Hatchet flap and rotation flap for distal dorsal finger defect reconstruction.
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ABSTRACT:
SUBMITTER: Balan JR
PROVIDER: S-EPMC5053009 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe purpose of this clinical research is to report our results using the free distal ulnar artery perforator flap for resurfacing complex tissue defects in the finger, and to provide empirical reference for the treatment of subsequent clinical cases.MethodsIn our research, eight patients with complex skin defects were treated with free distal ulnar artery perforator flaps. There were 4 index, 3 long, and 2 ring fingers. All the flaps were raised from the ipsilateral ulnar lateral wrist. The donor sites were covered with a full thickness skin graft or closed by direct suture.ResultsComprehensive analysis of the clinical treatment process of eight patients, all flaps survived completely without any necrosis during the 6-18 months follow-up. The patients were satisfied with the finger mobility, the sensation function, and the aesthetic appearance.ConclusionsResurfacing complex tissue defects in the finger using the free perforator flap in a single stage, especially when the defect is medium in size and accompanied by digit nerve loss, is a valuable technique to achieve satisfaction in both sensation and aesthetic appearance. The ulnar artery perforator flap seems to be a reliable and flexible flap for addressing complex hand injuries with tissue loss.
| S-EPMC9201136 | biostudies-literature
Project description:Nasal reconstruction after skin cancer excision has routinely been challenging without any aesthetic sequelae, and any defects on the nose are readily noticeable. To circumvent this problem, surgeons have developed different flap techniques to mobilize adjacent tissue to repair aesthetically sensitive defects. We describe our experience, outcomes, and valuable tips for using the "tree flap," a novel modification of the hatchet flap that extends the back cut to significantly increase mobility, leaving only a small skin paddle to maintain perfusion to the flap. The combination of undermining, a rotatory component, and minimal skin attachment allows radical mobility without compromising blood supply. Thus, the tree flap allows for reconstruction of defects of the dorsum of the nose and defects near the nasal tip with ease, given both advancement and rotational movements. Compared with other local flaps such as the shark pedicle flap or bilobed flap, the tree flap has a similar learning curve, minimal donor site morbidity, and equivalent aesthetic outcome. It may be used to repair larger defects that may not be amenable to the bilobed flap as an alternative to a full-thickness skin graft. In our experience, the tree flap also has the advantage of a lower rate of pin cushioning when compared with other options such as the bilobed flap. The tree flap has great mobility and is a reliable option for reconstruction of the lower one-third of the nose with excellent aesthetic results and minimal complications.
| S-EPMC11018149 | biostudies-literature
Project description:Surgical treatment of bronchobiliary fistula (BBF) is difficult. A 47-year-old woman presented with a cough with yellow yielding sputum due to BBF. The patient had the adhesion of the liver, diaphragm, and lung. We performed liver, diaphragm, and lung resections. Patient had a large defect of diaphragm. Diaphragm reconstruction was performed using a pedicled reverse latissimus dorsi muscle flap. No flap necrosis was observed. Seven months after surgery, the patient did not present yellow yielding sputum and the BBF was not observed in the computed tomography. This surgical procedure was useful for treating the diaphragm defect both safely and easily. We believe that the reverse pedicled latissimus dorsi muscle flap is a reliable alternative for large diaphragm reconstruction after severe BBF.
| S-EPMC7722541 | biostudies-literature
Project description:Background: The submental flap is an alternative repair technique in the maxillo-facial region when microsurgical reconstruction is not required or is difficult to apply. The purpose of this study was to illustrate the benefits of restoring the cheeks with an extended pedicled submental flap. Method: Eight patients aged 58 to 81 years with cheek cancer presented to the surgery department at the Benha University Hospital in Egypt, from May 2019 to October 2021 for the removal of their tumors and reconstruction of the resulting defects, using the extended submental perforator plus pedicled artery flap. Results: The average blood loss was 250 cm3 (range: 50–400 cm3). The average operation took 3 hours to complete, including excision and rebuilding (a range of 2.5 to 3.5 hours). The length of the postoperative hospital stay was 2 to 4 days. Fortunately, there was no complete flap loss; nonetheless, distal flap necrosis in one case left a raw area, which was allowed to heal naturally, and hemorrhages in two cases were conservatively handled. Conclusions: For the reconstruction of cheek abnormalities, the submental flap is a viable alternative, particularly in older patients or patients whose overall health has declined and who need less severe therapies and quicker surgery. The submental flap, which conceals the donor site, provides a dependable supply of skin for facial resurfacing with excellent color, shape, and texture matching. The flap is quick, and easy to raise.
