Using the Pedicle Flap for Taking Pressure off the Pedicle in Distally Based Skin Flaps

ABSTRACTreconstruction 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.

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Prolongation of Secondary Critical Ischemia Time of Experimental Skin Flaps Using UW Solution as a Normothermic Perfusate

Otolaryngology ◽

10.1177/019459989310800207 ◽

1993 ◽

Vol 108 (2) ◽

pp. 149-155 ◽

Cited By ~ 3

Author(s):

Ilsa Schwartz ◽

Michel Babajanian ◽

Wen X. Zhang ◽

Jonathan E. Aviv ◽

Hubert Weinberg ◽

...

Keyword(s):

Skin Flap ◽

Clinical Situation ◽

Ischemic Tolerance ◽

Time Interval ◽

Skin Flaps ◽

Critical Ischemia ◽

Pedicle Flap ◽

Abdominal Skin ◽

Normothermic Perfusion ◽

Secondary Ischemia

A myriad of investigations have been published on the pharmacologic manipulation of flaps to enhance tolerance to ischemia. We recently reported a threefold increase in ischemic tolerance of the rat abdominal skin flap pedicle after 6 hours of primary ischemia and 12 hours of reperfusion. Flaps underwent normothermic perfusion washout with lactated Ringer's or U.W. solution, a newly developed organ preservation medium. Perfusion washouts were performed at one of three different points in the protocol: (1) onset of primary ischemia; (2) onset of secondary ischemia; or (3) 2 hours after onset of secondary ischemia. The last group was used to simulate the clinical situation in which flaps are discovered and salvage procedures instituted at a delayed time interval. This is the longest normothermic ischemic interval reported. We undertook the present study to determine the utility of the U.W solution in prolonging the tolerance of the flap to a second ischemic insult after a period of reperfusion. Seventy-five unilateral rat abdominal skin flaps were raised. Secondary ischemia was produced by placing a microvascular clamp across the inferior epigastric pedicle. Flap survival was assessed at 1 week postoperatively. While none of the nonperfused flaps survived 8 hours of secondary ischemia, at least 50% of the U.W. perfused flaps survived an average of 14 hours of secondary ischemia. Lactated Ringer's perfusion washout only modestly increased the ischemic tolerance. Perfusion washout in the secondary ischemic phase improved the ischemic tolerance to a significantly greater degree than in the primary ischemic interval. (OTOLARYNGOL HEAD NECK SURG 1993;108:149-55.)

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

International Surgery ◽

10.9738/cc65.1 ◽

2013 ◽

Vol 97 (4) ◽

pp. 321-326 ◽

Cited By ~ 2

Author(s):

Ruixing Hou ◽

Jihui Ju ◽

Qiang Zhao ◽

Yuefei Liu

Keyword(s):

Skin Flap ◽

Terminal Segment ◽

Fasciocutaneous Flap ◽

Skin Flaps ◽

Scar Contracture ◽

Digital Reconstruction ◽

Fascial Flap ◽

Distally Based ◽

Digital Terminal

Abstract 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.

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Skin Flaps and Graft In Eyelid Reconstruction

Jurnal Kesehatan Andalas ◽

10.25077/jka.v8.i3.p755-761.2019 ◽

2019 ◽

Vol 8 (3) ◽

pp. 755

Author(s):

Khairiah Nevrianty ◽

Hendriati Hendriati

Keyword(s):

Skin Flap ◽

Wide Excision ◽

Skin Flaps ◽

Pedicle Flap ◽

Eyelid Reconstruction

Rekonstruksi kelopak mata merupakan salah satu operasi mata yang paling menantang karena menuntut kemungkinan hasil fungsional dan kosmetik yang terbaik. Flap dan graft merupakan suatu teknik pada bedah plastik dan rekonstruksi dengan tujuan untuk mengisi dan memperbaiki defek pada suatu luka tertentu. Prosedur skin flap dan graft dengan teknik semisirkular flap merupakan salah satu prosedur untuk rekonstruksi dengan defek luas pada kelopak mata bawah. Dilaporkan seorang pasien perempuan, usia 55 tahun dikonsulkan dari subbagian Tumor dengan diagnosa karsinoma sel skuamosa kelopak bawah mata kanan, terdapat massa pada palpebra inferior dengan ukuran  40mmx 25mmx15mm dengan bola mata dalam batas normal. Identifikasi luas defek setelah wide excision adalah sekitar 45mm x 30mm yang melibatkan margo kelopak mata dan kantus. Semicircular flap-pedicle flap dengan graft mukosa mulut dilakukan pada pasien ini. Dengan teknik ini telah dapat merekonstruksi kelopak mata inferior sehingga secara kosmetik dapat diterima oleh pasien. Terdapat komplikasi yang ditemukan yaitu lagoftalmus sebesar 3 mm setelah 1 bulan post operasi. Kesimpulan dari laporan kasus ini adalah penggunaan skin flap dan graft pada rekontruksi kelopak mata dapat menjadi solusi bila defek terlalu besar untuk dilakukan penutupan atau tidak dapat dilakukan penutupan secara primer untuk mengembalikan anatomi dan fungsi kelopak mata.

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Skin Flaps and Graft In Eyelid Reconstruction

Jurnal Kesehatan Andalas ◽

10.25077/jka.v8i3.1066 ◽

2019 ◽

Vol 8 (3) ◽

pp. 755

Author(s):

Khairiah Nevrianty ◽

Hendriati Hendriati

Keyword(s):

Skin Flap ◽

Wide Excision ◽

Skin Flaps ◽

Pedicle Flap ◽

Eyelid Reconstruction

Rekonstruksi kelopak mata merupakan salah satu operasi mata yang paling menantang karena menuntut kemungkinan hasil fungsional dan kosmetik yang terbaik. Flap dan graft merupakan suatu teknik pada bedah plastik dan rekonstruksi dengan tujuan untuk mengisi dan memperbaiki defek pada suatu luka tertentu. Prosedur skin flap dan graft dengan teknik semisirkular flap merupakan salah satu prosedur untuk rekonstruksi dengan defek luas pada kelopak mata bawah. Dilaporkan seorang pasien perempuan, usia 55 tahun dikonsulkan dari subbagian Tumor dengan diagnosa karsinoma sel skuamosa kelopak bawah mata kanan, terdapat massa pada palpebra inferior dengan ukuran  40mmx 25mmx15mm dengan bola mata dalam batas normal. Identifikasi luas defek setelah wide excision adalah sekitar 45mm x 30mm yang melibatkan margo kelopak mata dan kantus. Semicircular flap-pedicle flap dengan graft mukosa mulut dilakukan pada pasien ini. Dengan teknik ini telah dapat merekonstruksi kelopak mata inferior sehingga secara kosmetik dapat diterima oleh pasien. Terdapat komplikasi yang ditemukan yaitu lagoftalmus sebesar 3 mm setelah 1 bulan post operasi. Kesimpulan dari laporan kasus ini adalah penggunaan skin flap dan graft pada rekontruksi kelopak mata dapat menjadi solusi bila defek terlalu besar untuk dilakukan penutupan atau tidak dapat dilakukan penutupan secara primer untuk mengembalikan anatomi dan fungsi kelopak mata.

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