scholarly journals Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions

2011 ◽  
Vol 86 (6) ◽  
pp. 1145-1150
Author(s):  
Francisco Miguel Camacho-Martínez ◽  
Angel Rollón ◽  
Clara Salazar ◽  
Elena M Rodríguez-Rey ◽  
David Moreno
Keyword(s):  
Free Flap ◽  
Malignant Tumors ◽  
Donor Site ◽  
Free Flaps ◽  
Single Step ◽  
Rectus Abdominis ◽  
Original Position ◽  
Random Pattern ◽  
Recipient Site ◽  
Palmar Surface

BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position

The proximal first dorsal metacarpal artery free flap for reconstruction of complex digital defects

2012 ◽  
Vol 38 (4) ◽  
pp. 399-404 ◽  
Author(s):  
P. Hyza ◽  
T. Kubek ◽  
J. Vesely ◽  
L. Drazan ◽  
U. Choudry
Keyword(s):  
Patient Satisfaction ◽  
Surgical Technique ◽  
Free Flap ◽  
Primary Closure ◽  
Donor Site ◽  
Free Flaps ◽  
Outcome Data ◽  
Patient Demographics ◽  
Dorsal Metacarpal Artery ◽  
First Dorsal Metacarpal Artery

We describe our experience and outcome with the ‘Proximal first dorsal metacarpal artery free flap’. Ten consecutive cases utilizing the proximal first dorsal metacarpal artery free flap for complex digital defects were studied. Surgical technique, patient demographics, and flap outcome data were collected. Patient satisfaction was analysed using a questionnaire. All defects healed successfully with no loss of free flaps. The short-pedicle proximal first dorsal metacarpal artery free flap enables primary closure of the donor site up to 2 cm of width (in nine of the ten donor sites). The flap is a reliable and versatile alternative in selected cases of complex digital injuries.

The Role of Free Flaps in the Treatment of Persistent Scalp Osteomyelitis

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-64-ONS-67 ◽  
Author(s):  
Willy D. Boeckx ◽  
René R.W.J. van der Hulst ◽  
Lloyd V. Nanhekhan ◽  
Francesca De Lorenzi
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Muscle Flap ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Surgical Debridement ◽  
Neurosurgical Procedures ◽  
Latissimus Dorsi Muscle Flap ◽  
Flap Transfer ◽  
Free Flap Transfer

Abstract OBJECTIVE: To evaluate the efficacy of the combination of an extensive surgical debridement and simultaneous free flap repair in case of troublesome cranial osteomyelitis. METHODS: Five patients with persistent, frontal bone osteomyelitis were treated with surgical debridement of the infected bone and reconstruction with a free flap. In all patients, osteomyelitis occurred after neurosurgical procedures and lasted from 1 to 7 years. A latissimus dorsi muscle flap with a split skin graft has been performed. RESULTS: No flap failure occurred and donor site morbidity was negligible. No signs of osteomyelitis or soft tissue infection were observed during the mean follow-up period of 3.2 years. Furthermore, the contour of the cranium could be preserved without a need for bone grafts or implants. CONCLUSION: In our experience, the combination of an extensive surgical debridement and a free flap transfer is demonstrated to be an effective treatment for “chronic” osteomyelitis of the cranium.

scholarly journals Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

1970 ◽  
Vol 2 (3) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Free Flap ◽  
Weight Bearing ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Common Procedure ◽  
Anterolateral Thigh ◽  
Protective Sensation ◽  
And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

scholarly journals Versatility of radial forearm free flap for intraoral reconstruction

2015 ◽  
Vol 143 (5-6) ◽  
pp. 256-260 ◽  
Author(s):  
Jelena Jeremic ◽  
Zivorad Nikolic
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Free Flaps ◽  
Radial Forearm Free Flap ◽  
Sphincter Reconstruction ◽  
Vein Thrombosis ◽  
Single Donor ◽  
Radial Forearm ◽  
Acceptable Method ◽  
Palmaris Longus Tendon

Introduction. The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. Objective. The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Methods. This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5%) or delayed (2 patients, 9.5%) reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases), buccal mucosa (5 cases), lip (1 case) and a retromolar triangle (2 cases) defects, or after hemiglossectomy (7 cases). In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. Results. An overall success rate was 90.5%. Flap failures were detected in two (9.5%) patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis. The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. Conclusion. The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies.

scholarly journals Reconstruction of Angle of the Mouth by Microvascular Radial Forearm Free flap- A case report

2014 ◽  
Vol 40 (2) ◽  
pp. 62-64
Author(s):  
MA Litu ◽  
NK Chowdhury ◽  
M Rahman ◽  
S Hassan ◽  
ABM Korshed Alam ◽  
...  
Keyword(s):  
Case Report ◽  
Free Flap ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
The Body ◽  
Radial Forearm Free Flap ◽  
Recipient Site ◽  
Present Case Report ◽  
Tissue Transfer ◽  
Radial Forearm

