. A new design for superficial temporal fascial flap for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal system in one-stage procedure: medusa flap.

    PubMed

    Bozkurt, Mehmet; Kulahci, Yalcin; Kapi, Emin; Karakol, Percin

    2009-12-01

    Reconstruction of the eyebrows, eyelids, and destroyed lacrimal drainage system is a challenging procedure for plastic and reconstructive surgeons. In the case presented, a superficial temporal fascial flap was designed for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in a one-stage procedure in facial burn patient. To the authors' knowledge, this is the first combined reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in one surgical procedure with pedicled superficial temporal fascial flap including skin island and buccal mucosal graft. During the 1-year follow-up period, no complication was encountered and patient healed uneventfully.

  20. The use of thermography to design tissue flaps – experimental studies on animals

    PubMed Central

    Łokaj, Marek; Falkowski, Aleksander; Prowans, Piotr

    2014-01-01

    Introduction Methods allowing one to locate the position of a cutaneous perforator do not allow one to determine the boundaries of the vascularized skin. In clinical practice this causes complications in the form of marginal necrosis of the flap. Aim To examine the usefulness of thermography to assess the extent of vascularization of the skin and subcutaneous tissue by a single perforator. Material and methods Thirty-one male rats were used. Using dynamic thermography the perforators on the abdominal skin were located. Afterwards the flap was prepared on a randomly chosen perforator. After 24 h the extent of vascularization of the skin by a single perforator was examined. Results In 22.5% of cases the number of perforators marked in the thermography was equal to the number of perforators marked intraoperatively, in 64.5% it was lower and in 13% higher. The use of thermography has shown that basing the flap vascularization on the perforator with low efficiency resulted in statistically more frequent occurrence of ischemia and partial necrosis of the flap (p = 0.024). Partial necrosis of the flap occurred in 12 of 31 cases, always in the area in which during the preoperative thermography no perforators were found. The areas of necrosis occurred irrespectively of the distance from the supplying vessel. Conclusions When designing the shape of the flap, the distribution of all perforators must be considered. The perforators need to be included in the area of prepared tissues because their location indicates the area with a more efficient network of vessels. PMID:25337153

  1. A de-epithelialised 'turnover dartos flap' in the repair of urethral fistula.

    PubMed

    Ahuja, Rajeev B

    2009-03-01

    We report our experience in the management of urethrocutaneous fistulae following hypospadias repair by using a turnover, de-epithelialiszed dartos flap. From May 2003 to June 2007 we operated on 10 patients with urethral fistulae following hypospadias repair. Their ages ranged from 4 to 25 years (mean: 7 years). Four of these patients had their urethroplasty done elsewhere and reported for fistula repair alone. These four patients had no record of the urethroplasty procedure that was used. A solitary fistula was located at the corona in two patients, on the mid-shaft in three patients, and proximal penile in one patient. Two patients had multiple fistulae on the shaft, one patient had two fistulae on the shaft, and one patient had a long fistula from the proximal penile to peno-scrotal region. The technique involves using a circumscribing incision around the fistula and closing the inner skin edges by an inverting subcuticular stitch to form the urethral layer. A flap is marked on the skin adjacent to the circumscribing incision and de-epithelialised. It is raised with underlying dartos fascia/muscle and turned over the first layer of closure and secured. The vascular supply to the flap is based on a hinge of tissue around the defect. A long skin flap developed from shaft or the scrotum is approximated over this layer to complete the repair. Alternatively, the skin is closed in a 'pants over vest' technique. An indwelling catheter is placed for 3-4 days. Nine patients healed without complications, and one patient with multiple fistulae on the shaft had a residual tiny pin-point fistula which closed spontaneously. Thus, the success rate with this technique was 100%. Although dartos flaps have been used for many years as a waterproofing layer in urethroplasties or while repairing urethrocutaneous fistulae, their use as a 'de-epithelialised turnover flap' provides another reliable tool in the surgical repertoire.

  2. Experimental Study of Wake / Flap Interaction Noise and the Reduction of Flap Side Edge Noise

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.; Plassman, Gerald E.

    2016-01-01

    The effects of the interaction of a wake with a half-span flap on radiated noise are examined. The incident wake is generated by bars of various widths and lengths or by a simplified landing gear model. Single microphone and phased array measurements are used to isolate the effects of the wake interaction on the noise radiating from the flap side edge and flap cove regions. The effects on noise of the wake generator's geometry and relative placement with respect to the flap are assessed. Placement of the wake generators upstream of the flap side edge is shown to lead to the reduction of flap side edge noise by introducing a velocity deficit and likely altering the instabilities in the flap side edge vortex system. Significant reduction in flap side edge noise is achieved with a bar positioned directly upstream of the flap side edge. The noise reduction benefit is seen to improve with increased bar width, length and proximity to the flap edge. Positioning of the landing gear model upstream of the flap side edge also leads to decreased flap side edge noise. In addition, flap cove noise levels are significantly lower than when the landing gear is positioned upstream of the flap mid-span. The impact of the local flow velocity on the noise radiating directly from the landing gear is discussed. The effects of the landing gear side-braces on flap side edge, flap cove and landing gear noise are shown.

  3. The free groin flap in the rat: a model for improving microsurgical skills and for microvascular perfusion studies.

    PubMed

    Wallmichrath, Jens; Baumeister, R G H; Gottschalk, O; Giunta, R E; Frick, A

    2014-06-01

    The goal of this study was to evaluate the free groin flap in the rat transplanted to the neck as a tool for extending microsurgical skills and to assess its suitability as a model for microvascular perfusion studies following secondary venous ischaemia. An analysis of 60 consecutive groin flap transplantations was performed in male Sprague Dawley rats with special regard to anatomy and operation times (Part I, animals No. 1-60). Following flap transplantation, the animals No. 10-30 (n = 21) were used for the determination of the critical time period of a complete venous stasis of the free groin flap resulting in a total flap loss (Part II). The flaps of animals No. 31-41 (n = 11) were used for assessing the feasibility and reproducibility of intra-vital video microscopy (IVM) of the flaps (Part III). The mean total operation time decreased from 166 (± 26) minutes ins the first 10 animals to 126 (± 21) minutes and 130 (± 12) minutes in the latter two groups of 10 animals, respectively. After a critical period of 35 minutes of a complete artificial venous stasis a complete flap necrosis occurred. IVM detected a higher functional capillary density of the skin of the transplanted groin flaps in the animals in which the flaps were rinsed with 1 ml of Ringer's lactated solution prior to I/R. In conclusion, this model is simple and reliable. The model may be a useful tool for evaluating and comparing the effects of various anticoagulants or vasomotor drugss on microvascular perfusion in critically compromised free flaps.

  4. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    PubMed

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.

  5. [Vascular supply of the free fasciocutaneous forearm flap--an anatomical study].

    PubMed

    Trümper, K; Löwicke, G; Raschke, N

    1987-01-01

    The vascular supply of the forearm skin--especially of the ventral antebrachial region--was investigated by means of selective angiographies and intravascular dye injections in 43 upper extremities of corpses. Besides the definition of the interesting supply regions assertions were made about the kind and the character of the angioarchitecture as well as recommendations for the flap planning and other clinical references.

  6. Fascial Free Flap for Reconstruction of the Dorsolateral Hand and Digits: The Advantage of a Thin Contour

    PubMed Central

    Lee, Min Gue; Lee, Dong Chul; Roh, Si Young; Lee, Kyung Jin; Choi, Byeong Kyoo

    2016-01-01

    Background Fascial free flaps have been widely used for reconstruction of the hand because they are thin. However, studies reporting objective data regarding the advantages of this approach are lacking. Thus, we report our experience with such flaps. Methods Forty-five cases of fascial free flaps between November 2006 and March 2014 were reviewed. Nine cases involving reconstructed dorsal or lateral defects were included. Four anterolateral thigh fascial free flaps and 5 lateral arm fascial free flaps were examined. Maximal flap contour was assessed by measuring reconstructed tissue thickness at the central area from the surface of the skin to below the bone in a vertical manner using ultrasonography and X-ray data. Contralateral regions were examined in the same manner and a comparative analysis was performed. A questionnaire survey regarding aesthetic satisfaction was also administered. Results All reconstructed parts had a thicker contour than the contralateral side. The average relative percentage of reconstructed tissue thickness was found to be 152% using ultrasonography and 143% using X-ray imaging. According to the aesthetic satisfaction survey, the average rate of satisfaction for patients was 62%, and satisfaction with the flap contour was 72%. Conclusions Using a fascial free flap, the reconstructed tissue was approximately 1.5× as thick as the contour of the normal side, which led to positive responses regarding aesthetic satisfaction. PMID:27896187

  7. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating mechanisms, and their supporting structures must be designed for critical...

  8. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating mechanisms, and their supporting structures must be designed for critical...

  9. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating mechanisms, and their supporting structures must be designed for critical...

  10. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating mechanisms, and their supporting structures must be designed for critical...

  11. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating mechanisms, and their supporting structures must be designed for critical...

