scholarly journals Use of the Spare-Part Strategy to Reconstruct the External Auditory Canal After Subtotal Auriculectomy for Basal Cell Carcinoma

2021 ◽  
Author(s):  
Marco Pignatti ◽  
Gioia Sorbi ◽  
Valentina Pinto ◽  
Giovanni Sorrenti ◽  
Riccardo Cipriani
Keyword(s):  
External Auditory Canal ◽  
Skin Flap ◽  
Donor Site ◽  
Spare Part ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Spare Parts ◽  
Thin Skin ◽  
Adequate Coverage ◽  
Bone Exposure

AbstractAfter removal of an infiltrative BCC of the auditory meatus, a soft tissue defect of the temporal-mastoid area with bone exposure, needed reconstruction. Several options have been taken into account and a simple yet effective solution has been found following the spare-parts principle. The ear lobe, preserved during cancer removal, was split and used as a thin skin flap. Adequate coverage of the bone exposure and resurfacing of the external auditory canal was obtained with minimal donor site morbidity and a short surgery in a fragile patient with several comorbidities. The spare-parts strategy can provide successful solution to difficult reconstructive cases regardless of the anatomical area.

scholarly journals Radical Surgical Excision and Use of Axillary Flap for Intractable Axillary Hidradenitis Suppurativa

2021 ◽  
Vol 24 (2) ◽  
pp. 51-56
Author(s):  
Munny Momotaz ◽  
Abul Kalam ◽  
Md Sazzad Khondoker ◽  
Sharmin Akter Sumi
Keyword(s):  
Medical Treatment ◽  
Hidradenitis Suppurativa ◽  
Donor Site ◽  
Surgical Excision ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Radical Excision ◽  
Maximum Dimension ◽  
College Hospital ◽  
Excellent Outcome

Background: Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and reconstruction with axillary flap as a treatment option for such cases. Objectives: The purpose of the study was to see the outcome after radical surgical excision and coverage with axillary flap for intractable Hidradenitis suppurativa. Methods: This prospective observational study was carried out from July, 2014 to June,2016. Patients admitted at the Plastic Surgery Department of Dhaka Medical College Hospital with intractable Hydradenitis suppurativa were included the study population. Result:Among 20 cases, 12 cases were female and 8 cases were male. Maximum dimension of the soft tissue defect was 15x6.5 cm2 = (97.5 cm2). Maximum dimension of the flap was 17x7 cm2 = (119 cm2).Flap survived completely with minimum donor site morbidity. Result of reconstruction of 90% of the patients exhibited excellent outcome. In 10% patient’s outcome was considered good. Conclusion:With a suitable flap coverage option, the management paradigm of intractable Hydradenitis Suppurativa should shift from prolonged medical treatment to allowdecisive radical excision, which will improve the quality of life for patients. Axilary flap is the flap of choice to cover the defect. Journal of Surgical Sciences (2020) Vol. 24 (2) : 51-56

scholarly journals Versatility of Latissimus Dorsi Free Flap-a Prospective Study

2021 ◽  
Vol 28 (2) ◽  
pp. 142-152
Author(s):  
Abu Faisal Md Ariful Islam ◽  
Mohammad Rabiul Karim Khan ◽  
Sharmin Akter Sumi ◽  
Mohammad Hedayet Ali Khan ◽  
Md Abul Kalam
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Tissue Defect ◽  
Medical College ◽  
The Mean

Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the mean age was 35.65with an SD of + 10.81. The lowest age was 20years and the highest age was 56 years, Male female ratio was 3:2.The major cause (65.0%) of soft tissue defect of the samples was RTA. The flap was used to reconstruct the soft tissue defect over lower leg in 13 (65%)cases, on scalp 05 (25%) cases and over anterior trunk in two cases. The mean flap dimension was 229.25cm2 and its range was between 120 – 384 cm2. The standard myocutaneous flap was harvested in 80% cases, chimeric (10%) and partial Latissimus muscle flap in two cases. The donor site in all the 20 (100%) cases was closed primarily. The outcome of reconstruction was excellent in 16(80%), good in 02 (10%) cases and poor in 02 (10%) cases. There was no significant complication during the three months postoperative period. Conclusion: The Latissimus dorsi flap is a versatile option for resurfacing the soft tissue defect in different areas of the body with variable flap components and with minimal donor site morbidity. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 142-152

scholarly journals The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

2022 ◽  
Vol 12 (1) ◽  
pp. 87-91
Author(s):  
Lucretya Yeniwati Tanuwijaya ◽  
Agus Roy Rusly Hariantana Hamid ◽  
I Gusti Putu Hendra Sanjaya
Keyword(s):  
Case Report ◽  
Skin Graft ◽  
Skin Flap ◽  
Donor Site ◽  
Surgical Techniques ◽  
Operation Time ◽  
Donor Site Morbidity ◽  
Reconstruction Procedure ◽  
Local Skin ◽  
And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

scholarly journals The Clinical Application of Anterolateral Thigh Flap

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Yao-Chou Lee ◽  
Haw-Yen Chiu ◽  
Shyh-Jou Shieh
Keyword(s):  
Vastus Lateralis ◽  
Skin Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Team Work ◽  
Anterolateral Thigh Flap ◽  
Vastus Lateralis Muscle ◽  
Skin Paddle ◽  
Preoperative Mapping ◽  
Anterolateral Thigh

