Clinical Application of a Modified Local Transposition Flap Surgery in Repairing Fingertip Defects

Background: A modified local transposition flap surgery was performed for fingertip injuries, which allows a more significant transfer distance with good outcomes.Methods: The study collected patients who underwent parallelogram transposition flaps and V-Y flaps to repair fingertip defects from 2017 to 2020. 122 cases (122 fingers) were included in our study, The interval between the injury and operation was 5.78 h (the mean value was 4.7-8.4 h). All operations were performed by one surgical team, and the average operation time was 31.2 min.Record the operation time，two-point discrimination（2PD），Total Active Movement (TAM)and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.Results: All parallelogram （Group A）and V-Y flaps （Group B）had survived postoperatively. There was no difference with operative duration and follow-up time in two groups. At last follow-up, there was no difference with the 2PD of the palmar part of the flaps and the TAM of injured figures in Group A and Group B . The MHQ summary scores in Group A were much higher than in Group B . Evaluation of the MHQ subscale performance showed that the overall hand function, activities of daily living, work performance and pain score had no differences, but aesthetics and satisfaction score was higher in Group A .Conclusions: The reconstruction using parallelogram flaps is a easier and more versatile treatment with better functions, less morbidity and better aesthetics. This method is a better choice for reconstruction of fingertip injury.

Upper Lip Vermilion Transposition Flap pada Commisuroplasty dan Z Plasty pada Rekonstruksi Macrostomia

Macrostomia adalah kelainan kongenital yang jarang terjadi, biasanya disertai kelainan lain. Kelainan ini diperkirakan terjadi pada 1 dari 80.000 kelahiran. Beberapa literatur telah menjelaskan tehnik operasi rekontruksi macrostomia, meski emikian belum ada satu standart operasi yang rekomendasikan, setiap tehnik memiliki kelebihan dan kekurangan. Penulis melaporkan satu kasus operasi rekontruksi macrostomia dengan menggunakan tehnik Kaplan untuk comisuroplaty, otot dijahitkan secara overlapping serta menggunakan Zplasty untuk penutupan kulit

Umbilical trocar port site keloid management using a transposition flap after laparoscopic surgery

Background Keloids can occur anywhere in the human body. They are difficult to remove and can cause distress in patients. Although many options are available to treat keloids, no single method is considered the optimal treatment of choice. The authors encountered cases where an umbilical keloid developed at the trocar site after laparoscopic surgery and managed the keloid using a transposition flap.Methods A total of 10 umbilical keloid patients treated from 2013 to 2020 were included in this study. All patients developed a keloid due to the placement of a laparoscopic trocar incision port, and their major complaints varied from an asymptomatic nodule to pruritus or pain. All excisions were performed under local anesthesia, and transposition flaps were planned afterward. The surrounding tissue was rearranged so that the shape of the umbilicus was deformed to the minimum extent possible. The keloid scars were examined both preoperatively and 6 months postoperatively using the Patient and Observer Scar Assessment Scale (POSAS).Results All surgical wounds healed well without complications. The average time interval from laparoscopic surgery to keloid scar revision was 4.3 years. The mean postoperative follow-up period was 10.9 months, and no patient underwent reoperation. Four patients were treated with triamcinolone after surgery due to mild hypertrophy or pruritus. The POSAS observer scale showed significantly decreasing scores over time in all patients (P=0.002).Conclusions Cosmetically unfavorable keloids that form in the umbilicus following laparoscopic surgery can be improved with a simple procedure using excision and transposition flaps.

A Transposition Flap Reconstruction after Resection of a Soft-Tissue Sarcoma in the Buttock

Introduction:Large defects following resection in the gluteal region are challenging. Of note, there are a limited number of fairly morbid options for reconstruction. Case Report:A 65-year-old female presented with complaints of an enlarging mass in the left buttock over the past several months. A high-grade sarcoma was diagnosed based on a biopsy. The final diagnosis was an undifferentiated pleomorphic sarcoma based on the resected tumor. An 11-cm tumor with surrounding tissues, including the great gluteal muscle, was resected, which resulted in a 17-cm full thickness defect. The defect was reconstructed with a transposition flap elevated from the lateral thorax. A transposition flap can cover large buttock defects without sacrificing other muscles. Conclusion:Moreover, a transposition flap is esthetically acceptable because most of the operative scar is within the buttock area. A transposition flap reconstruction is one of the several options for large defects after soft-tissue sarcoma resection in the buttock. Keywords:Buttock, resection, reconstruction, musculocutaneous flap, soft-tissue sarcoma.