  12. Modeling the survival of Salmonella on slice cooked ham as a function of apple skin polyphenols, acetic acid, oregano essential oil and carvacrol

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Response surface methodology was applied to investigate the combined effect of apple skin polyphenols (ASP), acetic acid (AA), oregano essential oil (O) and carvacrol (C) on the inactivation of Salmonella on sliced cooked ham. A full factorial experimental design was employed with control variables ...

  13. Shape-based 3D vascular tree extraction for perforator flaps

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  14. Double free flaps for reconstruction of complex/composite defects in head and neck surgery.

    PubMed

    Mo, Kevin W L; Vlantis, Alexander; Wong, Eddy W Y; Chiu, T W

    2014-08-01

    OBJECTIVE. To demonstrate the feasibility of double free flap surgery in head and neck reconstruction. DESIGN. Descriptive case series. SETTING. A university-affiliated hospital in Hong Kong. PATIENTS. Twelve patients with head and neck cancer (encountered over a 2.5-year period) who had reconstructive surgery with planned simultaneous double free flaps. RESULTS. The mean total operating time was 660 minutes and there were no flap failures. Postoperative stays ranged from 11 to 82 days; nine patients were discharged within 3 weeks and seven were able to maintain their weight with oral feeding. The survival rate up to 1 year was 64%. CONCLUSION. The use of double free flaps is an option worth considering for complex head and neck defects in carefully selected patients.

  15. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap interconnection. 23.701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS... Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a...

  16. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  17. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  18. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  19. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  20. The Sternohyoid Flap for Facial Reanimation.

    PubMed

    Alam, Daniel S

    2016-02-01

    This article discusses the use of the sternohyoid muscle for facial reanimation. The report outlines the rationale for use, the technical aspects of flap harvest, and early clinical outcomes. The utility of the flap and its comparative attributes relative to the gracilis flap are discussed.

  1. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps.

    PubMed

    Pohlenz, P; Klatt, J; Schön, G; Blessmann, M; Li, L; Schmelzle, R

    2012-06-01

    This study analyzed the surgical outcome and complications of 1000 microvascular free flaps performed at the authors' institution in Germany, between 1987 and 2010. 972 patients underwent reconstruction with 1000 flaps: 28% latissimus dorsi flaps, 27% radial forearm flaps, 20% iliac crest flaps, 12% fibula flaps, 6% jejunal flaps, 2% anterolateral thigh flaps, and 5% other flaps. 130 failures (7.6%) were encountered, including 58 complete flap failures (44.6%) and 72 partial free-flap failures (55.4%). This study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck, but it is essential that complications be recognized and addressed early in their course to prevent or minimize devastating consequences. Owing to the large number of possible errors in flap transplantation, microsurgeons should always check everything for themselves. The on-duty doctors and nursing staff should not be trusted blindly. Venous thrombosis and cervical haematoma are the most common complications at the recipient site and are mainly responsible for flap failure, while complications occurring at the donor site may result from dehiscence and graft necrosis. When a compromised flap is identified, surgical re-exploration should not be deferred.

  2. Schooling of flapping wings: Simulations

    NASA Astrophysics Data System (ADS)

    Masoud, Hassan; Becker, Alexander; Ristroph, Leif; Shelley, Michael

    2014-11-01

    We examine the locomotion of an infinite array of wings that heave vertically with a prescribed sinusoidal motion and are free to translate in the horizontal direction. To do this, we simulate the motion of a freely translating flapping airfoil in a domain with periodic horizontal boundary conditions. These simulations indicate that the wings can ``take advantage'' of their collectively generated wake flows. In agreement with our experiments in a rotational geometry, we find ranges of flapping frequency over which there are multiple stable states of locomotion, with one of these swimming states having both higher speeds and efficiencies than an isolated flapping and locomoting wing. A simple mathematical model, which emphasizes the importance of history dependence in vortical flows, explains this multi-stability. These results may be important to understanding the role of hydrodynamic interactions in fish schooling and bird flocking.

  3. Efficient flapping flight of pterosaurs

    NASA Astrophysics Data System (ADS)

    Strang, Karl Axel

    In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for

  4. Pedicled posteromedial thigh (PMT) flap: A new alternative for groin defect reconstruction.

    PubMed

    Scaglioni, Mario F; Enrique Carrillo Jimenez, Leonardo; Kuo, Yur-Ren; Chen, Yen-Chou

    2015-11-26

    The posterior medial thigh is mainly vascularized by the profunda femoris artery (PFA), which nourishes the adductor magnus muscle and overlying skin, to supply a number of perforators that can potentially be used as pedicles for local perforator flaps. Here we present two cases utilizing the pedicled posteromedial thigh flap (PMT) to reconstruct the groin defects. Two patients underwent resection for metastatic malignant melanoma resulting in large defects of the groin with exposure of major inguinal vessels; the dimensions of the skin defects were 15 cm × 5 cm and 16 cm × 6 cm, two ipsilateral pedicled PMT flaps were designed to cover the defects. The pedicled PMT flaps were based on perforators arising from the PFA and were transposed through a submuscular tunnel into the defect. The postoperative course was uneventful and the wounds were reconstructed successfully. The pedicled PMT flap may be an option for reconstruction of groin defects and could be incorporated into the armamentarium of the reconstructive microsurgeon. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

  5. Skin Cancer

    MedlinePlus

    ... version of this page please turn Javascript on. Skin Cancer What is Skin Cancer? Skin cancer is the most common type ... of approximately 9,480 Americans in 2013. Can Skin Cancer Be Treated? Most basal cell and squamous ...

  6. Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study.

    PubMed

    Tamburino, Serena; Menez, Tiphaine; Laloze, Jérôme; Michot, Audrey; Paillet, Pierre; Perrotta, Rosario Emanuele; Casoli, Vincent

    2017-02-24

    Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dissection revealed the perforator's direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the serratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the possibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valuable option when harvesting a perforator flap in the lateral chest area.

  7. Fibular flap for mandibular reconstruction: are there old tricks for an old dog?

    PubMed

    Pitak-Arnnop, P; Hemprich, A; Dhanuthai, K; Pausch, N C

    2013-02-01

    Fibular free flap is considered as an "old dog" in reconstructive surgery because it was first described by Taylor and his colleagues in 1975, and was then introduced for mandibular reconstruction by Hidalgo in 1989. There are some "tricks" for fibular free flap that have been used and recognized in many European maxillofacial surgical units over the past decade. These include: 1) harvesting the distal fibula when recipient vessels are distant; 2) flap selection based on the anatomy of perforators; 3) use of the skin paddle for postoperative flap monitoring; 4) protection of the flap's soft-tissue cuff; 5) preventing venous thrombosis which is essential to reduce flap complications; 6) aligning fibular struts and protecting the vascular pedicle when the double-barrel technique is used; 7) minimizing the gap between the double-barrel struts and implementing a long-term follow-up of dental implants; 8) selecting osteosynthesis materials; and 9) learning curve and clinical competence in microvascular reconstruction. We also reviewed current data from the literature, which would be useful for maxillofacial reconstructive surgeons. With these tricks, one can teach an "old dog" "old tricks".

  8. Free neurovascular flap from the first web of the foot in hand reconstruction.

    PubMed

    May, J W; Chait, L A; Cohen, B E; O'Brien, B M

    1977-09-01

    To identify an anatomically reliable and functionally acceptable neurovascular free flap for use in hand reconstruction, 50 fresh cadaver feet were dissected under the operating microscope, with particular attention paid to the anatomy of the first web area. A distal communicating artery was seen in 100% of dissections, allowing either dorsal or plantar donor artery inflow to nourish the entire flap area. Because of the ease of dissection, the first dorsal metatarsal or dorsalis pedis is suggested as the donor artery, and a dorsal branch of the greater saphenous venous system is suggested as the donor vein. The deep peroneal nerve was seen to consistently innervate the first web and, along with the plantar digital nerves, is suggested as an anatomically identifiable donor nerve. Either part of the foot first web may be used alone or together as a free flap. When indicated further dorsal skin may be incorporated into the web flap to expand its application. Two-point discrimination studies of the lateral plantar surface of the great toe in 50 normal individuals showed an average of 11.2 mm. This was significantly better as a potential donor flap than the medial dorsum of the foot where the average was 32 mm. A single case demonstrating the application of this flap in hand reconstruction is presented.

  9. Studies of the Scottish oil shale industry. Final report. Volume 2. Shale workers' pneumoconiosis and skin conditions: epidemiological surveys of surviving ex-shale workers

    SciTech Connect

    Louw, S.J.; Cowie, H.; Seaton, A.

