The supraclavicular artery flap for lateral skull and scalp defects: effective and efficient alternative to free tissue transfer.
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ABSTRACT:
SUBMITTER: Hunt JP
PROVIDER: S-EPMC4110155 | biostudies-other | 2014 Aug
REPOSITORIES: biostudies-other
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Project description:Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm2. There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients.
| S-EPMC10573281 | biostudies-literature
Project description:Acquired tracheoesophageal fistulas can lead to large defects with fatal complications. Surgical management is challenging but necessary to prevent respiratory infections and poor weight gain. Therefore, a reliable and pliable flap like the pedicled supraclavicular artery island flap with its wide arc of rotation and robust vascularization is needed for reconstruction. We highlight the surgical technique and postoperative measures in managing a tracheoesophageal fistula due to button battery ingestion in a 9-month-old boy with the supraclavicular artery island flap. In summary, the supraclavicular artery island flap is a safe and successful tool for closure of large acquired tracheoesophageal fistulas in pediatric patients.
| S-EPMC10513133 | biostudies-literature
Project description:BackgroundThe reconstruction of nonhealing lumbosacral spinal defects remains a challenge, with limited options. The aim of this article was to review the authors' technique and experience with the modified fourth lumbar artery local perforator (MFLALP) flap for the coverage of nonhealing lumbosacral defects after spinal surgery.MethodsBetween August 2012 and May 2021, we reviewed all MFLALP flaps performed for lumbosacral spinal defects. Patient demographics, wound aetiologies, surgical characteristics, and outcomes were reviewed retrospectively.ResultsA total of 31 MFLALP flaps were performed on 24 patients during the research period. The median flap size was 152 cm2 (range, 84-441 cm2). All flaps survived successfully, although there were two cases of minor complications. One patient had a haematoma and required additional debridement and skin grafting at 1 week postoperatively. The other patient suffered wound dehiscence at the donor site at 2 weeks postoperatively and required reclosure. The follow-up time ranged from 6 months to 5 years.ConclusionsThe MFLALP flap has the advantages of a reliable blood supply, sufficient tissue bulk and low complication rate. This technique is an alternative option for the reconstruction of nonhealing lumbosacral spinal defects.
| S-EPMC9840304 | biostudies-literature
Project description:Objective When the use of the nasoseptal flap for endoscopic skull base reconstruction has been precluded, the posterior pedicle inferior turbinate flap is a viable option for small midclival defects. Limitations of the inferior turbinate flap include its small surface area and limited arc of rotation. We describe a novel extended inferior turbinate flap that expands the reconstructive applications of this flap. Design Cadaveric anatomical study. Participants Cadaveric specimens. Main Outcome Measures Flap size, arc of rotation, and reconstructive applications were assessed. Results The average width of the flap was 5.46 ± 0.58 cm (7.32 ± 0.59 cm with septal mucosa). The average length of the flap was 5.01 ± 0.58 cm (5.28 ± 0.37 cm with septal mucosa). The average surface area of the flap was ∼ 27.26 ± 3.65 cm(2) (40.53 ± 6.45 cm(2) with septal mucosa). The extended inferior turbinate flap was sufficient to cover clival defects extending between the paraclival internal carotid arteries. The use of the flap in 22 cadavers and 5 clinical patients is described. Conclusion The extended inferior turbinate flap presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable.
| S-EPMC4108488 | biostudies-other
Project description:ObjectiveThe traditional lateral arm free flap (tLAFF) has the disadvantages of short vascular pedicle, small vascular diameter, and non-perforator flap. We used a new method to prepare modified LAFF (mLAFF) and evaluate its application value in the repair of oral and maxillofacial soft tissue defects.MethodsThe anatomical features of the flap were recorded and compared between the tLAFF group and the mLAFF group. All the flaps in the modified group were perforator flaps. Statistical analysis was performed on the data using ANOVA on SPSS 22.0 statistical software package.ResultsForty-five mLAFFs were prepared as eccentric design rotation repair perforated flap, or multi-lobed or chimeric perforator flaps. Compared with the tLAFF, the vascular pedicle length of the mLAFF was increased, and the outer diameter of the anastomosis was thickened. The damage to the donor site was less. The difference was statistically significant.ConclusionThe mLAFF can effectively lengthen the vascular pedicle length and increase the anastomosis diameter. Perforator LAFFs in the repair of oral and maxillofacial defects have good application value.
| S-EPMC9178180 | biostudies-literature
Project description:BackgroundDigital defect is one of the most common types of emergency hand injuries. Plastic surgeons continue to search for a better method to repair digital defects, especially those of the thumb. The medial sural artery perforator (MSAP) flap has been widely used as a popular method for limb and head reconstruction. Our findings have led us to advocate the use of free medial sural artery perforator flap to repair large thumb defects.MethodsFrom July 2010 to July 2013, we used free MSAP flaps to resurface large defects of 9 thumbs in 9 clinical cases. There were 6 men and 3 women among the participants, aged 21-49 years (average age: 37.6 years). Flap sizes varied from 2 cm × 3 cm to 3 cm × 6 cm. Perforators of all flaps were accurately located by color Doppler detection.ResultsAccording to color Doppler detection, the distance from the popliteal crease to the points where first/second perforator pierced the deep fascia was 10.1±1.1/15.2±0.8 cm. The distance from the midline to the first/second perforator was 2.8±0.8/3.5±0.5 cm. A total of nine flaps fully survived. All defects of the nine thumbs were adequately resurfaced. Postoperative follow-up conducted at 12-24 months revealed satisfaction in both cosmetic and function results.ConclusionsThe MSAP flap, which can be easily harvested and well thinned, is an ideal choice to repair thumb defects. Accurate location of the perforator by Doppler detection ensures the surgical success, and minimizes injury to the donor site.
