Application of WALANT technique for repairing finger skin defect with a random skin flap

Abstract Background Wide-awake local anesthesia no tourniquet (WALANT) technique has emerged among hand surgeons with other indications. Surgeries involving pedicled flap and revascularization are no longer used as contraindications. The present study aimed to evaluate the feasibility and merits of the WALANT technique in random skin flap surgery. Methods From May 2018 to March 2019, 12 patients with finger skin defects repaired with random skin flaps were reviewed. Abdominal skin flaps or thoracic skin flaps were used to cover the wound. Both the fingers and the donor sites were anesthetized by the WALANT technique. A 40-mL conventional volume consisted of a mixture of epinephrine and lidocaine. A volume of 5 mL was injected at the distal palmar for nerve block, the other 5 mL was injected around the wound for hemostasis, and the remaining was injected at the donor site of flaps for both analgesia and hemostasis. Baseline data with respect to sex, age, side, type of finger, donor sites, flap size, dosage of anesthetics, usage of finger tourniquet, intraoperative and postoperative pain, hemostasis effect, operation time, Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) score, and hospitalization expense, were collected. Results All patients tolerated the procedure, and none of them needed sedation. Single finger skin defect in 8 patients and double finger skin defect occurred in 4 patients; 5 patients were repaired by abdominal skin flaps, and 7 patients were repaired by thoracic skin flaps. The good surgical field visibility was 91.7%. All flaps survived adequately, without necrosis, pulling fingers out, and other complications. The average visual analog scale (VAS) score of the maximal pain was 1.1 in fingers vs. 2.1 in donor sites during the operation. On postoperative day one, the average VAS score of the maximal pain in fingers and donor sites was 1.3 and 1.1, respectively. The average hospitalization expense before reimbursement of the whole treatment was 11% less expensive compared to the traditional method. The average QuickDASH score was 9.1. Conclusions Under wide-awake anesthesia, patients have the ability to control their injured upper extremities consciously, avoiding the complications due to pulling flap pedicles. With the merits of safety, painlessness, less bleeding, and effectivity, the WALANT technique in random skin flaps is feasible and a reliable alternative to deal with finger skin defect.

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Skin flaps

10.1093/med/9780199682874.003.0008 ◽

2021 ◽

pp. 39-50

Author(s):

Donald Dewar

Keyword(s):

Blood Supply ◽

Subcutaneous Tissue ◽

Skin Flap ◽

Donor Site ◽

Pedicled Flap ◽

Local Flaps ◽

Skin Flaps ◽

Local Skin ◽

Recipient Vessel ◽

Composite Defect

Flaps can reconstruct defects of the integument, resurface mucosal defects, as well as contribute to contour. They are used where grafting is not feasible because of the nature of the defect and/or where the aims of reconstruction would be better served by vascularized tissue with both cutaneous and subcutaneous components. A skin flap can also be combined with fascia, muscle, or bone to reconstruct a complex or composite defect, and to provide tissue to restore function. Flaps may be classified according to the origin of the flap: local skin flaps are raised from tissue adjacent to the defect (usually deriving their blood supply from the subcutaneous tissue and subdermal plexus), and distant flaps are raised on dedicated vascular pedicles from a non-contiguous region. A distant flap may be moved to the defect maintaining the continuity of the pedicle (a ‘regional’ or ‘pedicled’ flap) or as a free flap, where the flap is elevated from its remote donor site and the pedicle is divided to allow the flap to be transported ‘free’ to the defect and then the vascular continuity is re-established by anastomosis to a recipient vessel in the defect. This chapter focuses on local flaps.

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Using KISS Flaps in a Chest Wall Reconstruction After Mastectomy for Locally Advanced Breast Cancer: A New Technique

Surgical Innovation ◽

10.1177/1553350619877299 ◽

2019 ◽

Vol 27 (1) ◽

pp. 5-10

Author(s):

Jia Song ◽

Yong Han ◽

Jian Liu ◽

Kai Cheng ◽

Qiang Gao ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Primary Closure ◽

Locally Advanced Breast Cancer ◽

Skin Flap ◽

Donor Site ◽

Locally Advanced ◽

Radical Mastectomy ◽

Advanced Breast ◽

Skin Defect

This study described a technique for the reconstruction of large lateral thoracic defects after local advanced breast cancer resection that allows for complete cover of the defect and primary closure of the donor site. The authors performed reconstruction using the newly designed KISS flap in 2 women for coverage of their large skin defect (15 × 13 cm each) following mastectomies with extensive tissue resection. The KISS flap consisting of 2 skin islands (marked Flap A and Flap B; 15 × 6 cm each) was designed and transferred to the thoracic defect through the subcutaneous tunnel, and based on the same vessel. The flap covered properly without causing excessive tension and allowed primary closure of chest wound and donor defect. The security it brings is comparable with that of classical radical mastectomy, and its success rate is similar to that of single skin flap transplantation. Compared with the conventional pedicled latissimus-dorsi-musculocutaneous flap, we believe that the donor zone tension decreases, wherein the KISS flaps can reduce the incidence of incision dehiscence and nonhealing complications to some extent. The study reported good results from this technique and discussed the techniques that referenced previous reports.