| S-EPMC10287118 | biostudies-literature
Project description:Introductionand importance: Large cutaneous defects may result from excision of skin malignancies. Typically, skin grafting is used to manage such defects, but the final result may be compromised by inadequate take and poor cosmesis. Accordingly, transposition flaps may be indicated.Case Presentation and clinical discussion: A 93-year-old female presented with a painful, necrotic 12 cm × 12 cm Squamous Cell Cancer of left upper back. She underwent wide excision followed by a rhomboid transposition fasciocutaneous flap. The flap was easily designed, quickly executed, and did not require any special instruments. The overall result was a good cosmetic outcome with no complications.ConclusionOur case outlines successful use of rhomboid flap instead of a more complicated option to reconstruct a very large cutaneous defect. The flap healed with excellent contour, texture, thickness, and color match.
| S-EPMC7848721 | biostudies-literature
Project description: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.
| S-EPMC8490120 | biostudies-literature
Project description: Not available
| S-EPMC10698541 | biostudies-literature
Project description:Reconstruction of a complex defect around the knee, particularly involving a large soft-tissue defect or disruption of the extensor mechanism, is always a challenging problem. The purpose of this study was to introduce the use of a customized free perforator flap for complex soft-tissue reconstruction around the knee. Between June 2010 and March 2017, 16 patients underwent this procedure. The choice of flap design is based on the location of the wound, the required pedicle length, the missing tissue components and their volumes, and the risk of donor-site morbidity. The reconstruction was performed using anterolateral thigh perforator (ALTP) flaps in five cases, modified ALTP flaps in two cases, chimeric ALTP flaps in four cases, dual-skin paddle ALTP flaps in two cases, and chimeric thoracodorsal artery perforator flaps in two cases. Multiple perforator flaps and vascularized fascia lata were used in one case. All flaps survived postoperatively. No vascular congestion was observed, and partial necrosis was observed in only one case. Primary closure of the donor site was performed for all patients. At a mean follow-up time of 16.5 months, most cases showed satisfactory flap contours and acceptable functional outcomes. A free perforator flap is a reliable option for repairing complex soft-tissue defects in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches and can achieve better results.
| S-EPMC8205711 | biostudies-literature
Project description:Oncologic defects of the hand can be problematic for the reconstructive surgeon. These defects may require a delay in definitive coverage until clear margins of resection can be obtained, which can result in a prolonged period of painful dressing changes and increased risk of soft-tissue infection. In addition, reconstructive options for oncologic defects are often limited to skin grafting, which can yield functional deficits secondary to contracted healing. Currently, there is no definitive method for preventing skin graft contracture; however, acellular dermis has been proposed as a biomechanical scaffold to enhance subsequent skin graft healing and slow this functionally debilitating process. Here, we present a patient with recurrent melanoma of the first dorsal web space. After re-resection of the melanoma, the 11 cm x 5 cm defect was reconstructed using acellular dermis as temporary coverage to allow ample time for permanent section results. Ten days later, after confirming negative margins of resection, a split-thickness skin graft (STSG) was applied over the vascularized neo-dermis. Follow-up clinical examination and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires were used to assess outcome. At 7 months, the patient had no recurrence of melanoma and a DASH functional reduction of only 6.9%. After approximately 18 months, the patient's wounds had healed with excellent cosmetic and functional results, without any evidence of a web space contracture. These observations suggest that acellular dermis is a useful adjunct for wound coverage of the hand, particularly in areas of functional importance, such as the first dorsal web space.
| S-EPMC2527224 | biostudies-other
Project description:ObjectivesOncologic risk is a serious concern of submental artery island flaps. Here, we introduce the contralateral-based submental artery island flap (C-SAIF) and demonstrate its feasibility and long-term oncological safety in reconstructing oral cancer-related defects.MethodsAn anatomical study was performed concentrating on the pedicle length in seven cadavers. Then, a retrospective study was carried out on C-SAIF patients operated on by a single team. The standard surgical technique of C-SAIF was conducted. Outcomes including operative time, length of hospital stay, volume of intraoperative blood loss, and scores of the Multidisciplinary Salivary Gland Society (MSGS) questionnaire were compared with a similar cohort reconstructed with anterolateral thigh free flap (ALTF). In addition, oncological outcomes were evaluated by the 5-year cumulative survival rate between C-SAIF and ALTF patients.ResultsThe pedicle length of C-SAIF was sufficient for the flap to be extended to the contralateral oral cavity. Fifty-two patients were included in the retrospective study, and nineteen of them underwent reconstruction with C-SAIF. The operative time of C-SAIF was shorter (p = 0.003), and the intraoperative blood loss was less (p = 0.004) than that of ALTF. There was no difference in MSGS scores. The results of survival analysis revealed comparable survival curves for the two groups in terms of overall survival, disease-specific survival, and disease-free survival.ConclusionC-SAIF is a feasible and reliable flap for reconstructing oral cancer-related defects. Moreover, it is an effective island flap to preserve the perforator and pedicle without compromising oncological safety.
| S-EPMC10415524 | biostudies-literature