    1985-03-01

    This report (in 3 volumes) describes the now defunct Scottish oil shale industry and its effects on the health of its workers. This volume investigates the prevalence of skin disease and pneumoconiosis in Scottish ex-oil shale workers. A cross sectional epidemiological survey has been carried base on a population enrolled in the 1950 Scottish Oils Ltd Provident Fund. Investigation of the Fund indicated that it would have included almost all industrial workers employed in the oil shale industry between 1950 and its closure in 1962. It is concluded that workers in the Scottish shale oil industry in its latter years were not at excess risk of skin disease, perhaps because of steps taken within the industry to reduce the known hazards of dermatitis and skin cancer. However, pneumoconiosis was a definite hazard of miners and retort workers and its presence was associated with an impairment of lung function suggestive of fibrosis and possibly emphysema as well. It is suggested that prevention of this hazard might sensibly be based on the strategy used in the coalmining industry and, in the absence of further information on dust and fume exposures of shale workers, standards as applied in coalmining should be appropriate. Radiological surveillance of dust-exposed workers, whether in mines or at retorts or tips, is recommended. 39 refs., 10 figs., 48 tabs.

  10. Reconstructive indications of simultaneous double free flaps in the head and neck: a case series and literature review.

    PubMed

    Balasubramanian, Deepak; Thankappan, Krishnakumar; Kuriakose, Moni Abraham; Duraisamy, Sriprakash; Sharan, Rajeev; Mathew, Jimmy; Sharma, Mohit; Iyer, Subramania

    2012-09-01

    Extensive and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap. The indications of the simultaneous use of double free flaps can be broadly classified as: (a) large oro-mandibular bone and soft tissue defects (n = 13), (b) large oro-mandibular soft tissue defects (n = 4), (c) complex skull-base defects (n = 2), and (d) dynamic total tongue reconstruction (n = 2). Flap survival rate was 95%. Median follow-up period was 11 months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of flap combination for the appropriate indications is proposed.

  11. Composite vascularized skin/bone transplantation models for bone marrow-based tolerance studies.

    PubMed

    Ozmen, Selahattin; Ulusal, Betul G; Ulusal, Ali E; Izycki, Dariusz; Siemionow, Maria

    2006-03-01

    There is an ongoing need to understand the mechanisms of bone marrow-based allograft tolerance. This is important in clarifying the diverse variables influencing the ultimate outcome of the solid organ and composite tissue transplants. To establish bone marrow transplantation as a routine clinical application, further experimental studies should be conducted to overcome the obstacles related to the bone marrow transplantation. These obstacles include graft versus host disease, immunocompetence, and toxicity of the conditioning regimens. For these purposes, novel experimental models are needed. In an attempt to provide a reliable research tool for bone marrow-based tolerance induction studies, we introduced different experimental models of modified vascularized skin/bone marrow (VSBM) transplantation technique for tolerance induction, monitoring, and maintenance studies. In this skin/bone transplantation model, the technical feasibility of concurrent or consecutive transplantation of the combination of bilateral vascularized skin, vascularized bone marrow, or vascularized skin/bone marrow transplants was investigated. Isograft transplantations were performed between genetically identical Lewis (LEW, RT1) rats. Five different experimental designs in 5 groups of 5 animals each were studied. Group I: Bilateral vascularized skin (VS) transplantation; group II: bilateral vascularized skin/bone transplantation; group III: vascularized skin transplantation on one side and vascularized skin/bone transplantation on the contralateral side; group IV: vascularized bone transplantation on one side and vascularized skin/bone transplantation on the contralateral side; group V: vascularized bone transplantation on one side and vascularized skin transplantation on the contralateral side. Successful transplantations were performed in all groups. The survival of the isograft transplants was evaluated clinically and histologically. All skin flaps remained pink and pliable and grew new

  12. Cracking the perfusion code?: Laser-assisted Indocyanine Green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps.

    PubMed

    Ludolph, Ingo; Arkudas, Andreas; Schmitz, Marweh; Boos, Anja M; Taeger, Christian D; Rother, Ulrich; Horch, Raymund E; Beier, Justus P

    2016-10-01

    The aim of this prospective study was to assess the correlation of flap perfusion analysis based on laser-assisted Indocyanine Green (ICG) angiography with combined laser Doppler spectrophotometry in autologous breast reconstruction using free DIEP/ms-TRAM flaps. Between February 2014 and July 2015, 35 free DIEP/ms-TRAM flaps were included in this study. Besides the clinical evaluation of flaps, intraoperative perfusion dynamics were assessed by means of laser-assisted ICG angiography and post-capillary oxygen saturation and relative haemoglobin content (rHb) using combined laser Doppler spectrophotometry. Correlation of the aforementioned parameters was analysed, as well as the impact on flap design and postoperative complications. Flap survival rate was 100%. There were no partial flap losses. In three cases, flap design was based on the angiography, contrary to clinical evaluation and spectrophotometry. The final decision on the inclusion of flap areas was based on the angiographic perfusion pattern. Angiography and spectrophotometry showed a correlation in most of the cases regarding tissue perfusion, post-capillary oxygen saturation and relative haemoglobin content. Laser-assisted ICG angiography is a useful tool for intraoperative evaluation of flap perfusion in autologous breast reconstruction with DIEP/ms-TRAM flaps, especially in decision making in cases where flap perfusion is not clearly assessable by clinical signs and exact determination of well-perfused flap margins is difficult to obtain. It provides an objective real-time analysis of flap perfusion, with high sensitivity for the detection of poorly perfused flap areas. Concerning the topographical mapping of well-perfused flap areas, laser-assisted angiography is superior to combined laser Doppler spectrophotometry.

  13. The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients

    PubMed Central

    Ignatiadis, Ioannis A.; Tsiampa, Vassiliki A.; Galanakos, Spyridon P.; Georgakopoulos, Georgios D.; Gerostathopoulos, Nicolaos E.; Ionac, Mihai; Jiga, Lucian P.; Polyzois, Vasilios D.

    2011-01-01

    The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 11 men and 5 women with an average age of 41 years (17-81) and with a follow-up period between 2 and 7 years. The etiology was major velocity accident in six cases, diabetes mellitus with osteomyelitis after ORIF for fractures (2), work accident in five, and another two cases with complications of lower limb injuries. The defect areas were located on calcaneus, malleolar area, tarsal area and lower tibia. Associated risk factors in the patients for the flap performance were diabetes (five patients) and cigarette smoking (ten patients). The technique is based on the use of a reverse-flow island sural flap combined with other flaps in three cases (cross-leg, peroneal, gastrocnemius). The anatomical structures which constituted the pedicle were the superficial and deep fascia, the sural nerve, the lesser saphenous vein and skin. The flap was viable in all 15 patients. On 8 cases was achieved direct closure, on three cases occurred a superficial necrosis and was skin grafted, on one case was observed partial necrosis which was treated with a second flap (posterior tibial perforator flap) and another one occurred delayed skin healing. The sural fasciocutaneous flap is useful for the treatment of severe and complex injuries and their complications in diabetic and non diabetic lower limbs. Its technical advantages are easy dissection, preservation of more important vascular structures in the limb and complete coverage of the soft tissue defects in just one operation without the need of microsurgical anastomosis. Thus this flap offers excellent donor sites for repairing soft tissue defects in foot and ankle. PMID:22396826

  14. The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients.

    PubMed

    Ignatiadis, Ioannis A; Tsiampa, Vassiliki A; Galanakos, Spyridon P; Georgakopoulos, Georgios D; Gerostathopoulos, Nicolaos E; Ionac, Mihai; Jiga, Lucian P; Polyzois, Vasilios D

    2011-01-01

    The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 11 men and 5 women with an average age of 41 years (17-81) and with a follow-up period between 2 and 7 years. The etiology was major velocity accident in six cases, diabetes mellitus with osteomyelitis after ORIF for fractures (2), work accident in five, and another two cases with complications of lower limb injuries. The defect areas were located on calcaneus, malleolar area, tarsal area and lower tibia. Associated risk factors in the patients for the flap performance were diabetes (five patients) and cigarette smoking (ten patients).The technique is based on the use of a reverse-flow island sural flap combined with other flaps in three cases (cross-leg, peroneal, gastrocnemius). The anatomical structures which constituted the pedicle were the superficial and deep fascia, the sural nerve, the lesser saphenous vein and skin.The flap was viable in all 15 patients. On 8 cases was achieved direct closure, on three cases occurred a superficial necrosis and was skin grafted, on one case was observed partial necrosis which was treated with a second flap (posterior tibial perforator flap) and another one occurred delayed skin healing.The sural fasciocutaneous flap is useful for the treatment of severe and complex injuries and their complications in diabetic and non diabetic lower limbs. Its technical advantages are easy dissection, preservation of more important vascular structures in the limb and complete coverage of the soft tissue defects in just one operation without the need of microsurgical anastomosis. Thus this flap offers excellent donor sites for repairing soft tissue defects in foot and ankle.