The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.

scholarly journals Perforator-Pedicled Propeller Flaps for Lower Extremity Reconstruction

2020 ◽  
Vol 34 (03) ◽  
pp. 200-206
Author(s):  
Mohamed A. Ellabban ◽  
Ahmed I. Awad ◽  
Geoffrey G. Hallock
Keyword(s):  
Lower Extremity ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Peripheral Vascular ◽  
Perforator Flaps ◽  
Vascular Insufficiency ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Bone Exposure

AbstractReconstruction of the lower extremity is considered a major challenge due to frequent bone exposure and the absence of local tissue redundancy, as well as often due to the presence of vascular insufficiency. Many surgeons have preferred free flaps especially for reconstructing the more distal lower limb defects until the evolution of pedicled perforator flaps and propeller flaps in particular provided a like-with-like reconstruction of the lower extremity without affecting the main vessels of the limb or the underlying muscles, and without the risk of any microanastomosis especially in patients with multiple comorbidities. Perforator-pedicled propeller flaps as local flaps in the lower extremity are best suited for small- and medium-sized defects with minimal donor-site morbidity, regardless of the cause of the defect. Any of the three source vessels of the leg can provide reliable perforators for propeller flap coverage of the distal leg and foot. The three main risk factors that are relative contraindications may be advanced age, diabetes mellitus, and atherosclerotic peripheral vascular disease.

scholarly journals Surgical Closure of Sacral Pressure Sores by Gluteal Skin Flap.

2014 ◽  
Vol 4 (1) ◽  
pp. 5-9
Author(s):  
Mohammad Rabiul Karim Khan ◽  
Md Abdul Mannan ◽  
Liman Kumar Dhar ◽  
Md Sazzad Khondoker ◽  
Md Abul Kalam
Keyword(s):  
Plastic Surgery ◽  
Skin Flap ◽  
Donor Site ◽  
Medical Problem ◽  
Donor Site Morbidity ◽  
Stage Iii ◽  
Pressure Sores ◽  
Surgical Closure ◽  
Flap Monitoring ◽  
Secondary Closure

Pressure sores are an ancient medical problem; even found during autopsies of Egyptian mummies. This prospective study was carried out in the Department of Plastic Surgery, Dhaka Medical College & Hospital (DMCH), Dhaka between January 2012 to December 2012 to evaluate the outcome of surgical closure of sacral pressure sores by Gluteal skin flaps. Twenty two patients admitted into DMCH with stage III & IV sacral pressure sores were included. Over two-thirds (68.2%) of the ulcers were in Stage-III and over three-quarters (77.3%) had signs of local infection. The average horizontal and vertical lengths of the defects before excision were 10.4 and 8.8 cm respectively which increased to 12.6 and 10.6 cm respectively after excision of dead and devitalized tissues. The average medial advancement of the flap was 6.3 cm. Postoperative flap-monitoring did not reveal infection, seroma or hematoma in any of the patients. Only 2(9.1%) patients had marginal flap loss. Marginal flap losses developed in two cases were excised and direct-suturing (secondary closure) were done. More than 90% of the patients exhibited good outcome. The study concluded that Gluteal skin flap produces good result in majority of the patients with large sacral sores with almost no complications or recurrences. The Gluteal skin flap has the advantages of muscle sparing, less donor site morbidity, versatility in design and less effort to harvest DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18684 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 05-09

scholarly journals Risk of necrosis in the adjacent toe after one-toe fillet flap in diabetic foot: Retrospective study of 107 cases over 5 years

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095194
Author(s):  
Junhyung Kim ◽  
Kyubeom Kim ◽  
Jaehoon Choi ◽  
Woonhyeok Jeong ◽  
Taehee Jo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diabetic Foot ◽  
Revisional Surgery ◽  
Donor Site ◽  
Significant Risk ◽  
Metatarsophalangeal Joint ◽  
Spare Part ◽  
Donor Site Morbidity ◽  
Fillet Flap ◽  
Second Toe

Purpose: Fillet flap is a “spare part” concept. This technique allows the defect to be covered without donor site morbidity. Over the past 5 years, there were 107 diabetic foot cases of one-toe fillet flap in our hospital. After the operation, in some patients, there was necrosis of the adjacent toe that required additional amputation. The aim of our study was to determine the cause of necrosis of the adjacent toe after fillet flap. Methods: The patients were divided into two groups. One group had no necrosis of the adjacent toe (group A) after the operation, and the other group had necrosis of the adjacent toe that required additional amputation after the operation (group B). Then, to confirm the cause of the additional necrosis of the adjacent toe, χ 2 tests, Fisher’s tests, and logistic regression tests were performed. Results: A total of 107 patients were included, and 48 patients needed additional amputation. The logistic regression test revealed that a fillet flap at the metatarsophalangeal joint (MTPJ), horizontal sutures, and a fillet flap at the second toe were significant risk factors for developing necrosis. Conclusions: If a fillet flap with a second toe, fillet flap on MTPJ level and horizontal closure after fillet flap is needed, the chance of developing necrosis of the adjacent toe and additional revisional surgery must be communicated preoperatively.

