scholarly journals Horizontally oriented v-y flap may diminish lower lid retraction

2020 ◽  
Vol 3 (4) ◽  
pp. 01-02
Author(s):  
Hojjat Molaei ◽  
Javad Rahmati ◽  
Ali Atri ◽  
Shahriar Haddady Abianeh
Keyword(s):  
Wound Repair ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Advancement Flap ◽  
Skin Defect ◽  
Left Cheek ◽  
Local Flaps ◽  
Case Presentation ◽  
Tumor Excision ◽  
Orbital Area

Introduction: lower lid malposition following malignancy surgery in infra- orbital area is often challenging and any way to reduce its chance is appreciated. Case presentation: 36 years old women with confirmed Basal Cell Carcinoma (BCC) of left cheek underwent tumor excision with free margins and remained skin defect reconstructed with adipocutaneous v-y advancement flap, which designed in a horizontally orientation. Patient had no signs of ectropion with good wound repair and obscured scar. Conclusion: v-y flaps are commonly used local flaps with minimal donor site morbidity, and if designed horizontally, not only may reduce chance of lower lid malposition, but also can remain more acceptable scars.

Flap Related Complications Requiring Secondary Surgery in a Series of 851 Local Flaps Used for Fingertip Reconstruction

2019 ◽  
Vol 24 (01) ◽  
pp. 24-29 ◽  
Author(s):  
T. Karjalainen ◽  
S.J. Sebastin ◽  
K.G. Chee ◽  
Y.P. Peng ◽  
A.K.S. Chong
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Advancement Flap ◽  
Flexion Contracture ◽  
Island Flap ◽  
Local Flaps ◽  
Flap Necrosis ◽  
Secondary Surgery ◽  
Partial Necrosis ◽  
Fingertip Reconstruction

Background: Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. Methods: 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. Results: 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Conclusions: Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.

scholarly journals An island flap based on the anterior branch of the superficial temporal artery for perioral defects

2006 ◽  
Vol 39 (02) ◽  
pp. 136-140
Author(s):  
Raveendra Reddy Ganji ◽  
V. Bhattacharya ◽  
Adil Bashir Sheikh ◽  
Goyal Sunish
Keyword(s):  
Donor Site ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Donor Site Morbidity ◽  
Single Stage ◽  
Full Thickness ◽  
Local Flaps ◽  
Forehead Flap ◽  
Anterior Branch ◽  
Aesthetic Results

ABSTRACTDefects following excision of lesions in and around theoral commissure extending on either lip are not infrequent. A majority of them are malignant. Various local flaps have been described to correct these defects, but sometimes they may not be feasible. However, the advantage of single-stage reconstruction can still be achieved by using an island forehead flap based on the anterior branch of the superficial temporal artery. This is a versatile flap with a reliable blood supply. It is relatively less popular as it involves time-consuming dissection.Aims: We have modified the island forehead flap based on the anterior branch of the superficial temporal artery by designing the flap on the frontoparietal region based on the terminal course of the anterior branch of the superficial temporal artery. Materials and Methods: This flap was used in five cases of perioral defects involving both the upper and lower lips including the angle of the mouth. Conclusions: Small to moderate dimension full thickness perioral defects can thus be reconstructed effectively with this modified flap in a single stage. The functional and aesthetic results are gratifying with minimal donor site morbidity.

Treatment of congenital clasped thumb in arthrogryposis

2017 ◽  
Vol 42 (8) ◽  
pp. 794-798 ◽  
Author(s):  
H. Abdel-Ghani ◽  
M. Mahmoud ◽  
A. Shaheen ◽  
M. Abdel-Wahed
Keyword(s):  
Simple Procedure ◽  
Donor Site ◽  
Metacarpophalangeal Joint ◽  
Donor Site Morbidity ◽  
Advancement Flap ◽  
Surgical Reconstruction ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
The Mean ◽  
And Function

We report the result of treatment of 69 complex clasped thumbs in 39 patients with distal arthrogryposis. The mean age at surgery was 30 months. Surgical reconstruction included skin augmentation of the first web using modified dorsal rotation advancement flap (Abdel-Ghani flap), a la Carte release of tight structures of the first web, and chondrodesis of the thumb metacarpophalangeal joint. The mean follow-up was 4 years. We prefer chondrodesis because of the presence of global instability, abnormal joint structure, abnormal articular surfaces, and inefficient muscles for transfer. Also, chondrodesis shortens the thumb and may alleviate the need for release of deficient palmar skin and lengthening of a short flexor pollicis longus. The Abdel-Ghani flap provides ample skin that gives a wide rounded web. It is a simple procedure with minimal donor site morbidity. Surgical reconstruction significantly improved the cosmetic appearance and function of the thumb. Level of evidence: IV

scholarly journals Role of Glabellar flap in midfacial reconstruction.