  15. Reverse-flow anterolateral thigh perforator: an ad hoc flap for severe post-burn knee contracture.

    PubMed

    Ismail, H A; El-Bassiony, L E

    2016-03-31

    We evaluate function outcomes of the reverse-flow ALT perforator flap to reconstruct severe post-burn knee contracture. Between October 2012 and December 2014, 10 patients with severe post-burn knee contracture were subjected to reconstruction with 10 ipsilateral reversed-flow ALT perforator flaps. All the patients were male. Ages ranged from 15 to 47 years (mean = 32 years). Time from burn injury to patient presentation ranged from 2-8 months. All patients demonstrated post-burn flexion contracture of the knee joint, ranging from 35 to 75 degrees. Flap sizes ranged from 8×16 to 12×26 cm. The flaps and skin grafts were carried out without major complications. Only minor complications occurred, such as transient, mild congestion immediately after inset in two flaps. Two flaps developed superficial necrosis at the distal edge. One case sustained partial skin graft loss due to haematoma. One case complained of skin hyperpigmentation and hypertrophic scars around the graft. Secondary debulking procedures were required in two cases. The entire donor sites were closed by partial thickness skin graft with acceptable appearance, except one case that was closed primarily. Eight out of ten patients (80%) demonstrated gradual improvement in range of knee motion after a specialized rehabilitation program. Two patients (20%) did not get back full range of motion. RALT perforator flap is the cornerstone for the reconstruction of soft-tissue defects around the knee with acceptable aesthetic and functional results provided that the following items are fulfilled: inclusion of muscle cuff around the pedicle, the pivot point, prevention of pedicle compression after transfer and early surgical intervention on the post-burn knee contracture.

  16. Use of bipedicular advancement flaps for intrauterine closure of myeloschisis.

    PubMed

    Mangels, K J; Tulipan, N; Bruner, J P; Nickolaus, D

    2000-01-01

    Several groups have begun to explore the feasibility and utility of intrauterine closure of myelomeningocele. A subset of these fetuses have defects which fall into the category of myeloschisis, and therefore have inadequate skin to enable primary closure. After considerable discussion, it was decided to utilize bipedicular flaps to close these lesions. The procedure is described, and representative examples are shown. To date, 13 of 56 fetuses have required this approach for closure in utero. While this technique generally provides adequate coverage of the dural sac, the cosmetic results have been less than optimal.

  17. The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease

    PubMed Central

    Wisenbaugh, Eric S.; Gelman, Joel

    2015-01-01

    The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin. PMID:26664357

  18. Indications for the microvascular medial femoral condylar flap in craniomaxillofacial surgery.

    PubMed

    Thiele, Oliver Christian; Kremer, Thomas; Kneser, Ulrich; Mischkowski, Robert Andreas

    2014-07-01

    The medial femoral condylar flap makes it possible to reconstruct bone, cartilage, and skin, but elongation of the pedicle is usually required to bridge the distances to the vascular connections in the neck. The indications in the maxillofacial area include reconstruction of the temporomandibular joint (TMJ), pseudarthrosis of the jaws, osteonecrosis of the jaws and skull, and augmentation of bone in irradiated or otherwise compromised tissue. If small bony defects require safe and reliable osseous, osteochondral, or osteocutaneous reconstruction, the medial femoral condylar flap can be used to fill the gap between small avascular, and larger microvascular, bone transplants.

  19. Free filet extremity flap: indications and options for reconstruction.

    PubMed

    Tran, N V; Evans, G R; Kroll, S S; Miller, M J; Reece, G P; Ainsle, N; Robb, G L

    2000-01-01

    Radical and extended forequarter and hind limb amputations have been used for curative and palliative intents. Concerns regarding wound healing and closure, especially in irradiated fields, have occasionally limited the extent of ablation. This article reports an experience with coverage of these large defects by using the free filet extremity flap. A retrospective review was performed of 11 patients who had undergone immediate reconstruction with free filet extremity flaps between 1991 and 1998. There were nine men and two women with an average age of 43.9 years. All except three patients received preoperative radiotherapy. Resections included four hindquarter and seven forequarter amputations for palliation of intractable pain, tissue necrosis, and infections. Donor vessels included the brachial artery, its venae comitantes, cephalic and basilic veins, and common femoral and popliteal vessels. Immediate reconstruction was successful in all cases by the use of the amputated limb as the free filet flap. All wounds healed despite irradiation inclusive of defects up to 50 cm x 70 cm (3500 cm2). The average follow-up time was 5 months with a mean survival of 3.5 months. Four patients currently are alive, and one patient died within 30 days of surgery. The remaining six patients have died of their disease within 9 months of the palliative procedures. Pain, tissue necrosis, and infections were improved in all patients after hospital discharge. Extensive defects can be reconstructed and healed successfully, even in irradiated wounds, with the use of the free filet extremity flap. Appropriate advanced preoperative and intraoperative planning is essential. Although survival was unchanged, this technique allowed healed wounds with an improvement in the quality of life.

  20. [Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].

    PubMed

    Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F

    2015-06-01

    We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations.

  1. Achieving Direct Closure of the Anterolateral Thigh Flap Donor Site—An Algorithmic Approach

    PubMed Central

    Pachón Suárez, Jaime Eduardo; Sadigh, Parviz Lionel; Shih, Hsiang-Shun; Hsieh, Ching-Hua

    2014-01-01

    Background: Minimizing donor-site morbidity after free flap harvest is of paramount importance. In this article, we share our experience with achieving primary closure of 58 anterolateral thigh (ALT) free flap donor sites using a simple algorithm in cases where primary closure would otherwise have not been possible. Methods: Between 2004 and 2010, 58 patients who underwent free ALT flap reconstruction were included in the study. The inclusion criteria were those who had flap width requirements that were wider than 16% of the thigh circumference and had achieved direct primary closure of the donor site by the use of our technique. Results: Primary closure of the donor sites was facilitated in all cases by the use of 3 distinct techniques. This included the use of the V-Y advancement technique in 13 patients, split skin paddle technique in 7 patients, and the tubed skin paddle design in 38 patients. No episodes of postoperative wound dehiscence at the donor site were encountered; however, 2 cases were complicated by superficial wound infections that settled with a course of antibiotics. Conclusions: Direct primary closure of the ALT donor site can be facilitated by the use of our simple algorithm. Certain strategies need to be adopted at the design stage; however, the techniques used are simple and reliable, produce superior cosmetic results at the donor site, save time, and spare the patient the morbidity associated with the harvest of a skin graft. PMID:25426349

  2. Sternocleidomastoid Muscle Flap after Parotidectomy.

    PubMed

    Nofal, Ahmad Abdel-Fattah; Mohamed, Morsi

    2015-10-01

    Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.

  3. Force Generation by Flapping Foils

    NASA Astrophysics Data System (ADS)

    Bandyopadhyay, P. R.; Donnelly, M.

    1996-11-01

    Aquatic animals like fish use flapping caudal fins to produce axial and cross-stream forces. During WW2, German scientists had built and tested an underwater vehicle powered by similar flapping foils. We have examined the forces produced by a pair of flapping foils. We have examined the forced produced by a pair of flapping foils attached to the tail end of a small axisymmetric cylinder. The foils operate in-phase (called waving), or in anti-phase (called clapping). In a low-speed water tunnel, we have undertaken time-dependent measurements of axial and cross-stream forces and moments that are exerted by the vortex shedding process over the entire body. Phase-matched LDV measurements of vorticity-velocity vectors, as well as limited flow visualization of the periodic vortex shedding process have also been carried out. The direction of the induced velocity within a pair of shed vortices determines the nature of the forces produced, viz., thrust or drag or cross-stream forces. The clapping mode produces a widely dispersed symmetric array of vortices which results in axial forces only (thrust and rag). On the other hand, the vortex array is staggered in the waving mode and cross-stream (maneuvering) forces are then generated.

  4. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up

    PubMed Central

    Ortiz-Dominguez, Abel

    2016-01-01

    Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112

  5. Endoscopic ICG perfusion imaging for flap transplants: technical development

    NASA Astrophysics Data System (ADS)

    Stepp, Herbert; Schachenmayr, Hilmar; Ehrhardt, André; Göbel, Werner; Zhorzel, Sven; Betz, Christian Stephan

    2010-02-01

    Objective: Following tumour surgery in the head and neck region, skin flap transplants are usually required to cover the resection area. The purpose of the development was to provide a simple and reliable means to assess whether the transplanted flap is sufficiently perfused. Methods: Fluorescence of intravenously injected Indocyanine green (ICG) was detected with a slightly modified 3-chip CCD camera. Appropriately coated optical filters allow for excitation of ICG with NIR light and detection of NIR ICGfluorescence with the blue channel of the camera. In addition, low intensities of white light can be transmitted to allow for simultaneous display of a remission image in the green and red channels of the camera. Further processing was performed with a LabVIEW program. Results: A satisfactory white light image (red, green and blue display (RGB)) could be calculated from the remission images recorded with the green and red channels of the camera via a look-up table. The look-up table was programmed to provide an optimized blue intensity value for each combination of red and green values. This was generated using a reference image. Implementation of image tracking and intensity measurements in regions of interest (ROIs) in the images is useful to reliably monitor perfusion kinetics of flap and adjacent normal tissue.

  6. Chitosan/TiO2 composite membrane improves proliferation and survival of L929 fibroblast cells: Application in wound dressing and skin regeneration.

