Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps

Introduction: The repair of large urethrocutaneous fistulas (UCFs) commonly involves reconstruction of the urethra, waterproof layer and skin coverage, which deploy different tissues from different flaps. To simplify the multiple procedures, we explored to use one flap (a scrotal-septal flap) to reconstruct three layers in UCF repairing in one stage.Methods: Between January 2011 and July 2012, 29 patients with large UCFs (ranging from 1.0 to 2.0 cm) were treated using scrotal-septal flaps for three-layer reconstruction. Every patient has an unbroken scrotum. The hair follicles in the donor site were destroyed using a radiosurgical knife 2 months before the operation. The flap was divided into three zones, which were flipped, folded, and extended respectively to form the urethra, waterproof layer and skin coverage.Results: The patients were followed up between 6 to 12 months. No fistula recurrence was observed. All flaps survived, except in one case, in which the distal skin flap was lost but stenosis or fistula did not develop. Two patients underwent second operations to refine the aesthetic results.Conclusions: The scrotal-septal flap can be transferred in an overturning-folding-advancement fashion and can simultaneously involve the reconstruction of the urethra, waterproof barrier and skin coverage. This is a simple and reliable alternative for large UCFs (≤2 cm) repairing at the penoscrotal junction; however, it cannot be used in patients with a damaged scrotal septum.

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Split-Thickness Skin Excision: Its Use for Immediate Wound Care in Crush Injuries of the Foot

Foot & Ankle ◽

10.1177/107110078901000202 ◽

1989 ◽

Vol 10 (2) ◽

pp. 54-60 ◽

Cited By ~ 16

Author(s):

Mark Myerson

Keyword(s):

Wound Care ◽

Skin Flap ◽

Free Flaps ◽

Complete Coverage ◽

Compartment Syndromes ◽

Wound Debridement ◽

Thickness Skin ◽

Skin Excision ◽

Crush Injuries ◽

Skin Coverage

Split-thickness skin excision (STSE) was used as an adjunctive modality in the treatment of eight crush injuries of the foot. Compartment syndromes were present in four feet and were treated with fasciotomy. Wound debridement, internal fixation of fractures, and STSE followed. This technique accurately determined the viability of the skin flap, simultaneously providing skin for local wound coverage. All flaps treated in this manner survived and all (100%) of the degloved STSE grafts healed. Additional procedures were performed in four patients (two free flaps and two split-thickness skin grafts) adjacent to the debrided flap for complete coverage. STSE proved to be an effective modality for skin coverage in crush injuries of the foot associated with degloving of skin.

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Justification for preservation of the projected skin flap above the tumor during surgical treatment of primary resectable breast cancer

Kazan medical journal ◽

10.17816/10.17816/kmj2019-710 ◽

2019 ◽

Vol 100 (4) ◽

pp. 710-718

Author(s):

A R Khamitov ◽

K Kh Ismagilov

Keyword(s):

Breast Cancer ◽

Risk Factor ◽

Malignant Tumor ◽

Subcutaneous Tissue ◽

Skin Flap ◽

Significant Risk ◽

Significant Risk Factor ◽

Superficial Fascia ◽

Indirect Sign ◽

The Aesthetic

Aim. Improvement of the aesthetic outcomes of reconstructive plastic surgery for nodular breast cancer due to the scientific rationale of conservation of the projected skin flap and moving the postoperative scar to aesthetically acceptable zones. Methods. Data of clinical and instrumental methods of investigation of 240 patients with primary resectable breast cancer were analyzed. The probability of involvement of the front layer of the superficial fascia in the projection of a malignant tumor depending on its clinical and topographic anatomical figures was estimated. Results. The study revealed that the fascia involvement does not depend on the skin flattening. The skin flattening is an indirect sign of superficial tumors having a probability of intimate adherence of the tumor to the fascia of 31.8±0.401%. In turn, the intimate adherence of the tumor to the front layer of the superficial fascia with a probability of its involvement of 39.3±0.41% is a significant risk factor for the projected skin flap involvement. It was also found that involvement of the fascia studied does not depend neither on the size of the tumor, nor on the nodal status, nor on the biological subtype. The key risk factor is the depth of the tumor. Conclusion. The indication for the projection skin flap preservation is the location of a malignant tumor at a depth of more than 1.05 cm, at which the probability of affecting the fascia is statistically insignificant and is 1.7±0.1%, which requires placing the subcutaneous tissue resection line in the tumor projection from the side of preserved skin flap.

