Use of the Angularis Oris Axial Pattern Buccal Flap for the Correction of Facial Defects in Six Dogs

Background: Reconstructive surgery is an important area of veterinary surgery because it allows the reconstruction of large cutaneous defects in areas where a primary approach is not possible. Axial patterns flaps are composed by one direct cutaneous artery and vein, leading to a better blood supply with a good survival outcome. The angularis oris axial pattern buccal flap was introduced for correction of facial defects, but its versatility is not really explored in the existing literature. This article reports the use and complications of the angularis oris axial pattern buccal flap in six dogs, to treat defects in mandibular, temporal or labial regions.Cases: Five mixed breed dogs and one Labrador, with age between 4 and 9 years’ old were submitted for surgery and the angularis oris axial pattern buccal flap was used to close the different defects. Causes of defect included a lesion caused by myiasis in three of the dogs, and tumoral removal in the other three, where two were mast cell tumors and one a keratinizing basal cell carcinoma. The regions affected included rostral mandible with oral mucosa, intermandibular region, temporal region and upper lip. Before flap confection the tissue was cleaned, resected and prepared properly, according to each cause of lesion. The flap was made with two parallel incisions, wich center was usually the labial commissure, with the dorsal limits at the ventral aspect of the zygomatic arch, and the ventral incision on the ventral aspect of the mandibular ramus. Caudal extension was based on the length needed for surgical closure, but stained between the vertical auditory canal or up to atlas wing. Suture size and pattern depend the region and patient size. Patients were observed closely for any complication in the surgical site. From the six dogs presented here, five got some complications in the surgical site, including: lymphedema (2), suture dehiscence (4) and hematoma (1); however, regardless the complication, all patients had successful wound healing in 15 to 21 days after surgery. Also in two of the four suture dehiscence episodes, the cause of dehiscence was secondary to trauma and not the surgery.Discussion: The reconstruction of facial defects is noteworthy due the limited availability of flaps that can reach the region without excessive tension or healing complications. The angularis oris axial buccal flap pattern is the nearest flap to close defect in the intermandibular, temporal or labial regions. In the cases reported, it is possible to observe that the most frequent complication was suture dehiscence, but it occurred mostly in a small proportion of the flap, allowing healing in the expected time.The surgical planning is an important factor for reconstructive surgeries, so that there is enough tissue for the closure of the recipient and donor site, without tension over the flap or interference with tissue function and aesthetics. Despite the suture dehiscence in some of the cases, all patients showed adequate final recovery, since they returned to normal function with satisfactory cosmetic appearance.The angularis oris axial pattern buccal flap was applied in the correction of defects easily and all patients returned to normal function with satisfactory cosmetic appearance.

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Clinical Reasoning Web: An Evidence-based Educational Practice

Asian Journal of Nursing Education and Research ◽

10.52711/2349-2996.2021.00106 ◽

2021 ◽

pp. 437-440

Author(s):

Fancy Paul K

Keyword(s):

Nursing Students ◽

Clinical Reasoning ◽

Road Traffic ◽

Normal Function ◽

Verbal Response ◽

Evidence Based ◽

Temporal Region ◽

Reasoning Skills ◽

Nursing Diagnoses ◽

Clinical Reasoning Skills

Evidence-based educational practices always pave a way for better reasoning, judgment and decision making in clinical setting. Clinical Reasoning Web is a method of critical patient analysis in which relationships among nursing diagnoses supports the development of clinical reasoning skills. This method helps students to learn thinking like a nurse. Effective clinical reasoning ability promotes skills to collect data, solve problems, make decisions, provide quality care and survive in the workplace. Explaining relationships among nursing diagnoses supports the development of clinical reasoning skills. Explanations also encourage nurses and nursing students to reason forward from a problem to an outcome and also backwards from the outcome or effect to the current state of the patient. In this paper, the author has described the nursing care of a client, who was alleged with a road traffic accident and diagnosed to have right fronto-temporal-parietal contusion, brainstem contusion, acute extradural hematoma left temporal region. Cranio-cerebral trauma and traumatic brain injury are general designations to denote injury to the skull, brain, or both that is of sufficient magnitude to interfere with normal function and require treatment. The patient was unconscious, GCS- E 1VT M1 -2T/15 (verbal response cannot be assessed because of ET tube). Here the author illustrates how effectively a clinical reasoning web can be formulated by identifying keystone issue and related problems.

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Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699322 ◽

2009 ◽

Vol 42 (01) ◽

pp. 104-105

Author(s):

Puneet Tuli ◽

Atul Parashar ◽

Vipul Nanda ◽

Ramesh K. Sharma

Keyword(s):

Cleft Palate ◽

Nasal Mucosa ◽

Donor Site ◽

Unusual Complication ◽

Fat Pad ◽

Buccal Fat Pad ◽

The Third ◽

Buccal Flap ◽

Fat Herniation ◽

Cleft Surgery

ABSTRACTBuccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed.