    PubMed

    Behera, Sudhanshu Shekhar; Das, Urmimala; Kumar, Awanish; Bissoyi, Akalabya; Singh, Abhishek Kumar

    2017-05-01

    The microbial infection and growth of fibroblasts are the critical factors for the effective wound healing. The natural polymer-based dressing membranes may mimic extracellular matrix to support the survival, proliferation and differentiation of fibroblasts. The present study deals with the preparation of chitosan/titanium dioxide (CS/TiO2) composite membranes with different degree of TiO2 incorporation, and their characterization in terms of morphology, ultrastructure, thermal behavior and mechanical properties with SEM, FTIR, XRD and tensile strength analyses. The data demonstrated the formation of strong O-Ti-O bonding between TiO2 and CS resulting in superior porosity, mechanical strength, crystallinity and flexibility of the composite membranes. Further, the cyto-compatibility, proliferation, oxidative stress, cell cycle and apoptosis analyses of fibroblast L929 cells demonstrated the enhanced proliferation and survival, and decreased oxidative stress and apoptosis in L929 cells grown on CS/TiO2 membrane incorporated with 025% TiO2. Next, we measured the significant up-regulation in the expression of fibroblast-markers in L929 cells cultured on CS/TiO2 (0.25%) membrane. Furthermore, the CS/TiO2 composite membranes exhibited a superior antibacterial activity against Staphylococcus aureus. Taken together, the data confirmed that CS/TiO2 (0.25%) membrane improved the growth, survival and functional integrity of fibroblasts, and exerted antibacterial activity which may be utilized as potential dressing materials.

  7. Awkward defects around the elbow: The radial recurrent artery flap revisited

    PubMed Central

    Devale, Maksud M.; Munot, Rohit P.; Bhansali, Chirag A.; Bhaban, Neeraj D.

    2016-01-01

    Background: Soft tissue defects on the posterior aspect of the elbow are commonly seen in patients treated with internal fixation for fractures around the elbow joint. An axial flap based on the radial recurrent artery (RRA) is very useful for such defects, especially if a posterior midline arm incision has been taken for skeletal fixation. The aim of this study is to describe the usefulness of RRA flap (based on the RRA) in the management of such defects. Materials and Methods: We present a retrospective analysis of 4 cases managed with the RRA flap for soft tissue reconstruction of defects around the elbow joint at our institute from January 2015 to August 2016. All the patients were males with a history of exposed implant following internal fixation of olecranon/distal humerus fracture. The size of defects ranged from 4 cm × 4 cm to 7 cm × 5 cm. Results of the analysis are presented here. Results: All flaps survived completely. There was no infection, hematoma or distal neurovascular deficit. There was minimal donor site morbidity. Conclusion: The RRA flap is a useful, simple flap for defects around the elbow joint in select patients providing one stage, reliable, cosmetically acceptable coverage. PMID:28216816

  8. Modified Facial Artery Musculomucosal Flap for Reconstruction of Posterior Skull Base Defects

    PubMed Central

    Xie, Liyue; Lavigne, Philippe; Lavigne, François; Ayad, Tareck

    2016-01-01

    Objectives The superiorly pedicled facial artery musculomucosal (FAMM) flap has been successfully used for reconstruction of head and neck defects since 1992. Common sites of defects include the oral cavity and oropharynx. This article presents a clinical case in which we have successfully used a newly developed modification of the FAMM flap for bulky nasopharyngeal and skull base reconstruction. Results Our patient is a 71-year-old man who presented with a large parapharyngeal and clival chordoma. After tumor removal through combined endoscopic and cervical approach, the internal carotid artery (ICA) in the nasopharyngeal portion was left exposed. A modified superiorly based FAMM flap measuring up to 10 cm in length and 2.5 cm in width was successfully harvested and used to completely cover the defect and the ICA. The flap survived local radiation therapy at the long-term follow-up. Conclusion We have developed a new modification of the FAMM flap, using the fascia of the masseter muscle. This is the first reported case in the literature using a modified FAMM flap for the reconstruction of nasopharyngeal and skull base defect. PMID:27330928

  9. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...

  10. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...

  11. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...

  12. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...

  13. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...

  14. The Golden Spiral Flap: A New Flap Design that Allows for Closure of Larger Wounds under Reduced Tension – How Studying Nature’s Own Design Led to the Development of a New Surgical Technique

    PubMed Central

    Paul, Sharad P.

    2016-01-01

    This paper details the study of biodynamic excisional skin tension lines on the scalp and the development of a new flap technique for closure of scalp wounds. Recently, a study by this author, on pigskin, replicated whorls by placing tissue under rapid stretch using saline tissue expanders, by recreating rapid dermo-epidermal shear of skin – thereby concluding that the golden spiral pattern is nature’s own pattern for rapid expansion. Given the relationship between tissue expansion and stretch has been shown to cause deformation gradients that have both elastic and growth factors, the author set out to test the hypothesis that a golden spiral pattern therefore would be more efficient at closing wounds under less tension when compared with standard semicircular rotational flap patterns. The author conducted a series of experiments, both on pigskin (to first confirm the hypothesis, using a recently developed computerized tensiometer) and later a clinical study. This paper presents a new random pivotal flap technique for skin closures on the head and neck: the golden spiral flap. Biomechanics, planning, and advantages of this new flap are described in this paper. PMID:27900320

  15. The Golden Spiral Flap: A New Flap Design that Allows for Closure of Larger Wounds under Reduced Tension - How Studying Nature's Own Design Led to the Development of a New Surgical Technique.

    PubMed

    Paul, Sharad P

    2016-01-01

    This paper details the study of biodynamic excisional skin tension lines on the scalp and the development of a new flap technique for closure of scalp wounds. Recently, a study by this author, on pigskin, replicated whorls by placing tissue under rapid stretch using saline tissue expanders, by recreating rapid dermo-epidermal shear of skin - thereby concluding that the golden spiral pattern is nature's own pattern for rapid expansion. Given the relationship between tissue expansion and stretch has been shown to cause deformation gradients that have both elastic and growth factors, the author set out to test the hypothesis that a golden spiral pattern therefore would be more efficient at closing wounds under less tension when compared with standard semicircular rotational flap patterns. The author conducted a series of experiments, both on pigskin (to first confirm the hypothesis, using a recently developed computerized tensiometer) and later a clinical study. This paper presents a new random pivotal flap technique for skin closures on the head and neck: the golden spiral flap. Biomechanics, planning, and advantages of this new flap are described in this paper.

  16. Monitoring of intraoral free flaps with microdialysis.

    PubMed

    Nielsen, Henrik Toft; Gutberg, Nils; Birke-Sorensen, Hanne

    2011-10-01

    Because of the confined nature of their position, monitoring intraoral free flaps is a challenge, but it is essential to detect vascular complications in time to ensure the possibility of salvaging the flap. Microdialysis has been the standard technique of choice at the Department of Plastic Surgery, Aarhus University Hospital, since September 1998. In this study we present our experience of monitoring 78 intraoral free flaps. It is a retrospective evaluation of patients' casenotes from November 1998 to March 2008. Sixty-five of the 78 flaps healed without complications. Sixty-one of these showed no sign of ischaemia in the microdialysis values; in 4 cases the microdialysis system caused technical problems. Thirteen patients were reoperated on based on the results of microdialysis analysis, and in all but 2 cases critical ischaemia was found. Ten of the 11 critically ischaemic flaps were saved. The overall loss rate of flaps was 1.3%. The 2 flaps that were reoperated on but no critical ischaemia found were 2 fibular flaps during the time that we were learning how to monitor with microdialysis (1999 and 2000). Since then we have developed a decision algorithm for standard monitoring, and since 2000 we have had no false positive results. We have never lost a flap from neglected ischaemia. Our results show that microdialysis is a safe and reliable technique for postoperative monitoring of intraoral free flaps.

  17. What’s the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?

    PubMed Central

    Wei, Jiao; He, Jinguang; Wang, Tao; Liu, Ying; Xu, Hua; Dong, Jiasheng

    2017-01-01

    Background We developed a novel pedicled DIEP flap model in rat to explore the possible remedy for the distal necrosis of the flap. Methods A deep inferior epigastric perforator (DIEP) flap, based on the second right cranial perforator (P2) as the main pedicle, was elevated in 48 Sprague-Dawley rats. The rats were randomized into 4 groups: group I, the left P2 remaining intact as supercharging; group II, the left P2 artery alone kept as supercharging; group III, the left P2 vein alone kept as supercharging; group IV, no supercharging. Transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) were measured immediately after flap elevation, protein level of Hif-1a was measured 48 hours later, and flap survival was assessed 7 days postoperatively. Results Blockade of artery led to significantly lower TcPO2, higher TcPCO2, and higher expression level of Hif-1a in the distal side of the flap in group III and group IV, than those of group I and group II. At 7 days post surgery, significantly lower flap survival rates were observed in group III (81.9 ± 5.7%) and group IV (78.4 ± 6.5%), compared to observed in group I (97.2 ± 3.0%) and group II (94.2 ± 6.2%). Conclusions It might be arterial insufficiency, not venous congestion, which mainly caused the distal necrosis of the DIEP flap in rat. Arterial instead of venous supercharging might be a more effective procedure that improves circulation to zone IV of the flap. PMID:28187214