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Bilateral axillary skin fold flaps used for dorsal thoracic skin wound closure in a dog : clinical communication

Journal of the South African Veterinary Association ◽

10.4102/jsava.v81i1.98 ◽

2010 ◽

Vol 81 (1) ◽

Author(s):

B. G. Nevill

Keyword(s):

Skin Flap ◽

Skin Wound ◽

Clinical Report ◽

Skin Defect ◽

Skin Flaps ◽

Clinical Communication ◽

Dorsal Midline ◽

Skin Fold ◽

Flap Procedure ◽

Chronic Skin

A 10-year-old greyhound-cross dog was presented with a large, chronic skin wound extending over the interscapular region. The substantial skin defect was closed by making use of bilateral axillary skin fold flaps. It was possible to elevate the 2 skin flaps sufficiently to allow them to meet at the dorsal midline and thus facilitate complete closure of a large and awkwardly positioned wound. Small dorsal areas of the skin flaps underwent necrosis, but the resulting defects were closed without difficulty in a subsequent procedure. To the author's knowledge, this is the 1st clinical report of the use of bilateral axillary skin fold flaps in this fashion and describes an additional use of a versatile skin flap procedure.

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

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220112 ◽

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.

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Capsaicin on the viability of random-pattern skin flaps in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502010000500010 ◽

2010 ◽

Vol 25 (5) ◽

pp. 440-443 ◽

Cited By ~ 7

Author(s):

Gustavo Roberto de Godoy ◽

Richard Eloin Liebano ◽

Juliana Barbosa Corrêa ◽

Bernardo Hochman ◽

Lydia Masako Ferreira

Keyword(s):

Surgical Procedure ◽

Wistar Rats ◽

Skin Flap ◽

Donor Site ◽

Control Group ◽

Random Pattern ◽

Skin Flaps ◽

Flap Necrosis ◽

Group A

PURPOSE: To evaluate the effects of capsaicin on the viability of ischemic random-pattern skin flaps in rats. METHODS:Forty EPM1-Wistar rats were randomized into two groups of 20 animals each, the capsaicin group and the control group. A random-pattern skin flap measuring 10 x 4cm was raised and a plastic barrier was placed between the flap and the donor site. After the surgical procedure, the control group was treated with an inert vehicle in the form of a cream applied uniformly to a rayon bandage which, in turn, was applied to the surface of the skin flap. The capsaicin group was treated in the same way, but in this case capsaicin was added to the cream. This procedure was repeated for two consecutive days. RESULTS: There was a significantly smaller amount of flap necrosis in the capsaicin group (35.07%) than in the control group (44.75%) (p=0.035). CONCLUSION:Topical administration of capsaicin improved the viability of ischemic random-pattern skin flaps in rats.

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

Medical Science Monitor ◽

10.12659/msm.894458 ◽

2015 ◽

Vol 21 ◽

pp. 3042-3047 ◽

Cited By ~ 1

Author(s):

Feng Zhao ◽

Wei He ◽

Guoping Zhang ◽

Shaojun Liu ◽

Kunlun Yu ◽

...

Keyword(s):

Skin Flap ◽

Management Strategies ◽

Stage I ◽

Random Pattern ◽

Skin Defect ◽

Abdominal Skin ◽

Defect Repair

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Moist wound dressing and its application in distant skin flap in cats

Veterinary World ◽

10.14202/vetworld.2021.734-738 ◽

2021 ◽

Vol 14 (3) ◽

pp. 734-738

Author(s):

Erwin Erwin ◽

Etriwati Etriwati ◽

Rumi Sahara Zamzami ◽

Cindy Trie Permatasari Hosea

Keyword(s):

Wound Dressing ◽

Drug Effect ◽

Skin Flap ◽

Healing Process ◽

Donor Site ◽

Skin Flaps ◽

Wound Debridement ◽

Complex Process ◽

Thoracic And Abdominal ◽

Flap Closure

Background and Aim: Wound healing is a dynamic and complex process that requires an appropriate environment to promote healing process. The healing of distant flaps in cats is determined by vascularization, nutrient sufficiency for the cells, and stability of skin flaps. This study aims to evaluate the healing of distant flaps treated with moist wound dressing through subjective and objective observation in five cats with wounds in the forelimb and hindlimb area to determine the time to cut the skin flaps from the donor site. Materials and Methods: In this study, five Indonesian local cats with wounds of various sizes in the limb were brought to the Veterinary Teaching Hospital. The sterile wound treatment included the administration of anesthesia, wound debridement, and distant flap closure in the thoracic and abdominal area. The distant flap and time to cut the skin flaps from the donor site were evaluated through subjective and objective examinations. Results: The subjective observation on the color of the distant skin flaps showed redness and response to pain on day 3 after surgery, whereas the objective observation, which was based on drug absorption capability and drug effect showed good results. On day 7 after surgery, the skin flaps from the donor site were cut and showed good progress. Conclusion: Overall, moist dressing helps in stabilizing the distant flap, allowing the distant flaps from the donor site to be cut on day 7 after surgery.