Upper eyelid reconstruction using a combination of a nasal septal chondromucosal graft and a Fricke flap: a case report

Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a fullthickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a “Fricke flap.” The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.

Giant Primary Apocrine Carcinoma of Frontal Region: Clinical Presentation, Surgical Treatment and Review of the Literature

Background: Primary cutaneous apocrine carcinoma (PCAC), a subtype of sweat gland carcinoma, is an extremely rare malignant neoplasm. Distinguishing apocrine carcinoma from breast carcinoma metastasis is difficult even for pathologist. Most arise in regions of high apocrine gland density like axilla, and rarely on the scalp and eyelid, but it’s possible to occur elsewhere on the skin. Primary cutaneous apocrine carcinoma of the scalp is a rare malignancy most often reported in the literature as case reports or small case series. Giant form of primary cutaneous apocrine carcinoma in frontal region is not described in literature, to the best of our knowledge. There no established protocols for primary cutaneous apocrine carcinoma treatment.Case presentation: We report a case giant primary cutaneous apocrine carcinoma localized in frontal region. Definitive diagnosis of primary cutaneous apocrine carcinoma is made by biopsy with microscopic and immunohistochemical analysis. Wide surgical excision and reconstruction with large local transposition flap and split thickness skin grafts for secondary defect were our therapy of choice.Conclusion: Primary cutaneous apocrine carcinoma is very rare malignancy and giant form in not described yet. Surgical treatment provided the patients with the tumor free status as well satisfactory aesthetical appearances and quality of living.

Clinical Application of a Modified Local Transposition Flap Surgery in Repairing Fingertip Defects

Purpose: A modified local transposition flap surgery was performed for fingertip injuries. Given the shape of the flap turnover resembling a parallelogram, we called it a parallelogram flap. This transposition flap surgery allows a more significant transfer distance with good outcomes.Method: The study collected patients who underwent parallelogram transposition flaps to repair fingertip defects from 2017 to 2020. 32 cases (32 fingers) were included in our study, including 20 males and 12 females, aged 17 to 60 years, with an average age of 36 years. The causes of injury were crush injury in 13 cases, punch injury in 11 cases and sharp cutting injury in 8 cases. There were 6 cases in thumbs, 6 cases in index fingers, 14 cases in middle fingers, 4 cases in ring fingers and 2 cases in little fingers. The area of fingertip defects was 1.2 cm × 2~3 cm × 4 cm, with bone exposure. The interval between the injury and operation was 5.78 h (the mean value was 4.7-8.4 h). All operations were performed by one surgical team, and the average operation time was 31.2 min.Record The length and width of the finger，two-point discrimination（2PD），Total Active Movement (TAM)and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.Results: all our parallelogram flaps had survived postoperatively.，At last follow-up,There was no difference between the length and width of the reconstructed finger and that of the healthy side（P>0.05）. The qualification rate of the static 2PD of the flaps were 84.37% .The qualification rate of the TAM of injured figures were 100% . Evaluation of the MHQ subscale performance showed that the score of the overall hand function is 93.71, activities of daily living is 95.22, work performance is 94.23,pain score is 4.34 , aesthetics is 92.15 and satisfaction score is 92.45.All of these were perform well.Conclusion: This transposition flap surgery allows a more significant transfer distance with good outcomes.

Successful basal cell carcinoma defect reconstruction using combination of rotation and advancement flap: Two case reports

Defects resulting from surgical procedure may be challenging to reconstruct depending on the size and location. In case of large defects, primary closure is often not possible and thus requires skin flap or graft. In such cases, skin flap is advantageous as it produces a similar color and texture with the surrounding tissue. Skin flap techniques such as advancement flap, rotation flap dan transposition flap are useful in closing small defects. In moderate to large-sized defects, especially in areas with high tension, a combination of more than one type of flap might be necessary. This report describes two cases of large defects on the temple and cheek following basal cell carcinoma excisional surgery which were successfully closed using a combination of rotation and advancement flaps. Both patients showed excellent functional and cosmetic outcome.