JMS SKIMS ◽  
2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Haroon Rashid Zargar ◽  
Mir Mohsin ◽  
Hilal Ahmed Bhat ◽  
Raheeb Ahmed Shah ◽  
Sheikh Adil Bashir ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Care Center ◽  
Donor Site ◽  
Tertiary Care ◽  
Donor Site Morbidity ◽  
Advancement Flap ◽  
Care Hospital ◽  
Patient Demographics ◽  
Included Patient

Aims: Reconstruction of midface always poses a challenge to a Plastic surgeon as one has to address the convexities and concavities which are somewhat unique to this area. Various local flaps have been used for achieving these goals. This study was conducted to evaluate the indications, feasibility and outcome of midfacial reconstruction using Glabellar flaps at a tertiary care center. Materials and Methods: This is a prospective observational study conducted in the Department of Plastic and Reconstructive Surgery of a tertiary care hospital between January 2016 to December 2019. All the patients who underwent midfacial reconstruction with Glabellar flaps during this period and consented to be a part of this study were included. Patient demographics, wound etiology and area, flap size and its mode of transfer, number of surgeries required, type of anesthesia used, comorbid conditions, complications if any and the results of reconstruction were recorded. All the patients were followed up till May 2020. Results: Thirteen patients were managed with Glabellar flaps. Majority of the patients (n=9, 69.23%) were males, with a mean age of 34 years. Most common cause of wounds was animal bite/maul (n=5, 38.46%). Glabellar flap was most commonly used as V-Y rotation advancement flap in nine patients (69.23%). Most of the cases (n=9, 69.23%) was operated under local anesthesia. Donor site was closed primarily in V-Y or linear fashion in 12 cases, and skin grafted only in 1 case. Majority (n=12, 92.3%) of the patients graded reconstruction results as Good-Excellent. Conclusions: Glabellar flap is an excellent option for reconstruction of midfacial defects with minimal donor site morbidity and can be performed safely under local anesthesia.

scholarly journals Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Hyuma A. Leland ◽  
Beina Azadgoli ◽  
Daniel J. Gould ◽  
Mitchel Seruya
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Donor Site ◽  
Elbow Flexion ◽  
Donor Site Morbidity ◽  
Intercostal Nerve ◽  
Optimal Number ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

Gracilis Flap Reconstruction After Proctocolectomy for Malignancy and Inflammatory Bowel Disease

2021 ◽  
pp. 000313482110111
Author(s):  
Olivia M. DeLozier ◽  
Zachary E. Stiles ◽  
David Shibata ◽  
Jeremiah L. Deneve ◽  
Justin Monroe ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Neoadjuvant Chemoradiation ◽  
Wound Complications ◽  
Flap Reconstruction ◽  
Major Complications ◽  
Inflammatory Bowel ◽  
Perineal Wounds

Background Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation. Methods Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed. Results Patients underwent GFR for rectal cancer ( n = 28), anal cancer ( n = 3), inflammatory bowel disease ( n = 13), or benign fistulizing disease ( n = 1). 22.2% were chronically immunosuppressed, and 66.7% underwent preoperative chemoradiation. Twenty (44.4%) patients had minor wound complications, all treated nonoperatively. Nine patients had major complications with 4 patients requiring reoperation. The 4 threatened flaps were unilateral, and all were salvaged. Donor site morbidity was minimal. Patients with major complications were older (56 vs. 71 years, P = .030), and less likely to have pelvic drains ( P = .018). Conclusion In high-risk perineal wounds, GFR offers durable reconstruction with acceptably low morbidity.

scholarly journals Autogenous bone augmentation from the zygomatic alveolar crest: a volumetric retrospective analysis in the maxilla

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Irina Kuster ◽  
Livia Osterwalder ◽  
Silvio Valdec ◽  
Bernd Stadlinger ◽  
Maximilian E. H. Wagner ◽  
...  
Keyword(s):  
Gold Standard ◽  
Donor Site ◽  
Bone Defects ◽  
Donor Site Morbidity ◽  
Bone Volume ◽  
Autogenous Bone ◽  
Bone Augmentation ◽  
Maximum Volume ◽  
Alveolar Crest ◽  
Good Access

Abstract Background Autogenous bone augmentation is the gold standard for the treatment of extended bone defects prior to implantation. Bone augmentation from the zygomatic crest is a valuable option with several advantages, but the current literature for this treatment is scant. The aim of this study was to evaluate the increase in bone volume after locoregional bone augmentation using autogenous bone from the zygomatic alveolar crest as well as the complications and success rate. Results Analysis of the augmented bone volume in seven patients showed a maximum volume gain of 0.97 cm3. An average of 0.54 cm3 of autogenous bone (SD 0.24 cm3; median: 0.54 cm3) was augmented. Implantation following bone augmentation was possible in all cases. Complications occurred in three patients. Conclusion The zygomatic alveolar crest is a valuable donor site for autogenous alveolar onlay grafting in a locoregional area such as the maxillary front. Low donor site morbidity, good access, and its suitable convexity make it a beneficial choice for autogenous bone augmentation.

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