  18. Large antigenic skin load in total abdominal wall transplants permits chimerism induction.

    PubMed

    Nasir, Serdar; Bozkurt, Mehmet; Klimczak, Aleksandra; Siemionow, Maria

    2008-11-01

    The application of composite tissue allograft (CTA) transplants in clinical reconstruction is parallel with extended knowledge of anatomy, microsurgical skills and development of transplantation immunology. CTAs are composed of multiple tissues, some of which such as skin are highly immunogenic and cause strong immunologic responses. Strong antigenic nature of skin may be related to Langerhans cells, which are powerful antigen-presenting cells. They are leukocytes found in the epidermis as members of immunologic cascade. Large skin components of CTA transplant may cause higher antigenic load as a result of increased surface area of transplanted skin correlating with increased load of Langerhans cells. In clinical abdominal wall transplants, increased rejection episodes were reported compared with other CTA transplant. This complication may correlate to large skin component of these transplants. To evaluate correlation between large skin island flaps and immunologic responses, CTA models with large skin components should be tested in experimental studies. Here we propose a total abdominal wall (TAW) transplant model in rat to test the feasibility of TAW transplantation in 2 groups: the anatomic study and experimental transplantation group. In anatomic study, TAW flaps were elevated bilaterally on superficial epigastric vessels and replaced. The entire TAW skin islands of all flaps were viable at postoperative day 21. Dye study confirmed that TAW flap was supplied by 2 vascular pedicles. Data in this group demonstrated that this flap is composed of the largest skin island when compared with other CTA transplant models such as full face, hemiface, limb, and groin flap. In experimental group, isograft transplantations were performed between Lewis rats (RT1(1)) while allograft transplantations were performed Lewis (RT1(1)) donors and LBN (RT(1+n)) recipients. All TAW transplants showed viable islands at posttransplant day 200 under cyclosporine A monotherapy protocol

  19. Composite tissue flap at perforating branches of saphenous artery: a new design for repairing composite tissue defects in anterior knee.

    PubMed

    Sun, Guangfeng; Nie, Kaiyu; Jin, Wenhu; Wei, Zairong; Qi, Jianping; Wang, Dali

    2015-01-01

    So far it has been difficult to repair and reconstruct the composite tissue defects in knee. Saphenous artery flap has been widely used to repair complex wounds, but the design and clinical application of composite tissue flap at perforating branches of saphenous artery were not reported. In this research, we design a new composite tissue flap by carrying fascial flap in the medial gastrocnemius muscle with perforators flap in saphenous artery to repair and reconstruct the composite tissue defects in knee. By anatomic observation and analysis, we find that there exists blood-supply in netty form among saphenous arteries, medial artery below the knee, intermuscular branch in high-order position of posterior tibial artery and perforating branch in medial artery of calf. We chose saphenous artery as blood-supplying artery; utilized the netty blood-supplying mode in middle-up and medial part of shank; cut the composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle; reconstructed the ligamentum patellae using medial head of gastrocnemius muscle and Achilles's tendon; and covered the wounds at front side of knee with flap. Composite tissues were survived completely, free from infection at wounds and exosmosis of joint fluid. Motion function of knee-joint proved satisfactory, and ambulatory function was recovered. There was no complication in donor site. Composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle is one of the most ideal solutions for repairing the composite tissue defects at front side of knee joint.

  20. Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis

    PubMed Central

    Satake, Toshihiko; Nakasone, Reiko; Kobayashi, Shinji; Maegawa, Jiro

    2016-01-01

    The lumbar artery perforator (LAP) flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast. PMID:27274129

  1. Excitation, response, and fatigue life estimation methods for the structural design of externally blown flaps

    NASA Technical Reports Server (NTRS)

    Ungar, E. E.; Chandiramani, K. L.; Barger, J. E.

    1972-01-01

    Means for predicting the fluctuating pressures acting on externally blown flap surfaces are developed on the basis of generalizations derived from non-dimensionalized empirical data. Approaches for estimation of the fatigue lives of skin-stringer and honeycomb-core sandwich flap structures are derived from vibration response analyses and panel fatigue data. Approximate expressions for fluctuating pressures, structural response, and fatigue life are combined to reveal the important parametric dependences. The two-dimensional equations of motion of multi-element flap systems are derived in general form, so that they can be specialized readily for any particular system. An introduction is presented of an approach to characterizing the excitation pressures and structural responses which makes use of space-time spectral concepts and promises to provide useful insights, as well as experimental and analytical savings.

  2. Pedicle Temporalis Fascial Flap with Axial Scalp Flap Obviates Need of Free Flap in Extensive Scalp Wound

    PubMed Central

    Khainga, S. O.

    2017-01-01

    Extensive scalp defect with exposed bone is best reconstructed with flaps. Majority of these wounds are now routinely reconstructed with free flaps in many centers. Free flaps however require lengthy operative time and may not be available to all patients, where possible less extensive options should thus be encouraged. A sixty-eight-year-old patient presented to us with a Marjolin's ulcer on the vertex of the scalp. After wide local excision a defect of about 17 cm and 12 cm was left. The defect was successfully covered with a combination of an ipsilateral pedicle temporalis fascial flap and an axial supraorbital scalp flap with good outcome. In conclusion wide defects of the scalp can be fully covered with a combination of local flaps. The axial scalp flap and the pedicle temporalis fascial flap where applicable provide an easy and less demanding option in covering such wounds. These flaps are reliable with good blood supply and have got less donor side morbidity. PMID:28194294

  3. Skin Conditions

    MedlinePlus

    Your skin is your body's largest organ. It covers and protects your body. Your skin Holds body fluids in, preventing dehydration Keeps harmful ... it Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, ...

  4. Aging Skin

    MedlinePlus

    ... email address Submit Home > Healthy Aging > Wellness Healthy Aging Aging skin More information on aging skin When it ... treated early. Return to top More information on Aging skin Read more from womenshealth.gov Varicose Veins ...

  5. The free iliac flap: a lateral modification of the free groin flap.

    PubMed

    Acland, R D

    1979-07-01

    A lateral modification of the free groin flap, called the free iliac flap, is presented. By moving the outline of the free groin flap laterally, so that the medial margin lies lateral to the underlying femoral triangle, a flap is obtained which is uniformly slender and which has a long vascular pedicle. The anatomical findings, a method for safe dissection of the superficial circumflex iliac vessels, and the results of 18 clinical cases are presented.

  6. An extraordinary case of axillary contracture: trapped healthy skin and its adnexes under contracted scar.

    PubMed

    Nisanci, Mustafa; Sahin, Ismail; Guzey, Serbulent

    2014-01-01

    Although striking improvements have been achieved in overall management of burn injury, postburn contractures are still an ongoing challenge to burn surgeons. Axillary adduction contracture is one of the most common types of these disabling postburn complications that usually result from suboptimal treatment after acute burns. An unusual and complicated case of axillary contracture in which the unburned, healthy axillary dome skin was trapped as a cystic mass under the scarred area was reconstructed by transfer of a big (17×13-cm) thoracodorsal artery perforator flap after contracture release. The result was satisfactory in terms of function and acceptable cosmetically. The underlying reasons for the inadequate treatment the patient received after surviving a severe electrical injury were discussed.

  7. Pressure Distribution Over Airfoils with Fowler Flaps

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Anderson, Walter B

    1938-01-01

    Report presents the results of tests made of a Clark y airfoil with a Clark y Fowler flap and of an NACA 23012 airfoil with NACA Fowler flaps. Some of the tests were made in the 7 by 10-foot wind tunnel and others in the 5-foot vertical wind tunnel. The pressures were measured on the upper and lower surfaces at one chord section both on the main airfoils and on the flaps for several angles of attack with the flaps located at the maximum-lift settings. A test installation was used in which the model was mounted in the wind tunnel between large end planes so that two-dimensional flow was approximated. The data are given in the form of pressure-distribution diagrams and as plots of calculated coefficients for the airfoil-and-flap combinations and for the flaps alone.

