scholarly journals Regional Grafts for Closure of Postsurgical Defect in Anterior Maxilla: Versatility of Chin Graft and Local Rotational Flap

2013 ◽  
Vol 4 (1) ◽  
pp. 47-50
Author(s):  
Varsha Sunil Manekar
Keyword(s):  
Donor Site ◽  
Surgical Flaps ◽  
Donor Site Morbidity ◽  
No Donor ◽  
Anterior Maxilla ◽  
Mucosal Defect ◽  
Rotational Flap ◽  
Osseous Defect ◽  
The Right ◽  
Autogenous Grafts

ABSTRACT The management of postsurgical defect is a challenge for the maxillofacial surgeon. With the success of various autogenous grafts and surgical flaps the reconstruction surgery creates definitive results. This article is a case report of reconstruction of osseous defect and closure of soft tissue fenestration in the right anterior maxilla. An autogenous corticocancellous graft from the mandibular symphysis is used for reconstruction of the osseous defect of around 15 × 15 mm. The mucosal fenestration of around 10 × 10 mm is closed by rotational flap based in the labial sulcus. The defect and the donor site healed uneventfully. Both osseous and mucosal defect healed with esthetic results. Thus, the regional flaps prove the versatility by convenience of graft taking, no donor site morbidity and biological resemblance of tissues. How to cite this article Manekar VS. Regional Grafts for Closure of Postsurgical Defect in Anterior Maxilla: Versatility of Chin Graft and Local Rotational Flap. Int J Head and Neck Surg 2013;4(1):47-50.

Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal

2020 ◽  
Vol 45 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Bo Liu ◽  
Shanlin Chen ◽  
Esther Ching San Chow ◽  
Pengcheng Li ◽  
Kun Liu ◽  
...  
Keyword(s):  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Pinch Strength ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Type Iv ◽  
Type Iiib ◽  
Rotational Flap ◽  
Staged Reconstruction

We treated 16 patients with 17 hypoplastic thumbs (eight Type IIIB and nine Type IV) using a non-vascularized fourth metatarsal transfer with a rotational flap and multi-staged reconstruction. The average age at the first operation was 24 months. The average follow-up time was 46 months. All patients achieved reasonable hand function and were able to use the reconstructed thumb to grip small and large objects. The operated thumb achieved an average Kapandji score of 6.7 and average pinch strength of 0.9 kg. There were two cases of graft nonunion. All parents are satisfied with the function and appearance of the reconstructed thumb and donor foot. We conclude that non-vascularized fourth metatarsal transfer is a feasible reconstruction method for patients with Types IIIB and IV hypoplastic thumbs. The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. Level of evidence: IV

Autologous osteochondral graft for traumatic defects of finger joints

2011 ◽  
Vol 37 (3) ◽  
pp. 251-257 ◽  
Author(s):  
W. C. Wu ◽  
M. W. M. Fok ◽  
K. Y. Fung ◽  
K. H. Tam
Keyword(s):  
Donor Site ◽  
Joint Space ◽  
Donor Site Morbidity ◽  
Finger Joint ◽  
Osteochondral Graft ◽  
Range Of Movement ◽  
No Donor ◽  
The Mean ◽  
Open Injuries

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

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 Brachial artery perforator propeller flap reconstruction of post electrical burn defect axilla

2021 ◽  
Vol 8 (10) ◽  
pp. 3211
Author(s):  
Surya Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Brachial Artery ◽  
Preoperative Planning ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complication Rates ◽  
Vascular Pedicle ◽  
Propeller Flap ◽  
Current Scenario ◽  
The Right ◽  
Artery Perforator

In the current scenario, propeller flaps are an attractive choice for single stage coverage of a large number of defects. They have a more reliable vascular pedicle than traditional flap and allow for greater freedom in design and wide mobilization and minimal donor-site morbidity. Harvesting of a propeller flap requires appropriate patient selection, preoperative planning, and meticulous dissection and these techniques greatly reduce the complication rates. Here, we present a case of a post burn raw area of the right axilla which was debrided and covered with a brachial artery perforator propeller flap.

scholarly journals Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

2021 ◽  
Vol 8 (1) ◽  
pp. 30-37
Author(s):  
Narottama Tunjung ◽  
Nandita Melati Putri
Keyword(s):  
Retrospective Study ◽  
Operative Time ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complete Healing ◽  
Type Iv ◽  
Pressure Injury ◽  
The Mean ◽  
The Right ◽  
Thorough Debridement

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

scholarly journals Case Report

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. NP38-NP40 ◽  
Author(s):  
Sanjay Naran ◽  
Joseph E. Imbriglia
Keyword(s):  
Case Report ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
No Donor ◽  
Metacarpophalangeal Joints ◽  
Active Function ◽  
Patient Reported ◽  
Long Term Follow Up

Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.

Aneurysmal Bone Cysts in the Hand Treated by Free Non-Vascular Transfer of Metatarsal or Proximal Phalanx from the Foot

1993 ◽  
Vol 18 (6) ◽  
pp. 736-741 ◽  
Author(s):  
G. S. RAO ◽  
P. KEOGH ◽  
H. WEBSTER ◽  
P. G. LUNN ◽  
F. D. BURKE
Keyword(s):  
Donor Site ◽  
Bone Cyst ◽  
Proximal Phalanx ◽  
Donor Site Morbidity ◽  
No Donor ◽  
Joint Reconstruction ◽  
Articular Surfaces ◽  
Aneurysmal Bone Cysts ◽  
And Function ◽  
Second Toe

Two cases of aneurysmal bone cyst in the hand are reported. In one case the entire first metacarpal was resected and grafted using the fourth metatarsal. In the second case diaphysectomy of the middle phalanx of the index digit was performed, and the proximal phalanx of the second toe was used as graft. Satisfactory length and function were maintained, the grafts remained viable and there was no donor site morbidity. Transplant of a metatarsal or toe phalanx to the hand, as a free non-vascularized graft, is a relatively straight forward operation, requires minimal refashioning of the graft, provides articular surfaces for joint reconstruction and leaves little donor site morbidity.

