End-of-skin grafts in syndactyly release: description of a new flap for web space resurfacing and primary closure of finger defects.
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ABSTRACT:
SUBMITTER: Sharma RK
PROVIDER: S-EPMC2654950 | biostudies-other | 2009 Mar
REPOSITORIES: biostudies-other
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Project description:BackgroundIt has recently been attempted in the literature to analyze the aesthetic outcomes of syndactyly web space reconstruction utilizing dorsal pentagonal advancement flaps and dorsal rectangular flaps with skin grafting. The study utilized a categorical grading system for evaluating the aesthetic outcomes of reconstruction to be used in conjunction with a visual analog scale (VAS), which has yet to be validated in the assessment of aesthetic outcomes following web space reconstruction.ObjectivesTo utilize crowdsourced public perceptions to validate the grading of aesthetic outcomes in web space reconstruction for finger syndactyly.MethodsA prospective study was conducted of random volunteers recruited through an internet crowdsourcing service to gain responses for a survey to analyze patient opinions toward the aesthetic outcomes of web space reconstruction. Outcomes were graded based on descriptions of the appearance, color, matte, and distortion of the reconstruction.ResultsThe excellent dorsal flap demonstrated a mean VAS score of 6.66 (95% confidence interval [CI] = 6.45-6.87), and the very good, good, and poor dorsal flaps had mean VAS scores of 5.94 (95% CI = 5.73-6.15), 4.98 (95% CI = 4.77-5.19), and 3.55 (95% CI = 3.31-3.79), respectively. The odds ratio for receiving an excellent rating was 4.21 (95% CI = 3.04-5.82) for excellent dorsal flap with P < 0.0001.ConclusionsThis study confirms and validates the assessment of aesthetic outcomes of web space reconstruction by the Yuan Grading Scale. This evidence may guide future practice such that recommendations can be made to align with the aesthetic preferences of the patient.
| S-EPMC7760566 | biostudies-literature
Project description:Complex upper-limb trauma, in particular crush and avulsion injuries, present an ongoing challenge for the reconstructive hand surgeon given the extensive zone of injury, particularly involving the neurovascular structures. When replantation is deemed unsuitable, the reconstruction must be both robust and flexible enough to meet the functional needs of the patient. The authors present a case of a ring avulsion amputation of the middle digit of a young patient's dominant hand. Due to the distal extent of avulsion, the amputated digit was determined to be nonreplantable, and the patient's medical comorbidities precluded traditional delayed pedicle flap options. Therefore, a reverse radial adipofascial flap was used as a single-stage reconstruction to resurface the entirety of the circumferential digital defect. At 8 months of follow up, the patient demonstrated exceptional passive and active range of motion with excellent contour and cosmesis, illustrating the utility of this reconstructive option.
| S-EPMC9308155 | biostudies-literature
Project description:IntroductionMyelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, keystone island flap can be used for closure of large MMCs.Presentation of caseA new-born girl born as a product of 36 weeks of gestation had a weight of 3.020 kg and had multiple congenital anomalies including hydrocephalus, thoracolumbar myelomeningocele at the level of (T10-L4) and an atrial septal defect. Preoperative evaluation showed a head circumference of 42 cm (n: mean 34.4 ± 2SD), no lower limbs movements and a thoracolumbar soft tissue defect around 4 × 8 cm with exposed neuronal tissue and prominent thoracic kyphosis, and no obvious urogenital or limbs anomalies. The large thoracolumbar myelomeningocele was treated at KFSHRC with a Keystone Design Perforator Island Flap (KDPIF) to reconstruct the soft tissue defect following the neurosurgical reconstruction.DiscussionThe keystone flaps were deemed as viable as all wounds were healed without any complications, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers a simple and effective method of wound closure in situations that would, otherwise, have required complex flap closure.ConclusionThis flap can be an effective method for reconstruction of large thoracolumbar MMC defects that might improve outcome and minimize complications. It also ensures good watertight closure with minimal wound tension and breakdown.