  8. Freestyle Local Perforator Flaps for Facial Reconstruction.

    PubMed

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  9. Topology optimization of pressure adaptive honeycomb for a morphing flap

    NASA Astrophysics Data System (ADS)

    Vos, Roelof; Scheepstra, Jan; Barrett, Ron

    2011-03-01

    The paper begins with a brief historical overview of pressure adaptive materials and structures. By examining avian anatomy, it is seen that pressure-adaptive structures have been used successfully in the Natural world to hold structural positions for extended periods of time and yet allow for dynamic shape changes from one flight state to the next. More modern pneumatic actuators, including FAA certified autopilot servoactuators are frequently used by aircraft around the world. Pneumatic artificial muscles (PAM) show good promise as aircraft actuators, but follow the traditional model of load concentration and distribution commonly found in aircraft. A new system is proposed which leaves distributed loads distributed and manipulates structures through a distributed actuator. By using Pressure Adaptive Honeycomb (PAH), it is shown that large structural deformations in excess of 50% strains can be achieved while maintaining full structural integrity and enabling secondary flight control mechanisms like flaps. The successful implementation of pressure-adaptive honeycomb in the trailing edge of a wing section sparked the motivation for subsequent research into the optimal topology of the pressure adaptive honeycomb within the trailing edge of a morphing flap. As an input for the optimization two known shapes are required: a desired shape in cruise configuration and a desired shape in landing configuration. In addition, the boundary conditions and load cases (including aerodynamic loads and internal pressure loads) should be specified for each condition. Finally, a set of six design variables is specified relating to the honeycomb and upper skin topology of the morphing flap. A finite-element model of the pressure-adaptive honeycomb structure is developed specifically tailored to generate fast but reliable results for a given combination of external loading, input variables, and boundary conditions. Based on two bench tests it is shown that this model correlates well

  10. The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: a prospective trial.

    PubMed

    Munabi, Naikhoba C O; Olorunnipa, Olushola B; Goltsman, David; Rohde, Christine H; Ascherman, Jeffrey A

    2014-04-01

    Mastectomy skin flap ischaemia leading to necrosis is a common occurrence. Laser-assisted indocyanine green (ICG) angiography can assist to locate these poorly perfused areas intra-operatively. Our study aims to identify specific perfusion values produced by ICG angiography that accurately predict mastectomy flap necrosis. A total of 42 patients undergoing autologous or implant-based breast reconstruction had mastectomy flaps imaged using laser-assisted ICG angiography at the completion of reconstruction. Intra-operative perfusion values were correlated with postoperative skin flap outcomes. Risk factors for abnormal perfusion were recorded and analysed. A total of 62 breast reconstructions were imaged, including 48 tissue expander reconstructions, six transverse rectus abdominis myocutaneous (TRAM) flaps, six deep inferior epigastric perforator (DIEP) flaps and two direct-to-implant reconstructions. Eight cases (13%) of full-thickness skin necrosis were identified postoperatively. A SPY Elite(®) value of ≤ 7 accurately predicted the development of flap necrosis at 88% sensitivity and 83% specificity. False-positive cases (those with perfusion values ≤ 7 which did not develop necrosis) were more likely to have a smoking history and/or to have had an epinephrine-containing tumescent solution used during mastectomy. Excluding patients with smoking or epinephrine use, a SPY value of ≤ 7 predicted flap necrosis with a sensitivity of 83% and specificity of 97%. Thus, these data suggest that laser-assisted ICG angiography predicts postoperative outcomes with high accuracy. In our series, a SPY value of ≤ 7 correlated well with mastectomy flap necrosis. Furthermore, smoking and intra-operative injections containing epinephrine should be considered when evaluating low perfusion values as they can lead to false-positive test results.

  11. Pectoralis major flap for head and neck reconstruction in era of free flaps.

    PubMed

    Kekatpure, V D; Trivedi, N P; Manjula, B V; Mathan Mohan, A; Shetkar, G; Kuriakose, M A

    2012-04-01

    The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.

  12. Craniotomy flap osteomyelitis: a diagnostic approach

    SciTech Connect

    Blumenkopf, B.; Hartshorne, M.F.; Bauman, J.M.; Cawthon, M.A.; Patton, J.A.; Friedman, A.H.

    1987-01-01

    Nine cases of suspected craniotomy flap osteomyelitis evaluated by combined bone and gallium scanning are presented. In six cases, the clinical data were inconclusive and evaluation by radionuclide imaging provided an accurate negative diagnosis. The other three cases considered positive by this technique were proven infected at subsequent exploration and flap removal. The use of radionuclide bone and gallium imaging should be considered in cases of possible craniotomy flap osteomyelitis.

  13. Scaling Effects on Stern Flap Performance. Progress Report

    DTIC Science & Technology

    2009-09-01

    prototype stern flap on the USS RAMAGE ( DDG 61), the 11th destroyer of the DDG 51 Class, with associated stern flap evaluation trials, has provided...TERMS Stern flap scaling effects; DDG 61 stern flap performance trials; geosim model experiments 16. SECURITY CLASSIFICATION OF: a. REPORT...GUIDANCE FOR PROJECTING FULL-SCALE STERN FLAP PERFORMANCE 12 CONTINUED RESEARCH 17 DDG 51 Stern Flap Scaling Effects Study 17 Application to Other

  14. Skin abscess

    MedlinePlus

    Abscess - skin; Cutaneous abscess; Subcutaneous abscess; MRSA - abscess; Staph infection - abscess ... Skin abscesses are common and affect people of all ages. They occur when an infection causes pus ...

  15. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

    PubMed

    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.

  16. miR-125b can enhance skin tumor initiation and promote malignant progression by repressing differentiation and prolonging cell survival.

    PubMed

    Zhang, Liang; Ge, Yejing; Fuchs, Elaine

    2014-11-15

    Previously, we identified miR-125b as a key regulator of the undifferentiated state of hair follicle stem cells. Here, we show that in both mice and humans, miR-125b is abundantly expressed, particularly at early stages of malignant progression to squamous cell carcinoma (SCC), the second most prevalent cancer worldwide. Moreover, when elevated in normal murine epidermis, miR-125b promotes tumor initiation and contributes to malignant progression. We further show that miR-125b can confer "oncomiR addiction" in early stage malignant progenitors by delaying their differentiation and favoring an SCC cancer stem cell (CSC)-like transcriptional program. To understand how, we systematically identified and validated miR125b targets that are specifically associated with tumors that are dependent on miR-125b. Through molecular and genetic analysis of these targets, we uncovered new insights underlying miR-125b's oncogenic function. Specifically, we show that, on the one hand, mir-125b directly represses stress-responsive MAP kinase genes and associated signaling. On the other hand, it indirectly prolongs activated (phosphorylated) EGFR signaling by repressing Vps4b (vacuolar protein-sorting 4 homolog B), encoding a protein implicated in negatively regulating the endosomal sorting complexes that are necessary for the recycling of active EGFR. Together, these findings illuminate miR-125b as an important microRNA regulator that is shared between normal skin progenitors and their early malignant counterparts.

  17. The Gradual Expansion Muscle Flap

    DTIC Science & Technology

    2014-01-01

    Summary: High energy open fractures of the tibia have traditionally been fraught with challenges to include bone comminution or loss, soft tissue...and subsequent case series that obviates the need of free tissue transfer while treating high energy type IIIB open tibia fractures by performing an...Key Words: shortening and angulation, Taylor Spatial Frame, III B tibia fracture , flap coverage (J Orthop Trauma 2014;28:e15 e20) INTRODUCTION High

  18. Optimal propulsive flapping in Stokes flows.

    PubMed

    Was, Loïc; Lauga, Eric

    2014-03-01

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds numbers, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propulsion mechanism valid across the whole range of Reynolds numbers.

  19. Refining the intrinsic chimera flap: a review.

    PubMed

    Agarwal, Jayant P; Agarwal, Shailesh; Adler, Neta; Gottlieb, Lawrence J

    2009-10-01

    Reconstruction of complex tissue deficiencies in which each missing component is in a different spatial relationship to each other can be particularly challenging, especially in patients with limited recipient vessels. The chimera flap design is uniquely suited to reconstruct these deformities. Chimera flaps have been previously defined in many ways with 2 main categories: prefabricated or intrinsic. Herein we attempt to clarify the definition of a true intrinsic chimeric flap and provide examples of how these constructs provide a method for reconstruction of complex defects. The versatility of the intrinsic chimera flap and its procurement from 7 different vascular systems is described. A clarification of the definition of a true intrinsic chimera flap is described. In addition, construction of flaps from the lateral femoral circumflex, deep circumflex iliac, inferior gluteal, peroneal, subscapular, thoracodorsal, and radial arterial systems is described to showcase the versatility of these chimera flaps. A true intrinsic chimera flap must consist of more than a single tissue type. Each of the tissue components receives its blood flow from separate vascular branches or perforators that are connected to a single vascular source. These vascular branches must be of appropriate length to allow for insetting with 3-dimensional spatial freedom. There are a multitude of sites from which true intrinsic chimera flaps may be harvested.

  20. A water tunnel study of Gurney flaps

    NASA Technical Reports Server (NTRS)

    Neuhart, Dan H.; Pendergraft, Odis C., Jr.

    1988-01-01

    Several Gurney flap configurations were tested in the NASA Langley 16 x 24 inch Water Tunnel. These devices provided an increased region of attached flow on a wing upper surface relative to the wing without the flaps. The recirculation region behind the flap was visualized and shown to be consistent with hypotheses stated in previous research. Although the test Reynolds number for this study was several orders of magnitude below those in previous investigations, the effect of the Gurney flaps is in qualitative agreement with them. This is as would be expected from first order effects for high lift devices.

  1. Microsurgical free flaps: Controversies in maxillofacial reconstruction

    PubMed Central

    George, Rinku K.; Krishnamurthy, Arvind

    2013-01-01

    Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps. PMID:23662264

  2. Pressure Available for Cooling with Cowling Flaps

    NASA Technical Reports Server (NTRS)

    Stickle, George W; Naiman, Irven; Crigler, John L

    1941-01-01

    Report presents the results of a full-scale investigation conducted in the NACA 20-foot tunnel to determine the pressure difference available for cooling with cowling flaps. The flaps were applied to an exit slot of smooth contour at 0 degree flap angle. Flap angles of 0 degree, 15 degrees, and 30 degrees were tested. Two propellers were used; propeller c which has conventional round blade shanks and propeller f which has airfoil sections extending closer to the hub. The pressure available for cooling is shown to be a direct function of the thrust disk-loading coefficient of the propeller.