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The Modified Caldwell-Luc Approach with the Use of Collagen Material for Treatment of a Chronic Perforated Maxillary Sinusitis

Case Reports in Dentistry ◽

10.1155/2020/8874227 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Ekaterina Diachkova ◽

Elena Morozova ◽

Natalia Blagushina ◽

Svetlana Tarasenko

Keyword(s):

Maxillary Sinusitis ◽

Collagen Membrane ◽

Oroantral Fistula ◽

Surgical Closure ◽

Dental Implantation ◽

Dental Rehabilitation ◽

History Of ◽

Sinus Lifting ◽

Buccal Flap

Oroantral fistula (OAF) often develops after extraction of posterior maxillary teeth and requires surgical closure. If it persists, OAF may result in maxillary sinusitis. This paper reports a case of an oroantral fistula, associated with chronic maxillary sinusitis. A 46-year-old female patient presented with a history of traumatic tooth extraction, which led to OAF formation. Three unsuccessful attempts were made to close it elsewhere. With one operation, we performed Caldwell-Luc surgery and closed OAF with a collagen membrane and plug and a buccal flap. The patient was assessed at 1-, 3-, 6-, and 12-month and 8-year follow-up visits, with no signs of maxillary sinusitis or OAF recurrence being found with the efficient amount of bone and opportunity for further dental rehabilitation like sinus lifting and dental implantation. We believe that this approach may be a viable option in similar cases.

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Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft

The Journal of Laryngology & Otology ◽

10.1258/0022215011906939 ◽

2001 ◽

Vol 115 (1) ◽

pp. 22-25 ◽

Cited By ~ 33

Author(s):

T. J. Woolford ◽

N. S. Jones

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Observation Time ◽

Cartilage Graft ◽

Septal Perforation ◽

Surgical Closure ◽

Nasal Septal Perforation ◽

Graft Donor ◽

Conchal Cartilage Graft ◽

Suitable Technique

The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.

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Five-year Survival Data on the Role of Endoscopic Endonasal Nasopharyngectomy in Advanced Recurrent rT3 and rT4 Nasopharyngeal Carcinoma

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419887410 ◽

2019 ◽

Vol 129 (3) ◽

pp. 287-293 ◽

Cited By ~ 1

Author(s):

Eugene Hung Chih Wong ◽

Yew Toong Liew ◽

Siow Ping Loong ◽

Narayanan Prepageran

Keyword(s):

Prognostic Factors ◽

Nasopharyngeal Carcinoma ◽

Survival Data ◽

Disease Free Survival ◽

Survival Outcome ◽

Queen Elizabeth Hospital ◽

Good Survival ◽

Endoscopic Endonasal ◽

Patient Size

Aim: Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients’ survival. Methods: All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Results: Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified. Conclusion: This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.

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Soft tissue reinforcement interposition flaps in hypospadias repair

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699197 ◽

2007 ◽

Vol 40 (02) ◽

pp. 170-177

Author(s):

R B Singh ◽

S Dalal ◽

N M Pavithram ◽

B D Sharma

Keyword(s):