| S-EPMC8106104 | biostudies-literature
Project description:Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixty-eight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre- or postoperative radiation. Defects ranged from 6 to 836 cm(2). All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects.
| S-EPMC3314257 | biostudies-other
Project description:BACKGROUND:A variety of island flaps can be based on the superficial temporal artery with variable tissue composition. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release. METHODS:Seventy-two patients underwent facial reconstruction using a superficial temporal artery island flap from October 2010 to October 2014. The defects had various etiologies, including trauma, burns, tumors, exposed hardware, and congenital causes. We classified the patients by indication into 5 groups: cavity resurfacing, contracture release, facial hair restoration, skin coverage, and combined. The demographic data of the patients, defect characteristics, operative procedures, postoperative results, and complications were retrospectively documented. The follow-up period ranged from 24 to 54 months. RESULTS:A total of 24 females and 48 males were included in this study. The mean age of the patients was 33.7±15.6 years. The flaps were used for contracture release in 13 cases, cavity resurfacing in 10 cases, skin coverage in 17 cases, facial hair restoration in 19 cases, and combined defects in 13 cases. No major complications were reported. Conclusion: Based on our experiences with the use of superficial temporal artery island flaps, we have developed a detailed approach for the optimal management of patients with composite facial defects. The aim of this article is to provide the reader with a systematic algorithm to use for such patients.
| S-EPMC5869424 | biostudies-literature
Project description:The objective of this study was to characterize the relationships between motion in the scalp, skull, and brain. In vivo estimates of motion transmission from the skull to the brain may illuminate the mechanics of traumatic brain injury. Because of challenges in directly sensing skull motion, it is useful to know how well motion of soft tissue of the head, i.e., the scalp, can approximate skull motion or predict brain tissue deformation. In this study, motion of the scalp and brain were measured using magnetic resonance elastography (MRE) and separated into components due to rigid-body displacement and dynamic deformation. Displacement estimates in the scalp were calculated using low motion-encoding gradient strength in order to reduce "phase wrapping" (an ambiguity in displacement estimates caused by the 2 ?-periodicity of MRE phase contrast). MRE estimates of scalp and brain motion were compared to skull motion estimated from three tri-axial accelerometers. Comparison of the relative amplitudes and phases of harmonic motion in the scalp, skull, and brain of six human subjects indicate that data from scalp-based sensors should be used with caution to estimate skull kinematics, but that fairly consistent relationships exist between scalp, skull, and brain motion. In addition, the measured amplitude and phase relationships of scalp, skull, and brain can be used to evaluate and improve mathematical models of head biomechanics.
| S-EPMC5932239 | biostudies-literature
Project description:BackgroundAfter thoracic tumor resection, there is often a large area of soft tissue defect left, even with exposed ribs and sternum, which needs to be repaired by skin flap transplantation. This study aims to introduce lateral thoracic flaps combined with local flaps to repair the soft tissue defect of the chest wall after the repair of malignant tumors, and try to retain the latissimus dorsi myocutaneous flap as a spare repair myocutaneous flap to avoid subsequent tumor recurrence and lack of local flaps for supply body source.MethodsA total of 26 patients with chest wall soft tissue defect with or without exposed rib and sternum after tumor resection at presentation from January 2017 to October 2021 were included in this study. None of the patients required breast reconstruction. Patients ranged in age from 34 to 56 years old. The above patients were treated with lateral thoracic flaps combined with local rotational advancement flaps to repair chest wall soft tissue defects. The postoperative wound healing, scar hyperplasia and recurrence of the patients were followed up.ResultsAmong the patients in this study, 25 incisions healed by primary incision, 1 incision was delayed, and healed after 10 days of dressing change. Postoperatively, the incisions of the patients were all intact, and there were no complications such as skin necrosis and infection. All patients were followed up for 6-18 months, and the incision healed well without complications such as skin necrosis and infection. Of the patients, 2 males developed dermatofibrosarcoma carina recurrence 6 and 10 months after surgery, respectively. After extensive excision, an ipsilateral latissimus dorsi myocutaneous flap was used to repair the defect. The Vancouver scar scale was used to evaluate the hyperplasia of all incisions at 6 months postoperatively. The mean score was 5.92±1.6.ConclusionsThe lateral thoracic flap combined with the local flap to repair the chest wall soft tissue defect after tumor surgery is a strategic decision for surgical treatment, which is beneficial to the sequential surgical treatment of tumor patients.
| S-EPMC9562501 | biostudies-literature