The terms free flap and free tissue transfer are synonymous used to describe the movement of tissue from one site on the body to another. "Free" implies that the tissue, along with its blood supply, is detached from the original location (donor site) and then transferred to another location (recipient site). However, studies are still going on about the different aspects of its success and failure. The present case report is one such step to share our experience. In this case report successful microvascular free tissue transfer was possible With the increase in experience we can expect increased success rate as well. DOI: http://dx.doi.org/10.3329/bmj.v40i2.18515 Bangladesh Medical Journal 2011 Vol.40(2): 62-64

scholarly journals Microsurgical free tissue transfer as avaluable reconstructive procedure in foot reconstruction

2007 ◽  
Vol 40 (02) ◽  
pp. 141-146
Author(s):  
mohamed el-shazly ◽  
mohamed makboul
Keyword(s):  
Free Flap ◽  
Motor Vehicle ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Vehicle Accidents ◽  
Tissue Transfer ◽  
Scapular Flap ◽  
Radial Forearm ◽  
Foot Reconstruction

ABSTRACT Background: owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of upper egypt. free flaps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. they also improve the perfusion of the infected poorly perfused areas.Objectives: in this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and specific parameters of free tissue transfer to the foot area in concomitance with the patients needs.Materials and methods: eleven patients were included in this study. for each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. free flap transfers were applied in all cases as follows: latissimus dorsi flap in five cases, rectus abdominis flap in three cases, scapular flap in one case, gracilis flap in one case and radial forearm flap in one case.Results: nine flaps survived. no infection or donor site complications were recorded. every patient had the optimum free flap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels′ condition.Conclusion: the study of the optimum free flap for foot reconstruction in relation to the defect present and patient conditions is crucial to have significant results.

scholarly journals Facial contouring with parascapular free flap: A case series of 22 cases

2013 ◽  
Vol 46 (03) ◽  
pp. 561-567 ◽  
Author(s):  
Guru Dayal Singh Kalra ◽  
Ram Krishna Gupta
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Donor Site ◽  
Case Series ◽  
Facial Asymmetry ◽  
Free Flaps ◽  
Soft Tissue Augmentation ◽  
Facial Soft Tissue ◽  
Skin Paddle ◽  
Hemifacial Atrophy

ABSTRACT Background: The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA) and hemifacial microsomia (HFM) can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency. Materials and Methods: Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring. Results: All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up. Conclusion: Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.

Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach

2021 ◽  
Author(s):  
Ping Song ◽  
Lee L. Q. Pu
Keyword(s):  
Preoperative Evaluation ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Primary Role ◽  
Recipient Site ◽  
Recipient Vessel ◽  
Scalp Reconstruction ◽  
Core Concepts ◽  
Contemporary Approach

Abstract Background Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp. Methods In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described. Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction. Conclusion We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.

Novel STSG Donor Site for Forearm Flaps: Radial Skin Paddle

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P31-P31
Author(s):  
Tamer Abdel-Halim Ghanem ◽  
Mark K Wax
Keyword(s):  
Free Flap ◽  
Medical Center ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Patch Repair ◽  
Skin Grafts ◽  
Skin Paddle ◽  
Forearm Skin ◽  
Radial Forearm

Objective Split thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial forearm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial. Methods Prospective data was collected from patients undergoing forearm free flap reconstruction at a tertiary medical center in a 6-month period. The radial forearm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after arm tourniquet activation. Results There were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean forearm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the forearm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the forearm donor sites healed well, except one patient required a later revision procedure for exposed tendon. Conclusions Based on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial forearm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied forearm muscles were likely to require a thigh donor site.

scholarly journals Experiência de um hospital de referência com o retalho livre anterolateral da coxa na reconstrução de extremidades

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Nikolas Higa Benites ◽  
Guilherme Leipner Margatho ◽  
Fernanda Ruiz de Andrade ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Anterolateral Thigh ◽  
Anterolateral Thigh Flaps ◽  
The Impact