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Using KISS Flaps in a Chest Wall Reconstruction After Mastectomy for Locally Advanced Breast Cancer: A New Technique

Surgical Innovation ◽

10.1177/1553350619877299 ◽

2019 ◽

Vol 27 (1) ◽

pp. 5-10

Author(s):

Jia Song ◽

Yong Han ◽

Jian Liu ◽

Kai Cheng ◽

Qiang Gao ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Primary Closure ◽

Locally Advanced Breast Cancer ◽

Skin Flap ◽

Donor Site ◽

Locally Advanced ◽

Radical Mastectomy ◽

Advanced Breast ◽

Skin Defect

This study described a technique for the reconstruction of large lateral thoracic defects after local advanced breast cancer resection that allows for complete cover of the defect and primary closure of the donor site. The authors performed reconstruction using the newly designed KISS flap in 2 women for coverage of their large skin defect (15 × 13 cm each) following mastectomies with extensive tissue resection. The KISS flap consisting of 2 skin islands (marked Flap A and Flap B; 15 × 6 cm each) was designed and transferred to the thoracic defect through the subcutaneous tunnel, and based on the same vessel. The flap covered properly without causing excessive tension and allowed primary closure of chest wound and donor defect. The security it brings is comparable with that of classical radical mastectomy, and its success rate is similar to that of single skin flap transplantation. Compared with the conventional pedicled latissimus-dorsi-musculocutaneous flap, we believe that the donor zone tension decreases, wherein the KISS flaps can reduce the incidence of incision dehiscence and nonhealing complications to some extent. The study reported good results from this technique and discussed the techniques that referenced previous reports.

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Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The American Surgeon ◽

10.1177/000313481207800229 ◽

2012 ◽

Vol 78 (2) ◽

pp. 151-154 ◽

Cited By ~ 7

Author(s):

Ron Hazani ◽

Ryan Whitney ◽

Bradon J. Wilhelmi

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Secondary Intention ◽

Donor Skin ◽

Aesthetic Results ◽

The Aesthetic ◽

Sheet Graft ◽

Surrounding Skin ◽

Tissue Defects

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

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Long-term evaluation of autologous lamellar corneal grafts for the treatment of deep corneal ulcer in four dogs: a case report

Veterinární Medicína ◽

10.17221/139/2017-vetmed ◽

2019 ◽

Vol 64 (No. 02) ◽

pp. 84-91

Author(s):

SY Kim ◽

JY Kim ◽

SW Jeong

Keyword(s):

Case Report ◽

Corneal Ulcer ◽

Donor Site ◽

Ultrasound Biomicroscopy ◽

Corneal Graft ◽

Corneal Ulcers ◽

Term Evaluation ◽

The Aesthetic

Autologous lamellar corneal grafts were performed on four dogs with two deep corneal ulcers and two corneal perforations to achieve better visual and aesthetic outcomes. The donor corneal graft was harvested from the relatively normal corneal region of the affected eye and used to cover the corneal defect. At the two-year follow-up examination, ultrasound biomicroscopy was performed to confirm the thickness and endothelial continuity of the transplanted grafts and donor site of the cornea. The evaluations revealed that the dogs had healed without incident and that their vision had been maintained. Furthermore, the owners were satisfied with the aesthetic outcomes in all cases. Our findings show that autologous lamellar corneal grafts are useful and effective in treating canine corneal ulcers and perforations.

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Current Controversies in Hair Replacement Surgery

The American Journal of Cosmetic Surgery ◽

10.1177/074880689401100407 ◽

1994 ◽

Vol 11 (4) ◽

pp. 283-292

Author(s):

James M. Swinehart

Keyword(s):

Clinical Study ◽

Hair Follicles ◽

Master Plan ◽

Significant Group ◽

Replacement Surgery ◽

New Challenges ◽

The Aesthetic

Like zucchini seeds in Hawaii, implanted hair follicles will grow almost anywhere: the skill lies in the aesthetic placement and design of the “master plan” for each patient. In this article the author examines seven current controversies in hair replacement surgery. Different techniques, each successful for a significant group of hair replacement surgeons, are evaluated via discussion, table, references, and photographs. Successful hair replacement surgeons often achieve excellent results from a wide variety of techniques. Rather than providing dogmatic answers, the author hopes to stimulate the reader to explore new challenges in fields of clinical study for hair and scalp surgery.