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Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.803750 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yucheng Ma ◽

Zhong-Yu Jian ◽

Qibo Hu ◽

Zhumei Luo ◽

Tao Jin

Keyword(s):

Success Rate ◽

Oral Mucosa ◽

Meta Analysis ◽

Skin Flap ◽

Operation Time ◽

Skin Flaps ◽

Penile Skin ◽

Anterior Urethra ◽

Significant Difference ◽

Fixed Model

Background: The purpose of this study is to compare the effectiveness and safety of oral mucosa and penile skin flaps in the treatment of anterior urethral stricture.Methods: This meta-analysis was carried out according to the principle of preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered at PROSPERO (CRD42021277688). The Cochrane Library, PubMed, Embase, CKNI databases were searched and reviewed up to Sep 2021. Quality evaluation was performed with Newcastle-Ottawa Scale (NOS) system for non-randomized studies and Cochrane stools for randomized studies. Data synthesis was conducted with RevMan 5.4 software (Cochrane) and a Stata 15.0 environment (Stata Corpor, College Station, TX, USA).Results: After the research screening, eight studies (comprising 445 patients) were finally included in the quantitative analysis. In the success rate comparison, there was no significant difference between oral mucosa and penile skin flaps (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.80, 95% CI: 0.47–1.34, P = 0.39). There was no significant difference in the post-operative complication comparison (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.68, 95% CI: 0.40–1.16, P = 0.15). However, considering that the site of oral mucosa is far from the anterior urethra, it may have advantages in operation time through simultaneous operations (oral mucosa vs. penile skin flap, MD: −40.05, 95% CI: −79.42, −0.68, P = 0.046).Conclusion: When the oral mucosal graft was used in the anterior urethra urethroplasty, it had a similar success rate and post-operative complication rate, and oral mucosa substitution had a shorter operation time. This evidence-based medical research further supports the view that oral mucosa is the preferred substitution material for the anterior urethra urethroplasty.

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Preclinical efficacy of stem cell therapy for skin flap: a systematic review and meta-analysis

Stem Cell Research & Therapy ◽

10.1186/s13287-020-02103-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Yuan Li ◽

Qi-lin Jiang ◽

Leanne Van der Merwe ◽

Dong-hao Lou ◽

Cai Lin

Keyword(s):

Systematic Review ◽

Stem Cells ◽

Stem Cell ◽

Survival Rate ◽

Meta Analysis ◽

Skin Flap ◽

Cochrane Library ◽

Skin Flaps ◽

Cell Based Therapy ◽

Stem Cell Treatment

Abstract Background A skin flap is one of the most critical surgical techniques for the restoration of cutaneous defects. However, the distal necrosis of the skin flap severely restricts the clinical application of flap surgery. As there is no consensus on the treatment methods to prevent distal necrosis of skin flaps, more effective and feasible interventions to prevent skin flaps from necrosis are urgently needed. Stem therapy as a potential method to improve the survival rate of skin flaps is receiving increasing attention. Methods This review followed the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. Twenty studies with 500 animals were included by searching Web of Science, EMBASE, PubMed, and Cochrane Library databases, up until October 8, 2020. Moreover, the references of the included articles were searched manually to obtain other studies. All analyses were conducted using Review Manager V.5.3 software. Results Meta-analysis of all 20 studies demonstrated stem cell treatment has significant effects on reducing necrosis of skin flap compared with the control group (SMD: 3.20, 95% CI 2.47 to 3.93). Besides, subgroup analysis showed differences in the efficacy of stem cells in improving the survival rate of skin flaps in areas of skin flap, cell type, transplant types, and method of administration of stem cells. The meta-analysis also showed that stem cell treatment had a significant effect on increasing blood vessel density (SMD: 2.96, 95% CI 2.21 to 3.72) and increasing the expression of vascular endothelial growth factor (VEGF, SMD: 4.34, 95% CI 2.48 to 6.1). Conclusions The preclinical evidence of our systematic review indicate that stem cell-based therapy is effective for promoting early angiogenesis by up regulating VEGF and ultimately improving the survival rate of skin flap. In summary, small area skin flap, the administration method of intra-arterial injection, ASCs and MSCs, and xenogenic stem cells from humans showed more effective for the survival of animal skin flaps. In general, stem cell-based therapy may be a promising method to prevent skin flap necrosis.

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