Experience with Flaps After Resection of Vulvar Carcinoma: A Case Series

Background: A defect caused by the radical resection of vulvar cancer requires repair with flap transplantation or vulvoplasty. Therefore, the aim of this study is to present a review of our practice of post-surgical defect reconstruction in cases using different skin flaps.Methods: An observational study was performed among 26 patients with vulvar cancer who were admitted to Sun Yat-Sen Memorial Hospital between February 2015 and February 2020 for surgical and reconstructive procedures. Clinical data of these 26 patients were analyzed. All patients underwent radical resection of vulvar cancer, followed by the repair of post-surgical defects by random flap or axial flap transplantation (even for very complex defects).Results: Among the 26 cases in this study, all patients received 38 soft tissue reconstruction procedures for vulvar perineal defects during the study period. Squamous cell carcinoma was the most commonly diagnosed cancer (80.8%). The average size of the defect was 9.3 ´ 7 cm2. Rhomboid flaps were the most commonly used flaps for performing reconstruction in both the primary and recurrent groups. Poor wound healing was the most commonly discovered complication that occurred in 3 of the 38 flaps (7.9%) used. Previous surgery or radiotherapy did not increase the rate of complications after proper reconstruction was performed.Conclusion: Expanding resection is an effective technique for treating vulvar cancer. Different skin flaps, are effective premium options for post-surgical defect reconstruction, and selective use of skin flaps for treating vulvar defects preserves the vulvar morphology and allows for relatively better functionality.

Reconstruction of Complex Lateral Skull Base Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Flap

ObjectivesComplex lateral skull base defects resulting from advanced or recurrent oral cancer resection are continuously challenging reconstructive surgeons. This study aimed to use reconstructive methods for lateral skull base defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) flaps.Patients and MethodsWe performed a retrospective case series of 37 patients who underwent lateral skull base defect reconstruction using the ALT/anteromedial thigh (AMT) flap between March 2016 and May 2021 at the Second Xiangya Hospital. The design and harvest of the flaps, methods for defect reconstruction, and reconstructive efficacy are described.ResultsOf the 37 patients, 3 were women and 34 were men, with a mean age of 51.7 years. Among the defects, 26 were through-and-through defects and were reconstructed using ALT chimeric flaps, double ALT flaps, folded ALT flap, combined ALT chimeric flaps and AMT flaps, or combined ALT chimeric flaps and pectoralis major flaps; the large lateral skull base dead spaces were filled with muscle tissues or fatty tissues. Postoperatively, 38 of the 39 ALT/AMT flaps survived completely, and the remaining flap experienced partial necrosis. Venous compromise occurred in one patient who was salvaged after operative exploration. Oral and maxillofacial wound infections occurred in two patients, salivary fistula in three patients, and thigh wound effusion in three patients. The wounds healed gradually in all patients after repeated dressing changes. Thirty-three patients were followed up for approximately 3–60 months; their oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.ConclusionsWith the convenient flap design and muscle flap harvest, large and individualized tissue supply, feasible combination with other flaps, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT flap is an appropriate choice for complex lateral skull base defect reconstruction.

Sternal defect reconstruction using a double-barrel vascularized free fibula flap: a case report

Total and subtotal sternectomy oncological defects can result in large deficits in the chest wall, disrupting the biomechanics of respiration. Reviewing the current literature involving respiratory function and rib motion after sternectomy, autologous rigid reconstruction was determined to provide the optimal reconstructive option. We describe a novel technique for sternal defect reconstruction utilizing a double-barrel, longitudinally oriented, vascularized free fibula flap associated with rib titanium plates fixation. Our reconstructive approach was able to deliver a physiological reconstruction, providing rigid support and protection while allowing articulation with adjacent ribs and preservation of chest wall mechanics.

Retroauricular Advancement Flap In Single Stage Auricular Defect Reconstruction

Auricular defects must be treated early and properly because they may interfere with facial symmetry. Retroauricular skin is an ideal flap source for a non-reduction reconstruction procedure of the upper, middle, and lower auricular defects. Auricular reconstruction aims to achieve good anthropometric and aesthetic ear unit. The purpose of this case report is to present a reconstruction of auricular defects using the rectroauricular flap that results in a favorable aesthetic and normal anthropometric dimensions of the auricular. We report a case of auricular defect caused by post-excision of keloid located in the helical and antithetical area of the middle third of the right auricular, using a retroauricular flap. Normal values of the auricular’s anthropometric measurements were achieved, followed by a complete aesthetic ear unit. Retroauricular flaps are suitable for reconstructing partial auricle defects in the helical rim, temporal area, and conchae. Keywords: auricular defect, retroauricular flap, aesthetic ear unit, auricular anthropometry. Jabir Retroaurikular untuk Rekonstruksi Defek Telinga Abstrak Daun telinga berperan penting pada simetri wajah sehingga defek di daun telinga harus ditangani dengan baik sejak dini. Kulit retroaurikular merupakan sumber jabir ideal untuk rekonstruksi tanpa reduksi pada defek daun telinga bagian atas, tengah, dan bawah. Rekonstruksi daun telinga bertujuan untuk mendapatkan hasil yang baik secara antropometri dan estetika unit telinga. Tujuan laporan kasus ini adalah menunjukkan hasil yang baik berdasarkan unit telinga estetik dan dimensi normal antropometri pada rekonstruksi defek daun telinga menggunakan jabir rektroaurikular. Dilaporkan satu kasus defek telinga pasca-eksisi keloid, di area heliks dan antiheliks sepertiga tengah daun telinga kanan, menggunakan jabir retroaurikular. Didapatkan nilai normal pada pengukuran antropometri telinga dan kelengkapan estetika unit telinga. Jabir retroaurikular baik untuk rekonstruksi defek telinga parsial di lengkung heliks, area temporal, dan konka. Kata kunci: defek aurikular, jabir retroaurikular, unit telinga estetik, antropometri daun telinga.

Reconstruction of Complex Soft-Tissue Defects in Buttock Using The Proximally Based Anterolateral Thigh Flap: An Alternative Algorithm

Background Local and free flaps are most widely used in buttock reconstruction. However, local flaps and free flaps may not be appropriate for all complex soft tissue defects in buttock. In this study, we propose an alternative approach for buttock reconstruction and provide preliminary assessment in clinical efficacy of using a proximally based anterolateral thigh flap for buttock reconstruction. Methods In this study, we retrospectively analyzed the data of the patients with medium- to large-sized defects of buttock. All patients underwent buttock defect reconstruction using a proximally based anterolateral thigh flap between August 2012 and December 2020. Results Eight pedicled anterolateral thigh flaps were used to reconstruct buttock defects after tumor ablation in six patients, scar revision in one patient, melanocytic nevus resection in one patient. Flap size ranged from 25 × 8 cm to 30 × 12 cm, with pedicle length ranging from 12 to 20 cm. Flaps were elevated based on the distal musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery and completely survived without any perfusion-related complications. We achieved satisfactory results from both the functional and aesthetic point-of-view at the 6-month follow-up in all cases. Conclusions The proximally based anterolateral thigh flap can be a valuable reconstructive option with sufficient tissue and a long vascular pedicle for buttock defect reconstruction.