Soft Tissue ◽

Mechanism Of Action ◽

Donor Site ◽

Suture Line ◽

Fistula Formation ◽

Corpus Spongiosum ◽

Meatal Stenosis ◽

Surgical Closure ◽

Urethral Strictures

ABSTRACT Purpose: To discuss the role and mechanism of action of soft tissue reinforcement interposition flaps (strifs) in hypospadias repairs (reinforced hypospadiac urethroplasties). Materials and methods: between 2000-2005, 120 consecutive hypospadiacs (distal 85, mid 20, proximal 15), who underwent primary reinforced urethroplasties employing different types of strifs, were retrospectively analyzed. the strifs were highly vascular soft tissue pedicled flaps (devoid of epithelium) interposed between neo-urethras and the covering skin to reinforce the neo-urethras against fistula formation. the strifs were harvested, without much donor site deformity, from: preputial skin, penile skin and scrotal skin by de-epithelialization. those from buck′s fascia, corpus spongiosum and tunica vaginalis are strifs without epithelium anyway, therefore do not need de-epithelialization. redo urethroplasties and micropenises were not included. seven patients were excluded because they had incomplete follow-up. the remaining 113 (distal 84, mid 17, proximal 12) were followed up for nine to 40 months for number, size, location, spontaneous closure and persistence of urethro-cutaneous fistula (ucf), and other complications with regard to the severity of hypospadias, method of neourethral re-construction, types of strifs employed and skin cover used. a total of 158 strifs and 124 skin covers were used in 113 hypospadiac urethroplasties. Results: the first surgery was curative in 74 (65%) of 113 patients. in the remaining 39 (35%), various complications included 12 urethro-cutaneous fistulas (ucfs), 10 urethral strictures, six cases each of penile torsion and meatal stenosis and five cases each of superficial necrosis and poor cosmesis. of these 39 patients, 25 (64%) recovered with conservative treatment and 14 (36%) required re-operation, i.e. ucfs and strictures in four cases each and penile torsion, meatal stenosis and dog-ears in two cases each. all the 12 ucfs were single, pinpointed and were located at the corona in five and at the shaft in seven. eight (67%) of the 12 ucfs healed spontaneously during the follow-up period of 12 weeks.Conclusions: harvesting strifs is technically easy, however, great care is required in their handling, accurate placement and suturing over and around the re-constructed neo-urethras for their secured reinforcement against fistula formation. use of strifs in hypospadias repairs decreases fistula-associated morbidity but does not absolutely prevent fistula formation. the strifs reduce the size and prevent multiplicity of ucfs and locate the ucfs eccentrically well away from the neo-urethra to facilitate their spontaneous (conservative) as well as subsequent (surgical) closure. the mechanism of action of strifs is multi-factorial, like acting as a mechanical barrier; preventing suture line superimposition; inducing neo-angio-genesis; working as biological drain; providing mechanical support; and, filling the dead spaces.

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Reconstruction of Combined Full-Thickness Defect of the Lateral Canthus and Lateral Upper and Lower Third Eyelids With an Extended Modification of the Fricke Flap, Periosteal Flap, and Conjunctival Flap

Plastic Surgery Case Studies ◽

10.1177/2513826x19879454 ◽

2019 ◽

Vol 5 ◽

pp. 2513826X1987945

Author(s):

L. Ashley Griffin ◽

Benjamin C. McIntyre

Keyword(s):

Donor Site ◽

Lower Eyelid ◽

Temporal Region ◽

Clinical Report ◽

Periosteal Flap ◽

Conjunctival Flap ◽

Lateral Canthus ◽

Aesthetic Appearance ◽

Fricke Flap ◽

Composite Defect

Introduction: The Fricke flap was originally described in 1829 as a laterally based flap from the temporal region that could be used to reconstruct potentially total lower eyelid defects. There have been a few minor modifications of this flap to allow for adjustments of the donor site scar, but none that address the sequelae of brow elevation and allow for reconstruction of a composite defect of the lateral canthus, lateral upper, and lower eyelids. We report our modification of the Fricke flap that allows for total reconstruction of these structures. Clinical Report: A 61-year-old male presented with composite defect of the lateral eyelids and canthus following resection of a basal cell carcinoma by Mohs technique. A Fricke flap was designed and modified to included elements of the above brow and below brow skin as an additional pennant flap. A “Y” shaped periosteal flap and inferior fornix conjunctival flap were also used to reconstruct the posterior lamella. Our surgical technique and follow-up are demonstrated. Discussion: Lateral eyelid and canthal reconstruction can be difficult to reconstruct with a single rotational flap from local sources. We describe our technique of modifying the Fricke flap to include an additional pennant of below brow skin that can be used to reconstruct the lateral eyelids and canthus allowing for a crisp lateral eyelid crease and acceptable donor site and aesthetic appearance. Conclusions: This is the first description of a modification of the Fricke flap that allows for total lateral eyelid and canthus reconstruction.

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Surgical Closure of Sacral Pressure Sores by Gluteal Skin Flap.

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v4i1.18684 ◽

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

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Treatment of Enchondromas of the Hand with Bone Substitute

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80272-0 ◽

1997 ◽

Vol 22 (4) ◽

pp. 476-478 ◽

Cited By ~ 2

Author(s):

P. JACOULET ◽

P. FAURE

Keyword(s):

Bone Substitute ◽

Operative Time ◽

Operative Procedure ◽

Full Range ◽

Donor Site ◽

Infectious Complications ◽

Normal Function ◽

X Ray ◽

Allogenic Bone

We report five patients with enchondromas of long bones in the hand. They were successfully treated by curettage and implantation of a biodegradable bone substitute (calcium phosphate). Bone regained normal X-ray appearance by 9 months. The full range of motion and normal function of the hand were restored. There were no complications and no recurrence at follow-up visits 28 months after operation. There are several advantages to this technique. The operative procedure may be performed under local anaesthesia on an out-patient basis and the operative time is shortened. Complications of a cancellous bone donor site are avoided, as are the potential infectious complications of allogenic bone implantation.

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