Introdução: Com a evolução da microcirurgia ao longo dos anos o Retalho Anterolateral da Coxa vem se tornando uma das principais opções para reconstruções na cabeça, pescoço, tronco e extremidades devido sua versatilidade e confiabilidade. Objetivo: Descrever dados de um hospital terciário referência em trauma na reconstrução de extremidades com o Retalho Anterolateral da Coxa. Método: Este é um estudo retrospectivo de 18 retalhos Anterolateral da Coxa microcirúrgicos realizados entre Março de 2016 e Outubro de 2019 em pacientes de todas as idades, na reconstrução de membros, onde se observou dados referentes ao paciente: idade, sexo, membro acometido, tempo entre a lesão e a confecção do retalho; ao intraoperatório: anatomia dos vasos perfurantes, tempo cirúrgico total, vasos receptores utilizados; e informações do pós-operatório: número de cirurgias relacionadas ao retalho, necessidade de reabordagem e número de perdas. Foram excluídos pacientes que perderam seguimento ou que apresentaram dados do prontuário incompletos. Realizou-se estatística descritiva e cruzamento de algumas variáveis utilizando o teste t-Student. Resultados: Nas reconstruções houve predomínio de pacientes do sexo masculino (72%), em idade produtiva, de etiologia traumática e nos membros inferiores. O tempo médio até a reconstrução foi de 21 dias e o tempo cirúrgico foi de 384 minutos. O paciente permaneceu, em média, 39 dias internado. Dos 18 retalhos, 3 evoluíram com necrose, 2 por trombose arterial e 1 por infecção. 6 retalhos necessitaram de reaborgadem de emergência, 3 por sangramento, 2 por congestão e 1 por infecção. Foram realizadas uma média de 3 cirurgias até a alta. Foram identificadas 15 perfurantes miocutâneas (83%) e 3 septocutâneas (17%). A análise do sucesso do retalho em relação ao tempo cirúrgico e dos dias até a cirurgia não mostrou significância estatística, assim como a necessidade de reabordagem em relação ao tempo cirúrgico. Conclusão: O retalho Anterolateral da Coxa mostrou-se confiável, além de apresentar diversas vantagens como: por ser retirado com uma grande ilha de pele, apresentar pedículo longo, vasos de bom calibre, não necessitar de mudança de decúbito e apresentar baixa morbidade da área doadora.Descritores: Retalho Miocutâneo; Microcirurgia; Hospitais Especializados.ReferênciasDaniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg. 1973;52(2):111-17.Ninkovic M, Voigt S, Dornseifer U, Lorenz S, Ninkovic M. Microsurgical advances in extremity salvage. Clin Plast Surg. 2012;39(4):491-505.Tamimy MS, Rashid M, Ehtesham-ul-Haq, Aman S, Aslam A, Ahmed RS. Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions? J Pak Med Assoc. 2010; 60(2):76-81.Spyropoulou A, Jeng SF. Microsurgical coverage reconstruction in upper and lower extremities. Semin Plast Surg. 2010;24(1):34-42.Xiong L, Gazyakan E, Kremer T, Hernekamp FJ, Harhaus L, Saint-Cyr M et al. Free flaps for reconstruction of soft tissue defects in lower extremity: a meta-analysis on microsurgical outcome and safety. Microsurgery. 2016; 36(6):511-24.Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concepted based on the septocutaneous artery. Br J Plast Surg. 1984; 37(2):149-59.Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219-26Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variation and technical problems of the anterolateral thigh flap: A report of 74 cases. Plast Reconstr Surg. 1998; 102(5):1517-23Spindler N, Al-Benna S, Ring A, Homann H, Steinsträsser L, Steinau HU et al. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. GMS Interdiscip Plast Reconstr Surg DGPW. 2015;4:Doc05.Kimura N, Satoh K, Hasumi T, Ostuka T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg. 2001;108(5):1197-210.Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg. 2012;20(1):17-23.Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC et al. Free anterolateral thigh flap for extremity reconstruction: Clinical experience and functional assessment of donor site. Plast Reconstr Surg. 2001;107(7):1766-71Novak CB, Lipa JE, Noria S, Allison K, Neligan PC, Gilbert RW. Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery. 2007;27(8):651-54.Pagano M, Gauvreau K. Princípios de Bioestatística. São Paulo: Pioneira Thomson Learning; 2004.SAS Institute Inc., SAS/STAT® User’s Guide. Version 9.4. Cary, NC: SAS Institute Inc.Arruda LRP, Silva MAC, Malerba FG, Turíbio FM, Fernandes MC, Matsumoto MH. Fraturas expostas: estudo epidemiológico e prospectivo. Acta ortop bras. 2009;17(6):326-30.Cunha FM, Braga GF, Drumond Jr SN, Figueiredo CTO. Epidemiologia de 1.212 fraturas expostas. Rev Bras Ortop. 1998;33(6):451-56.Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529-34.Shabtai M, Rosin D, Zmora O, Munz Y, Scarlat A, Shabtai EL et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills. Surg Endosc. 2004;18(9):1328-30.Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg.1986;78:285-292Smit JM, Acosta R, Zeebregts CJ, Liss AG, Anniko M, Hartman EH. Early reintervention of compromised free flaps improves success rate. Microsurgery. 2007;27(7):612-16.

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