  3. The free serratus anterior artery perforator flap-A case report and anatomic study.

    PubMed

    Park, Seong Oh; Chang, Hak; Imanishi, Nobuaki

    2016-05-01

    We report a reconstructive case using a free serratus anterior artery perforator flap and an anatomic study. A 50-year-old man with upper esophageal sphincter stricture underwent segmental cervical esophageal resection. The size of the defect was approximately 5.5 cm. We then performed esophageal reconstruction using the free serratus anterior artery perforator flap. Esophagography performed on postoperative day 7 revealed no definite leakage and a viable anastomosis site with wide patency. No complications developed during the long-term follow-up period of 3 years. We reviewed the literature and performed an anatomic study using four fresh cadavers. We performed an angiographic study using two specimens and dissection of this perforator using other two specimens. We found that a direct connection existed between the serratus anterior artery and intercostal perforator to the skin in two of eight chests. The connection was located at the 4th intercostal space in the left chest of one cadaver and at the 6th/7th intercostal space in the left chest of the other cadaver. The free serratus anterior artery perforator flap is a new flap that could be considered for use during the elevation of a perforator flap in the lateral chest area, and especially in the area overlying the serratus anterior muscle. © 2016 Wiley Periodicals, Inc. Microsurgery 36:339-344, 2016.

  4. Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects

    PubMed Central

    2016-01-01

    Background: Reconstruction of extensive lower lip defects is challenging, and functional outcomes are difficult to achieve. Methods: A modified bilateral neurovascular cheek (MBNC) flap has been described. The data of patients with cancer of the lower lip treated with wide excision and reconstructed with the MBNC flap in the Plastic Surgery Unit, Srinagarind Hospital, Khon Kaen University, from 1966 to 2012 were reviewed. Results: Of the total of 143 patients included, 90.91% were women, and their age ranged from 32 to 100 years. All defects involved 70% or greater of the lower lip, which included oral commissure, buccal mucosa, or cheek skin and upper lip. All 20 patients who were followed up demonstrated good outcomes of intercommissural distance, interlabial distance, sulcus depth, and 2-point discrimination compared with normal lip parameters according to age group and satisfaction with treatment. Conclusions: Reconstruction of extensive lower lip defects with the MBNC flap provided good oral competence and functional outcomes. The flap provided adequate lip height and width, with proper position of oral commissure and vermilion reconstruction. The awareness about neurovascular anatomy of the lip and cheek and gentle dissection preserve the lip function. The flap overcomes the drawbacks of Karapandzic technique, which is microstomia, and of Bernard technique, which is a tight adynamic lower lip. It can be used in defects of more than two-thirds of the lip, extending to the cheek, commissural reconstruction, and secondary reconstruction. PMID:27579245

  5. POSTERIOR INTERBONE ARTERY FLAP FOR COVERING SERIOUS FOREARM, WRIST AND HAND INJURIES

    PubMed Central

    de Lima, Sérgio José; Domingos da Costa, Ricardo Pereira; de Oliveira, Emanoel; Prudente, Fabrício Guimarães; Mendonça, Marcelo Paris; Soares de Camargo, Christiano

    2015-01-01

    To assess the results achieved with posterior interbone artery flap covering serious injuries of the distal third of the forearm, wrist and hand, evaluating the degree of effectiveness of this procedure. Methods: 35 patients with serious injuries of the distal third of upper limbs were studied. We assessed the kind of trauma, injury site, flap size, skin coverage need, clinical outcome and complications. Results: The most frequent mechanism of trauma was motorcycle accident. The most commonly affected regions were: dorsal hand, wrist volar regions and the first commissure. In all patients, the flap size was enough to cover key tissues exposed by the injury. The donor area did not show complications, being primarily closed in 23 cases. The outcomes were good for 31 cases. In 22 patients, no complication was found, and the flap was completely lost in four. Conclusion: Posterior interbone artery flap provides good outcomes in covering serious injuries of the distal third of upper limbs, leading to a stable and reliable coverage, not compromising key irrigating arteries of the hand, enabling the performance of reconstruction procedures. Therefore, this is a useful alternative in such cases. PMID:26998451

  6. Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction

    PubMed Central

    Olcina, M.; Merck, B.; Giménez-Climent, M. J.; Almenar, S.; Sancho-Merle, M. F.; Llopis, F.; Vázquez-Albadalejo, C.

    2008-01-01

    The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment. We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS. PMID:18464918

  7. Breast reconstruction with single-pedicle TRAM flap in breast cancer patients with low midline abdominal scar

    PubMed Central

    Wu, Jun-Dong; Huang, Wen-He; Qiu, Si-Qi; He, Li-Fang; Guo, Cui-Ping; Zhang, Yong-Qu; Zhang, Fan; Zhang, Guo-Jun

    2016-01-01

    Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average flow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year. Eight breast cancer patients with low midline abdominal scar (scar group) and 20 without (control group) underwent immediate breast reconstruction with SP-TRAM flaps consisting of zone I and III and zone II tissues. Flap complications, donor-site complications, and cosmetic results were compared between the two groups. All flaps survived and both groups presented similar flap and donor site complications, including fat necrosis, seroma, hematoma, infection, delayed wound healing, and abdominal hernia, and patients in both groups had similar aesthetic results (p > 0.05). Thus, the study demonstrated that breast reconstruction using SP-TRAM flap was a safe approach in carefully selected patients with low midline abdominal scar. PMID:27406872

  8. Reconstruction of Abdominal Wall Defects Using a Pedicled Anterolateral Thigh Flap including the Vastus Lateralis Muscle: A Report of Two Cases

    PubMed Central

    Fujioka, Masaki; Ishiyama, Satoko

    2016-01-01

    The purpose of abdominal wall reconstruction is to prevent hernias and protect the abdominal viscera. In cases involving full-thickness defects of the rectus abdominis muscle, the muscle layer should be repaired. We present 2 cases in which full-thickness lower rectus abdominis muscle defects were reconstructed using vastus lateralis-anterolateral thigh flaps. The pedicled vastus lateralis-anterolateral thigh flap provides skin, fascia, and muscle tissue. Furthermore, it has a long neurovascular pedicle and can reach up to the periumbilical area and cover large defects. We consider that this muscle flap is a good option for repairing full-thickness lower abdominal defects. PMID:28074168

  9. miR-125b can enhance skin tumor initiation and promote malignant progression by repressing differentiation and prolonging cell survival

    PubMed Central

    Zhang, Liang; Ge, Yejing

    2014-01-01

    Previously, we identified miR-125b as a key regulator of the undifferentiated state of hair follicle stem cells. Here, we show that in both mice and humans, miR-125b is abundantly expressed, particularly at early stages of malignant progression to squamous cell carcinoma (SCC), the second most prevalent cancer worldwide. Moreover, when elevated in normal murine epidermis, miR-125b promotes tumor initiation and contributes to malignant progression. We further show that miR-125b can confer “oncomiR addiction” in early stage malignant progenitors by delaying their differentiation and favoring an SCC cancer stem cell (CSC)-like transcriptional program. To understand how, we systematically identified and validated miR125b targets that are specifically associated with tumors that are dependent on miR-125b. Through molecular and genetic analysis of these targets, we uncovered new insights underlying miR-125b’s oncogenic function. Specifically, we show that, on the one hand, mir-125b directly represses stress-responsive MAP kinase genes and associated signaling. On the other hand, it indirectly prolongs activated (phosphorylated) EGFR signaling by repressing Vps4b (vacuolar protein-sorting 4 homolog B), encoding a protein implicated in negatively regulating the endosomal sorting complexes that are necessary for the recycling of active EGFR. Together, these findings illuminate miR-125b as an important microRNA regulator that is shared between normal skin progenitors and their early malignant counterparts. PMID:25403182

  10. [Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection].

    PubMed

    Song, D J; Li, Z; Zhou, X; Zhang, Y X; Peng, X W; Zhou, B; Lyu, C L; Yang, L C; Peng, W

    2017-02-20

    Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two

  11. Effects of perforated flap surfaces and screens on acoustics of a large externally blown flap model

    NASA Technical Reports Server (NTRS)

    Burns, R. J.; Mckinzie, D. J., Jr.; Wagner, J. M.

    1976-01-01

    Various model geometries and combinations of perforated flap surfaces and screens mounted close to the flap surfaces were studied for application to jet-flap noise attenuation for externally blown flap, under-the-wing aircraft. The efforts to reduce jet-flap interaction noise were marginally successful. Maximum attenuations of less than 4 db in overall sound pressure level were obtained in the flyover plane. Noise reductions obtained in the low-to-middle-frequency ranges (up to 7 db) were generally offset by large increases in high-frequency noise (up to 20 db).