| S-EPMC7452152 | biostudies-literature
Project description: Not available
| S-EPMC5053009 | biostudies-literature
Project description:The vascularized nasoseptal flap has become a principal reconstructive technique for the closure of endonasal skull base surgery defects. Despite its potential utility, there has been no report describing the use of the modern nasoseptal flap to repair traumatic cerebrospinal fluid (CSF) leaks and documenting the outcomes of this application. Specific concerns in skull base trauma include septal trauma with disruption of the flap pedicle, multiple leak sites, and issues surrounding persistent leaks after traumatic craniotomy. We performed a retrospective case series review of 14 patients who underwent nasoseptal flap closure of traumatic CSF leaks in a tertiary academic hospital. Main outcome measures include analysis of clinical outcome data. Defect etiology was motor vehicle collision in eight patients (57%), prior sinus surgery in four (29%), and assault in two (14%). At the time of nasoseptal flap repair, four patients had failed prior avascular grafts and two had previously undergone craniotomies for repair. Follow-up data were available for all patients (mean, 10 months). The overall success rate was 100% (no leaks), with 100% defect coverage. The nasoseptal flap is a versatile and reliable local reconstructive technique for ventral base traumatic defects, with a 100% CSF leak repair rate in this series.
| S-EPMC3312593 | biostudies-other
Project description:BackgroundHypothenar hammer syndrome (HHS) is traditionally treated with venous bypass grafting, but controversy has arisen as arterial grafts have become more available.MethodsA retrospective review of all patients undergoing ulnar artery bypass grafting for HHS with an arterial graft from 2008 to 2017 was performed. We also review the literature for patency rates and discuss the scenarios that favor different graft choices.ResultsSix patients were included in our series. Five had primary surgery and 1 had revision surgery for HHS. Five arterial grafts were from the deep inferior epigastric artery and 1 was from the lateral circumflex femoral artery. The proximal anastomotic site was the ulnar artery for all: n = 6. The distal anastomosis site was the palmar arch and common digital artery (CDA) of the ring/small finger and CDA of the middle/ring finger: n = 3; the palmar arch and the CDA of the ring/small finger: n = 3. All patients were symptom-free at follow-up and had a patent ulnar artery on Allen's testing or angiogram.ConclusionPatency rates of arterial grafts for HHS appear to be excellent and this small series and may offer an alternative to traditional venous grafts and end-to-end arterial anastomoses. We suggest using arterial perforator grafts from free flap donor sites. These have well-described anatomy, are easily harvested, and carry minimal donor site morbidity. Lateral circumflex femoral artery graft is favored in patients requiring a single distal anastomosis, who have a ventral hernia, or who are obese. Deep inferior epigastric artery graft is preferred when multiple distal targets or versatile configurations are needed, in thin patients, or in female patients.
| S-EPMC7644834 | biostudies-literature
Project description:BackgroundExtensive through-and-through oromandibular defects after advanced oral carcinoma excision pose a reconstructive challenge for the head and neck surgeon. These complex oromandibular wounds often involve the mandible, oral and/or aerodigestive mucosa, and the external skin. As a result, these defects are often not amenable to reconstruction with a single flap due to the volume of soft tissue needed and the three-dimensional reconstructive requirement. The use of two free flaps has often been suggested to overcome this reconstructive challenge. A simpler and less technically demanding way to deal with this may involve the use of a free flap in combination with a pedicled regional flap. We present our experience of the use of a simultaneous microvascular fibula free flap (FFF) with a pectoralis major myocutaneous flap (PMMC) for addressing these defects.MethodsA retrospective chart review was performed of patients treated with a FFF and PMMC combination for the reconstruction of oromandibular defects at the University of Mississippi Medical Center (Jackson, MS) between October 2013 and February 2016. A minimum follow-up of 12 months was required. Data collected included the extent and location of tumor involvement, size of the postablative defect, tumor histology, clinical and pathological staging, length of follow-up, functional outcomes, and associated complications.ResultsA total of three patients were identified to have been treated with the above technique. Defects repaired involved through-and-through mandibular defects with associated oral mucosa and external skin defects. In all cases, the FFF was used for restoring bony continuity with the skin paddle used to reconstruct the intraoral lining. The PMMC was used for reconstruction of the external skin defect and for providing soft tissue bulk. The average size of the fibula skin paddle used for intraoral reconstruction was 7.7 cm × 11.7 cm. The average size of the PMMC paddle was 7.3 × 9 cm. The mean follow-up was 21.7 months. Both the FFF and PMMC survived in all cases, although postoperative wound healing complications occurred in two of the three patients. There was one partial flap loss. Two patients regained good oral intake while one patient tolerated oral intake but was PEG tube-dependent.ConclusionsThe combination of pectoralis major myocutaneous flap and a vascularized free fibular flap is a viable option for the reconstruction of complex through-and-through oromandibular defects. This technique may be useful when a single microvascular free flap is not sufficient for reconstruction of such defects.