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Retroauricular skin flap and primary Z-plasty for donor site closure in partial ear reconstruction

The Journal of Laryngology & Otology ◽

10.1258/002221503321892352 ◽

2003 ◽

Vol 117 (6) ◽

pp. 487-489 ◽

Cited By ~ 7

Author(s):

Raymund E. Horch ◽

Joerg Schipper ◽

Roland Laszig

Keyword(s):

Primary Closure ◽

Skin Flap ◽

Donor Site ◽

Single Stage ◽

Ear Reconstruction ◽

Cartilage Graft ◽

Conchal Cartilage ◽

Primary Donor ◽

Conchal Cartilage Graft ◽

Donor Site Defect

Helical rim defects are noticeable and may well need reconstruction, especially in men. A method for reconstructing this type of defect together with primary donor site closure by Z-plasty is described.To close partial helical rim defects, a retroauricular caudally based rotational skin flap is performed to cover a conchal cartilage graft from the same ear that is harvested first and sutured into place to remodel the helical rim. To primarily close the donor site defect a retroauricular Z-plasty was developed which easily allowed primary closure of the donor site.The technique described here is straightforward, safe and reproducible. The Z-plasty approach for closing the donor site is useful, since the slight disturbance of the hairline is well hidden retroauricularly. This technique can be considered as a single-stage repair modality for the reconstruction of helical rim defects within primary donor site closure.

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Treatment of Toe-to-toe Defect with Arterial Skin Flap

Advanced Emergency Medicine ◽

10.18686/aem.v6.77 ◽

2017 ◽

Vol 6 (1) ◽

Author(s):

Jingbin Zhu ◽

Lei Shen ◽

Ying Xia ◽

Zhengui Guo

Keyword(s):

Blood Vessels ◽

Clinical Result ◽

Skin Flap ◽

Donor Site ◽

The Other ◽

Skin Grafts ◽

Normal Walking ◽

Partial Removal ◽

Repairing Effect

Objective: To study the repairing effect of arterial skin flap on the toe defect. Methods: Six patients with hallux defect were treated in our hospital from February 2014 to February 2016. The skin flap of the thumb was used to repair the defect. Results: After the operation, the skin flap had symptom of venous crisis. One patient survived after the dressing and partial removal of the pedicle of the flap. The other 5 cases survived and the wounds were healed. The skin grafts in the donor site survived and the incision reached grade I healing. The average follow-up period was 10 months. The flap elasticity and texture were good. Patients’ foot felt with burden, with normal walking, without obvious discomfort and without ulceration. Conclusion: The toe-to-toe defect is repaired with the arterial skin flap. The skin flap does not cause damage to the blood vessels, and the clinical result is ideal.

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Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20202834 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2268

Author(s):

Sujana Ravada ◽

Surya Rao Venkata Mahipathy ◽

Alagar Raja Durairaj ◽

Narayanamurthy Sundaramurthy ◽

Anand Prasath Jayachandiran

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Sensory Function ◽

Soft Tissue Defects ◽

Aesthetic Outcome ◽

Dorsal Metacarpal Artery ◽

The Mean ◽

The Aesthetic ◽

Tissue Defects ◽

First Dorsal Metacarpal Artery

Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

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The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220112 ◽

2022 ◽

Vol 12 (1) ◽

pp. 87-91

Author(s):

Lucretya Yeniwati Tanuwijaya ◽

Agus Roy Rusly Hariantana Hamid ◽

I Gusti Putu Hendra Sanjaya

Keyword(s):

Case Report ◽

Skin Graft ◽

Skin Flap ◽

Donor Site ◽

Surgical Techniques ◽

Operation Time ◽

Donor Site Morbidity ◽

Reconstruction Procedure ◽

Local Skin ◽

And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

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