scholarly journals Outcome of scalp reconstruction in a teaching hospital

2016 ◽  
Vol 48 (1-2) ◽  
pp. 3-6
Author(s):  
Md Tariqul Islam ◽  
SK Nishat Abdullah ◽  
Md Mehedi Newaz ◽  
Mizanur Rahman ◽  
Md Ashikur Rahman
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Graft Loss ◽  
Tissue Expansion ◽  
College Hospital ◽  
Transposition Flap ◽  
Rotation Flap ◽  
Medical College ◽  
Scalp Reconstruction ◽  
Free Flap Surgery

An area of loss of scalp could be covered by various methods including local flap, distant flaps, skin graft, free flap surgery or tissue expansion. Each method has some disadvantages, such as postoperative alopecia or donor site morbidities. The study was conducted in the Department of Burn and Plastic Surgery, Khulna Medical College Hospital from July 2011 to June 2015. Scalp reconstruction was performed on 16 patients who sustained scalp loss from RTA, surgery for cancer, burn injuries and machinery injury. The size of the wound ranged from 6 cm2 to 320 cm2. Transposition flap, rotation flap, removal of osteomyelitic bone and skin grafts were done. Among 16 cases, 3 cases (18.75%) were skin grafted, 6 cases (37.5%) were reconstructed with transposition flaps, 5 cases (31.25%) were reconstructed with rotation flap and 2 cases (12.5%) were reconstructed with skin graft after removal of osteomyelitic outer table of skull bone. The postoperative complications seen in this series includes partial graft loss in 2 cases (skin graft), marginal necrosis in 1 case (transposition flap) and alopecia in 11 cases (in skin graft and transposition flap). There was no alopecia in reconstruction with rotation flap. Rotation flaps brings the best outcome in terms of durability and aesthetic acceptability where it is applicable in comparison to other procedure.Bang Med J (Khulna) 2015; 48 : 3-6

scholarly journals Scalp Reconstruction Following High Voltage Electric Burn

2014 ◽  
Vol 3 (2) ◽  
pp. 49-52 ◽  
Author(s):  
Md Zakir Hossain ◽  
Bidhan Sarker ◽  
Lutfar Kader Lenin ◽  
Ayesha Hanna ◽  
Limon Kumar Dhar
Keyword(s):  
Plastic Surgery ◽  
High Voltage ◽  
Skin Grafting ◽  
College Hospital ◽  
Transposition Flap ◽  
Reconstructive Procedures ◽  
Rotation Flap ◽  
Medical College ◽  
Scalp Reconstruction ◽  
Scalp Defects

Background: Scalp reconstruction following high voltage electric burn can be challenging. A useful Reconstructive algorithm is lacking. The purpose of this study was to evaluate our experience and to identify an appropriate reconstructive strategy. Methodology: This was a prospective observational study, conducted in the Burn unit of Dhaka Medical College Hospital & Department of Burn & Plastic Surgery,Sir Salimullah Medical College & Mitford Hospital over a period of five years. Reconstructive procedures, independent factors and outcomes were evaluated. A total of 7 procedures were performed in 30 patients. Techniques for reconstruction included skin grafting, outer table drilling & skin grafting, Bipedicle flap, Single rotation flap, Double opposing rotation flap, Transposition flap, Tissue expansion & primary closure. Conclusion: Important tenets for successful management of scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local scalp flaps with skin grafts remain the mainstay of reconstruction in most instances. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18251 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 49-52

scholarly journals Reconstruction of scalp with local axial flaps

2020 ◽  
Vol 6 (9) ◽  
pp. 1692
Author(s):  
Saket Srivastava ◽  
Pradeep Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Healing Time ◽  
Surrounding Tissue ◽  
Surgical Reconstruction ◽  
Local Flaps ◽  
Transposition Flap ◽  
Scalp Reconstruction ◽  
Scalp Defects ◽  
Scalp Defect

<p><strong>Background:</strong> The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.</p><p><strong>Methods:</strong> From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm<sup>2</sup> in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.</p><p><strong>Results:</strong> The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm<sup>2</sup>) and 28 patients had 90-150 cm<sup>2</sup> defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.</p><p><strong>Conclusions</strong>: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.</p>

scholarly journals Hinged multiperforator-based extended dorsalis pedis adipofascial flap for dorsal foot defects

2020 ◽  
Vol 47 (4) ◽  
pp. 340-346
Author(s):  
Magdy A. Abd Al Moktader
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Graft Loss ◽  
Plantar Fascia ◽  
Donor Site Morbidity ◽  
Adipofascial Flap ◽  
Dorsalis Pedis Artery ◽  
Flap Viability ◽  
Cutaneous Flap ◽  
The Right

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects.Methods Twelve patients aged 5–18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact.Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing.Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

scholarly journals Tissue expansion in operated cases of transposition flap of scalp for correction of donor site alopecia and patient’s satisfaction