| S-EPMC6458920 | biostudies-literature
Project description:Polydactyly is a highly common congenital limb defect. Extra digits may appear as an isolated anomaly or as a part of a syndrome. Mutations in GLI3 have been shown to cause Greig cephalopolysyndactyly, Pallister-Hall syndrome and non-syndromic polydactyly. Genotype-phenotype correlation studies of GLI3 mutations suggest a model by which mutations in the zinc-finger domain (ZFD) of GLI3 likely lead to syndromic polydactyly. Here we describe a rare case of autosomal dominant heterozygous missense mutation in the ZFD of GLI3 leading to a variable polydactyly-syndactyly complex.A large Jewish Moroccan family presented with apparently autosomal dominant heredity of bilateral thumb polydactyly in hands and feet combined with post-axial polydactyly type B or type A. Syndactyly was evident in most patients' hands and feet. Apart from head circumference beyond 90th percentile in some of the affected individuals, none had craniofacial dysmorphism. A novel GLI3 c.1802A >?G (p.His601Arg) mutation was found in all affected individuals.We demonstrate that a mutation in the ZFD domain of GLI3 leads to phenotypic variability, including an isolated limb phenotype. Thus, the variability in phenotypes caused by mutations in this master developmental regulator is more profound than has been previously suggested.
| S-EPMC4256830 | biostudies-literature
Project description:Background: There are several congenital hand differences that cause thumb-index (TI) web space deficiency. There is a knowledge gap in the literature about the hand differences that are associated with TI web space deficiency. We aimed to identify these congenital differences and the various specific reconstructive surgical procedures that are used for these conditions. Methods: We conducted a retrospective chart review of children treated operatively over a period of 30 years for congenital TI web space deficiency by the senior author (G.M.R.). We gathered data on demographics and associated congenital hand differences and compiled a list of all surgical procedures performed for the web space and the ipsilateral upper extremity. Results: We included 71 patients (77 hands) with 12 congenital hand differences (62 developmental and 9 spastic). The total number of upper extremity operations, (ie), anesthetics performed for these patients was 186, averaging 2.6 settings and 7.5 procedures for each patient. Cutaneous reconstructive procedures included first dorsal metacarpal artery pedicle flaps (49 patients), 4-flap Z-plasties (15), and transposition flaps (13). In addition, 16 different thumb reconstructive procedures were necessary. Ten patients required revision of their TI web space procedures for recurrence. Conclusions: The prevalence of TI web space deficiency is underappreciated. These patients often have multiple musculoskeletal anomalies of the hand and upper extremity that should be ruled out and require surgical treatment to optimize hand function. Consideration should be given to performing more than one procedure in one setting when possible.
| S-EPMC7818023 | biostudies-literature
Project description:Background After cleft palate repair is performed, oronasal fistulas are potential consequences with resultant regurgitation of fluid and food, hearing loss, and velopharyngeal insufficiency. Treatment of oronasal fistulas is a challenge for plastic surgeons especially when the fistulas are large and scarring is significant. The facial artery musculomucosal (FAMM) flap, introduced by Pribaz in 1992, is a reliable and useful procedure for the closure of wide palatal fistulas. A new modification of facial artery composite flap is presented here including a skin component that avoids extended procedures for nasal layer reconstruction and reduces the mucosal component size. The flap described here is the nasal artery musculomucosal (NAMMC) flap; the main blood supply comes from the lateral nasal artery, a terminal branch of facial artery. Methods We present a series of anteriorly and posteriorly based NAMMC flaps, which were used to close large palatal fistulas after cleft palate repair in 12 patients. Results All flaps were successful. One flap had an anterior wound dehiscence in a bilateral case, and we have seen no total flap failure or postoperative palatal fistulas. The aesthetic appearance of the skin donor site was acceptable in all cases. Conclusions The NAMMC flap is a good alternative for closing wide and recurrent fistulas. It is associated with a high rate of success. The traditional FAMM flap should be named as "nasal (lateral) artery musculomucosal flap" because the distal branch of the facial artery is the main blood supply of the flap.
| S-EPMC3578655 | biostudies-other