Onlay Fascial Grafts to Silicone-Polytetrafluorethylene Composite Implants in Augmentation Rhinoplasty: A Retrospective Study of 241 Cases

2019 ◽  
Vol 39 (11) ◽  
pp. 1182-1190
Author(s):  
Lee Seng Khoo ◽  
Cheng-I Yen ◽  
Chun-Shin Chang ◽  
Hung-Chang Chen ◽  
Chih-Jung Huang ◽  
...  
Keyword(s):  
Patient Group ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Control Group ◽  
Complication Rates ◽  
Augmentation Rhinoplasty ◽  
Level Of Evidence ◽  
No Donor ◽  
Asian Ethnicity

Abstract Background Silicone-polytetrafluoroethylene composite implants are fast gaining popularity in Asian rhinoplasty. Nonetheless, implant displacement, erythematous reactions, and infections still occur in the authors’ patient group during long-term follow-up. Objectives The authors reported successful experience of combining the utilization of silicone-polytetrafluoroethylene composite implants with onlay temporal fascial grafts to circumvent these complications. Methods Sixty-four patients of Asian ethnicity underwent augmentation rhinoplasty utilizing an I-shaped composite implant with an onlay fascial graft from January 2015 to June 2018, with a mean follow-up period of 13.5 months. This patient group was compared with a control group of 177 Asian patients who underwent augmentation rhinoplasty utilizing the same composite implant but without the addition of a fascial graft; the control group was treated from February 2012 to June 2015, with a mean follow-up of 42.0 months. Complications were compared between these 2 patient groups, specifically focusing on malposition/deviations, erythema, and infections. Results There was a marked decrease in complication rates with the addition of an onlay temporal fascial graft to cover the composite implant in augmentation rhinoplasty (7.8% vs 14.7%) as well as the rate of erythematous reactions (0% vs 6.2%, P = 0.04), infection (1.6% vs 1.1%), and implant malposition/deviation (0% vs 4.5%). Harvesting the temporal fascia and fashioning the onlay graft added an additional 33 minutes on average per procedure. No donor site morbidity was encountered. Conclusions Although the operative time increased, the benefits of adding onlay fascial grafts to silicone-polytetrafluoroethylene implants in alloplastic augmentation rhinoplasty outweigh the drawbacks, as evidenced by the decrease in erythematous reactions. Level of Evidence: 4

scholarly journals Pick-up Test: An Indication for Opponensplasty in Patients with Severe Carpal Tunnel Syndrome

2009 ◽  
Vol 17 (2) ◽  
pp. 183-186 ◽  
Author(s):  
Siu-Leung Yip ◽  
Chi-Hung Yen ◽  
Wai-Lam Chan ◽  
Hon-Bong Leung ◽  
Kan-Hing Mak
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Motor Deficit ◽  
No Donor ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Test Failure

Purpose. To use a pick-up test to assess thenar motor deficit and results of opponensplasty. Methods. Eight consecutive patients with idiopathic severe carpal tunnel syndrome and severe thenar motor deficit were identified. All were females aged 39 to 60 (mean, 53) years and right-hand dominant. The severity of thenar motor deficit was assessed using the pick-up test. Failure to pick up a coin with the thumb and index finger only in a normal pulp-to-pulp pincer grip was an indication for an opponensplasty (in addition to open carpal tunnel release) to hasten recovery of thumb abduction. Treatment outcome was assessed using the pick-up test at 6, 8, and 12 weeks. Results. Preoperatively, all patients were unable to perform the pick-up test. At postoperative 6 weeks, all patients could pick up the coin with no difficulty and were satisfied with the result of opponensplasty. There was no relapse at subsequent follow-ups and no donor-site morbidity in terms of cosmesis, scar pain or infection. Grip strength and the range of wrist motion were 63% and 92% of the normal side, respectively. Conclusion. The pick-up test is a simple and reliable means of identifying those in need of an opponensplasty.

scholarly journals Ear Reconstruction

2021 ◽  
pp. 731-745
Author(s):  
Paritkumar Ladani
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Congenital Deformity ◽  
Ear Reconstruction ◽  
No Donor ◽  
Rib Cartilage ◽  
Self Confidence ◽  
Emerging Trends ◽  
The Face ◽  
Reconstructive Techniques

AbstractMicrotia is a congenital deformity of the external ear, with a prevalence rate of approximately 1 in 10,000 live births worldwide. The auricle is a distinguishing feature of the face. Its deformity may have severe psycho-social implications on the affected children, affecting their self-confidence. Current reconstructive techniques for microtia mainly include the auricular prosthesis, implantation of alloplastic or an autologous rib cartilage framework. Alloplastic implant reproduces an excellent shape of the ear with no donor site morbidity, however its bio-integration is questionable and may make them prone for extrusion and infection. Sub-cutaneous implantation of autologous rib cartilage still remains the gold-stand treatment for microtia. However this technique has its surgical morbidities and skill demands, which makes it difficult to master. Translational research in the fields of tissue engineering for generation of bone and cartilage for ear reconstruction are emerging trends.

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