2018 ◽  
Vol 5 (7) ◽  
pp. 2461
Author(s):  
Pradeep Goil ◽  
Abhimanyu Singh ◽  
Hiranmayi Kumari ◽  
Ayush Jain
Keyword(s):  
Donor Site ◽  
Major Complication ◽  
Tissue Expansion ◽  
Transposition Flap ◽  
Tissue Expanders ◽  
Patient’S Satisfaction ◽  
Scalp Defects ◽  
Scalp Defect ◽  
Post Traumatic ◽  
The Mean

Background: Scalp defects managed by local transposition flaps with donor site alopecia are aesthetically not acceptable to patients. Scalp expansion with tissue expanders is needed for proper correction of this deformity.Methods: Authors retrospectively reviewed all cases of post traumatic and post burn scalp defects that were managed initially by local transposition flap and later by scalp expansion by tissue expanders at our institute over a period of 5 years and conducted an outcome survey. Authors’ institutional protocol in such patients and results of the review are presented.Results: Twenty-eight patients were included in the study. Eight patients had post traumatic and 20 cases had post electric burn scalp defect. The mean age of patients was 28.92±8.26 years. Thirty-eight tissue expanders of various sizes (200-600 ml) were used in 28 patients. The mean follow-up time was 9.07±1.92 months. Major complication rate in present study was 2.63%. Results of outcome survey revealed more than 90% patients were satisfied after third surgery.Conclusions: Scalp transposition flap donor site alopecia can be easily corrected by tissue expansion. The complications are not severe and can be managed easily. It should be offered to all such types of patients, as it leads to proper social rehabilitation and satisfaction among these groups of patients.

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap

2017 ◽  
Vol 33 (08) ◽  
pp. 544-548 ◽  
Author(s):  
Adam Satteson ◽  
Joshua Waltonen ◽  
Zhongyu Li ◽  
Ethan Wiesler ◽  
Peter Apel ◽  
...  
Keyword(s):  
Skin Graft ◽  
Free Flap ◽  
Donor Site ◽  
Graft Loss ◽  
Radius Fracture ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Radial Forearm Free Flap ◽  
Hardware Complications ◽  
Radial Forearm

Background This study sought to characterize the donor-site complications associated with the osteocutaneous radial forearm free flap (ORFFF) used for mandibular reconstruction, as well as to compare donor-site complications between the ORFFF and fasciocutaneous radial forearm free flap (FRFFF). Methods An Institution Review Board approved, retrospective review identified all ORFFF and FRFFF performed for head and neck reconstruction with a single otolaryngology surgeon at an academic medical center over a 3-year period. Patients requiring an ORFFF underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by hand surgeons. Donor-site outcomes including infection, skin graft loss, tendon exposure, neuropathy, radius fracture, hardware complications, and need for additional donor-site surgery were compared. Results In this study, 25 patients underwent ORFFF harvest, and 52 underwent FRFFF harvest. There was one radius fracture occurring in association with a hardware infection requiring reoperation. No fractures or other major donor-site complications were seen in the FRFFF group. Similar rates of minor complications were noted with skin graft take less than 50% in 4% (n = 1) and 8% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group. Conclusion The risk of fracture following ORFFF harvest with prophylactic plating is small. Other donor-site complication rates were similar with both flap techniques.

scholarly journals Evaluation of scrotal reconstruction with thigh flap

2018 ◽  
Vol 50 (1-2) ◽  
pp. 13-17
Author(s):  
Md Tarikul Islam ◽  
Palash Kumar Dey ◽  
Abu Hena Mustafa Kamal ◽  
Md Farid Uddin
Keyword(s):  
Prospective Study ◽  
Donor Site ◽  
Scrotal Skin ◽  
College Hospital ◽  
Medical College ◽  
Advantages And Disadvantages ◽  
Aesthetic Appearance ◽  
Skin Loss ◽  
Cutaneous Flap ◽  
Surgery Department

Background: Scrotal skin can be lost in many ways. Partial loss of scrotum is easy to manage but major scrotal skin loss represents a significant challenge to the reconstructive surgeon. Although many techniques have been established for the treatment of major scrotal defects, each technique has its own advantages and disadvantages in specific situations.Objective: The aim of this prospective study was to evaluate the outcome of thigh fascio-cutaneous flap for reconstruction of major scrotal loss with exposed testis.Methods: This prospective study was done for 5 years extending from January 2012 to December 2016. In this period we reconstructed major scrotal defects of eight patients with antero medial and pudendal thigh fascio-cutaneous flap in Burn and Plastic Surgery department, Khulna Medical College Hospital. Total eleven thigh fascio-cutaneous flaps were used for reconstruction of major scrotal defects.Results: The mean patient age was 41 years (range 24 to 62 years). The aetiology of scrotal loss was Fournier's gangrene in 4 cases and trauma in 4 cases. Three cases had bilateral and five cases had unilateral flap reconstruction. The flaps allowed sensate coverage and took well. Primary donor site closure obviated the need for skin grafts in most of the cases, Complications were flap tip necrosis (12.50%) and minor wound infection (12.50%) which were treated conservatively. Donor site scar was limited and acceptable. The flap had good aesthetic appearance except in one fatty patient where the flaps were bulky.Conclusion: The study concluded that thigh fascio-cutaneous flap is very reliable for coverage of major scrotal defects.Bang Med J (Khulna) 2017; 50 : 13-17