“Spare Part” Forearm Free Flaps Harvested from the Amputated Limb for Coverage of Amputation Stumps

1997 ◽  
Vol 22 (5) ◽  
pp. 615-619 ◽  
Author(s):  
M. J. WEINBERG ◽  
M. M. AL-QATTAN ◽  
J. MAHONEY
Keyword(s):  
Soft Tissue ◽  
Radial Artery ◽  
Donor Site ◽  
Free Flaps ◽  
Spare Part ◽  
Donor Site Morbidity ◽  
Soft Tissue Reconstruction ◽  
Amputation Stumps ◽  
Tissue Reconstruction ◽  
Different Tissues

The use of “spare part” flaps from a non-replantable limb to cover amputation stumps in the upper extremity preserves limb length, provides durable coverage and sensation and will avoid additional donor site morbidity. We have studied the blood supply of the forearm based on the radial artery. The potential for harvesting different tissues is confirmed. In five clinical cases reliable primary soft tissue reconstruction was achieved, even in the presence of trauma.

Facilitated self-assembly of a prevascularized dermal/epidermal collagen scaffold

2020 ◽  
Author(s):  
Kerry A Morrison ◽  
Ross H Weinreb ◽  
Xue Dong ◽  
Yoshiko Toyoda ◽  
Julia L Jin ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Self Assembly ◽  
Skin Flap ◽  
Donor Site ◽  
Multiphoton Microscopy ◽  
Collagen Scaffold ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Microvascular Network ◽  
3D Network

Introduction: Resurfacing complex full thickness wounds requires free tissue transfer which creates donor site morbidity. We describe a method to fabricate a skin flap equivalent with a hierarchical microvascular network. Materials & methods: We fabricated a flap of skin-like tissue containing a hierarchical vascular network by sacrificing Pluronic® F127 macrofibers and interwoven microfibers within collagen encapsulating human pericytes and fibroblasts. Channels were seeded with smooth muscle and endothelial cells. Constructs were topically seeded with keratinocytes. Results: After 28 days in culture, multiphoton microscopy revealed a hierarchical interconnected network of macro- and micro-vessels; larger vessels (>100 μm) were lined with a monolayer endothelial neointima and a subendothelial smooth muscle neomedia. Neoangiogenic sprouts formed in the collagen protodermis and pericytes self-assembled around both fabricated vessels and neoangiogenic sprouts. Conclusion: We fabricated a prevascularized scaffold containing a hierarchical 3D network of interconnected macro- and microchannels within a collagen protodermis subjacent to an overlying protoepidermis with the potential for recipient microvascular anastomosis.

scholarly journals Customized Reconstruction of Complex Soft Tissue Defect Around the Knee with Individual Design of Free Perforator Flap

2020 ◽  
Author(s):  
Jinfei Fu ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Knee Region ◽  
Tissue Defect ◽  
Individual Design ◽  
Free Perforator Flap

Abstract Background Reconstruction of complex soft tissue defect around the knee, particularly in involving with large soft tissue defect or disruption of extensor mechanism, always is a challenging problem. The purpose of this study was to introduce our clinical experience on using individual design of free perforator flap for complex soft-tissue reconstruction around the knee. Methods Between June 2010 and March 2017, 16 patients underwent the reconstruction of complex soft tissue defect in the knee region with free perforator flap, Various flap designs was performed basing on the location of wound, the require pedicle length, the tissue components that are deficient, the volume of such components and the risk of donor site morbidity.Results Complex soft tissue defect of the knee was reconstructed with anteriorlateral thigh perforator (ALTP) flap in 5 cases, modified ALTP flap in 2 cases, chimeric ALTP flap in 4 cases, dual skin paddles ALTP flap in 2 cases and chimeric thoracodorsal artery perforator (TDAP) flap in 2 cases. Multiple perforator flaps and vascularized fascia lata in combination were performed in one case. All flaps survived postoperative. None vascular congestion was observed. Only one case suffered partial necrosis. Primary closure of donor site was performed for all patients. The mean follow-up time was 16.5 months. Most cases showed satisfactory flap contour and acceptable function outcome. Conclusions Free perforator flap is a reliable option for repairing complex soft tissue defect in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches.

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