scholarly journals TISSUE EXPANSION

2006 ◽  
Vol 13 (01) ◽  
pp. 87-91
Author(s):  
RAYHANA AWWAL ◽  
SHAFQUAT HUSSAIN KHUNDKAR ◽  
RUHUL HASSAN JOARDER
Keyword(s):  
Hospital Setting ◽  
Tissue Expansion ◽  
Study Data ◽  
The Body ◽  
Tissue Loss ◽  
College Hospital ◽  
Medical College ◽  
Body Design ◽  
Data Source ◽  
Almost All

Objective: To study the use of tissue expansion for reconstruction in various sitesof the body. Design :Retrospective study. Data source: Hospital records of plastic surgery dept of Dhaka Medicalcollege Hospital. Setting: Dhaka Medical College Hospital. Period:Jan2001-Dec2004. Materials and Methods:12patients with various amount of tissue loss undergone tissue expansion to cover the defect. Results: In this studysuccessful reconstruction was possible in 10 out of 12 cases. In 2 case expander had to be taken out .It was possibleto use expander in almost all sites of the body. Complication occurred in 7patients ,of which major complicationoccurred in 3 cases.

The Assessment of Postoperative Patency and Flow Pattern of Twisted Vascular Pedicle in Propeller Perforator Flaps in Lower Extremities Reconstruction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Lotfy Hamed ◽  
Amir Samir Elbarbary ◽  
Abd El Rahman Mohamed Sayed ◽  
Ahmed Mohamed Abdel Salam ◽  
Dalia Mohamed Galal
Keyword(s):  
Lower Extremity ◽  
Flow Pattern ◽  
Skin Graft ◽  
Donor Site ◽  
Graft Loss ◽  
Soft Tissue Reconstruction ◽  
Vascular Pedicle ◽  
Perforator Flaps ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Abstract Background The propeller perforator flap is a variant of perforator flaps in which complete skeletonization of the perforator with venae commitantes is done to transfer the islanded flap on its pedicle with up to 180 degrees of twisting that predispose to its gradual occlusion by time. These flaps have been recently advocated for lower extremity reconstruction. However, reconstruction of the lower extremity especially in the distal third of the leg quite often involves multistage procedures that might necessitate flap re-elevation and little knowledge is available about postoperative patency of these flaps. Aim of the work The aim of this study is to assess the postoperative patency and flow pattern in twisted vascular pedicle of propeller perforator flaps used in lower extremity reconstruction. Materials and methods A Prospective study was conducted on 15 patients 18 years or older of both genders undergoing lower extremity soft tissue reconstruction by propeller perforator flaps rotated from 90 to 180 degrees at Ain Shams University Hospitals and Nasser Institute between 1st February and 31th December 2019. With exclusion of smoking, peripheral vascular diseases and diabetes mellitus, each patient was evaluated preoperatively in regards to age, gender, comorbidities, bacterial contamination or infection, cause of tissue loss. The flap size, source vessel, arc of rotation, donor site closure was analyzed. The flow pattern was evaluated by handheld Doppler device and used as a control for the study. Postoperatively, the same handheld Doppler device was used to localize the vascular pedicle, evaluate its patency and assess the flow pattern at a minimum follow up period of 3 months postoperatively in all patients. Results The mean age of the fifteen patients included was 35.3 years old. Six patients lost tissue was caused by unstable scar, while post-traumatic in the remaining. Preoperatively, four patients had osteomyelitis and four had wound infection. The rest of patients did not report any infection. Eight out of fifteen patients used perforators from peroneal vessel source, while seven patients used posterior tibial artery source. Forty percent of included participants had a 180 degrees arc of rotation, while 26.7% of participants had an arc rotation angle of 120 degrees, and 33.3% had 90 degrees. Five patients had early post-operative congestion that improved by conservative methods without de-rotation of the flap, one patient had skin graft loss over the donor site of the flap, and another patient suffered in addition to skin graft loss distal congestion leading to superficial skin necrosis. Eight patients had no complications. All patients had patent vessels with biphasic flow pattern postoperatively at a minimum of 3 months postoperatively. Conclusion The perforator propeller flaps are safe, reliable procedures and are considered as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg providing similar skin texture with low rate of vascular obstruction. The present study documented patent vascular pedicle of propeller perforator flaps at three months postoperatively.

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