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Bilateral axillary skin fold flaps used for dorsal thoracic skin wound closure in a dog : clinical communication  [cached]
B. G. Nevill
Journal of the South African Veterinary Association , 2012, DOI: 10.4102/jsava.v81i1.98
Abstract: A 10-year-old greyhound-cross dog was presented with a large, chronic skin wound extending over the interscapular region. The substantial skin defect was closed by making use of bilateral axillary skin fold flaps. It was possible to elevate the 2 skin flaps sufficiently to allow them to meet at the dorsal midline and thus facilitate complete closure of a large and awkwardly positioned wound. Small dorsal areas of the skin flaps underwent necrosis, but the resulting defects were closed without difficulty in a subsequent procedure. To the author's knowledge, this is the 1st clinical report of the use of bilateral axillary skin fold flaps in this fashion and describes an additional use of a versatile skin flap procedure.
The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery
Fa-yu Liu, Zhong-fei Xu, Peng Li, Chang-fu Sun, Rui-wu Li, Shu-fen Ge, Jun-lin Li, Shao-hui Huang, Xuexin Tan
World Journal of Surgical Oncology , 2011, DOI: 10.1186/1477-7819-9-135
Abstract: Twenty-one consecutive patients who underwent repair of a variety of defects of the head and neck with cervicofacial or cervicothoracic flaps in our hospital from 2006 to 2009 were retrospectively analysed. Statistics pertaining to the patients' clinical factors were gathered.Cheek neoplasms are the most common indication for cervicofacial and cervicothoracic rotation flaps, followed by parotid tumours. Among the 12 patients with medical comorbidities, the most common was hypertension. Defects ranging from 1.5 cm × 1.5 cm to 7 cm × 6 cm were reconstructed by cervicofacial flap, and defects from 3 cm × 2 cm to 16 cm × 7 cm were reconstructed by cervicothoracic flap. The two flaps also exhibited versatility in these reconstructions. When combined with the pectoralis major myocutaneous flap, the cervicothoracic flap could repair through-and-through cheek defects, and in combination with a temporalis myofacial flap, the cervicofacial flap was able to cover orbital defects. Additionally, 95% patients were satisfied with their resulting contour results.Cervicofacial and cervicothoracic flaps provide a technically simple, reliable, safe, efficient and cosmetic means to reconstruct defects of the head and neck.The variable surgical defects that can result from head and neck operations necessitate a broad range of surgical reconstructions, ranging from primary closures and pedicle flaps to free tissue transfers. According the distribution of blood supply, the pedicle flap can include random flaps and axial flaps. A random blood supply pattern is needed to maintain a wide pedicle[1]. Therefore, many random flaps, such as cheek advancement-rotation flaps and forehead flaps, have poor mobility and are only suitable for reconstructing small defects. Although axial flaps (e.g., trapezius flaps[2] and pectoralis major myocutaneous flaps (PMMF)[3]) can overcome these limitations, they often appear too bulky or large, result in a poor colour match with the recipient site, and someti
Microvascular free flaps in the management of war wounds with tissue defects  [PDF]
Kozarski Jefta,Panajotovi? Ljubomir,Novakovi? Marijan
Vojnosanitetski Pregled , 2003, DOI: 10.2298/vsp0306669k
Abstract: Background. War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. Methods. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defects. The main criteria for the application of free flaps were: general condition of the wounded, size, localization, and structure of tissue defects. For the extensive defects of the tissue, as well as for severely contaminated wounds latissimus dorsi free flaps were used. For tissue defects of distal parts of the lower extremities, scapular free flaps were preferred. While using free tissue transfer for recompensation of bone defects, free vascularized fibular grafts were applied, and in skin and bone defects complex free osteoseptocutaneous fibular, free osteoseptocutaneous radial forearm, and free skin-bone scapular flaps were used. Results. After free flap transfer 16 (14,4%) revisions were performed, and after 8 unsuccessful revisions another free flaps were utilized in 3 (37,5%) patients, and cross leg flaps in 5 (62,5%) patients. Conclusion. The treatment of war wounds with large tissue defects by the application of free microvascular flaps provided shorter wound-closing period, earlier beginning of physical therapy, as well as the treatment of great number of patients with the extensive tissue defects in the conditions of massive influx of the wounded.
Ipsilateral fasciocutaneous flaps for leg and foot defects  [cached]
Bhattacharya V,Watts R
Indian Journal of Plastic Surgery , 2003,
Abstract: It was a revolutionary enhancement for lower limb reconstruction when fasciocutaneous flaps were first described and used in clinical practice in 1981. Subsequently persistent studies were made to emphasize and confirm the rich vascular network associated with deep fascia. Thereafter studies were directed to identify the various types of perforators supplying the deep fascia and the overlying subcutaneous tissue and skin. Accordingly the scientists classified these flaps keeping in mind their clinical applications. The authors of this article have also performed extensive research on various aspects. This has led to better understanding about the finer details of vascularity. Based on this various modifications have been made for safe application of reconstruction for defects extending from knee to sole. To avoid complications the clinician should be able to select the proper procedure as regards the donor site and the possible preoperative and postoperative technical faults. A well-designed and meticulously executed flap usually has smooth recovery. Both Colour Doppler and Audio Doppler are useful tools in planning a safe flap. Now these flaps have proved to be standard technique without requiring a special set up extensive training.
Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review  [PDF]
Davide Lazzeri,Georg M. Huemer,Fabio Nicoli,Lorenz Larcher
Archives of Plastic Surgery , 2013, DOI: http://dx.doi.org/10.5999/aps.2013.40.1.44
Abstract: Background The aim of this investigation was to systematically review the current literatureto provide the best data for indications, outcomes, survival, and complication rates ofpedicled propeller perforator flaps for upper body defects.Methods A comprehensive literature review for articles published from January 1991 toDecember 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articleswithout available full-text, single case reports or papers with excessive missing data wereexcluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremityreconstruction were excluded from meta-analysis.Results From the initial 1,736 studies our search yielded, 343 studies qualified for the secondstage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusionand exclusion criteria. Of the selected 41 articles, 26 were case series, original papers orretrospective reviews and were included, whereas 15 were case report papers and thereforewere excluded. Two hundred ninety-five propeller flaps were reported to have been used ina total of 283 patients. Indications include repair of trauma-induced injuries, post-traumarevision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with amajor complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteriafor the procedure were presented in the studies reviewed.Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that areeasy and quick to raise and that provide unlimited clinical solutions because of the theoreticalpossibility of harvesting them based on any perforator chosen among those classified in the body.
Reconstruction of Nasal Skin Cancer Defects with Local Flaps  [PDF]
A. C. Salgarelli,P. Bellini,A. Multinu,C. Magnoni,M. Francomano,F. Fantini,U. Consolo,S. Seidenari
Journal of Skin Cancer , 2011, DOI: 10.1155/2011/181093
Abstract: Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose. 1. Introduction The most common site of facial skin cancer is the nose (25.5%), because of its cumulative exposure to sunlight [1–3]. When dealing with primary non-melanoma nasal skin cancers, the most important goal is to obtain a tumor-free patient. Several studies have outlined the surgical parameters necessary for the excision of primary nonmelanoma skin cancers [4–6]. Well-defined primary basal cell carcinomas (BCCs) less than 2?cm in diameter should be excised with 4.0-mm margins to obtain a 95% cure rate [5]. Primary squamous cell carcinomas (SCCs) require 4.0-mm margins for low-risk tumors and 6.0?mm margins for high-risk tumors (≥2.0?cm; >II histological grade; nose, lip, scalp, ears, eyelids; invasion into the subcutaneous tissue) to obtain a 95% cure rate [4, 6]. For these tumors, Mohs micrographic surgery offers improved cure rates, as it is a technique that allows for complete microscopic control of tumor removal in addition to superior tissue preservation. The Mohs technique described in 1941 is based on the concept of excising skin cancer layer by layer and examining horizontally cut specimen sections to view the entire surgical margin. The disadvantages of the Mohs technique are that it is labor intensive, time consuming, and quite dependent on the skills of not only the Mohs surgeon/pathologist but also the histotechnician who prepares the specimens. In addition, high cost has been a criticism of Mohs surgery in the literature [7].
Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle  [PDF]
Lifeng Liu, Xuexin Cao, Lin Zou, Zongyu Li, Xuecheng Cao, Jinfang Cai
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083696
Abstract: The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps.
Distal perforator based cross leg flaps for leg and foot defects  [cached]
Bhattacharya V,Reddy Ganji
Indian Journal of Plastic Surgery , 2005,
Abstract: The cross leg fasciocutaneous flaps are less frequently indicated for distal leg and foot defects due to the availability of other alternative options. However they still remain one of the more realistic options for the surgeon in situations like unsuccessful attempt of free flaps, non-availability of ipsilateral proximal calf tissue, damaged distal perforators following trauma, burns, radiation etc., and inadequate reach beyond mid sole. In the present article we share our experience emphasizing the significance and use, with redefined indications and surgical technique of cross leg retrograde fasciocutaneous flaps for various distal leg and foot defects. We are of the opinion that these flaps are still useful as they continue to prove to be the flap of choice in demanding situations.
Reconstruction of Pretibial Defect Using Pedicled Perforator Flaps  [PDF]
In Soo Shin,Dong Won Lee,Dong Kyun Rah,Won Jai Lee
Archives of Plastic Surgery , 2012, DOI: http://dx.doi.org/10.5999/aps.2012.39.4.360
Abstract: Background Coverage of defects of the pretibial area remains a challenge for surgeons. Thedifficulty comes from the limited mobility and availability of the overlying skin and soft tissue.We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps andfree flaps on the pretibial area.Methods Eight patients who had the defects in the anterior tibial area were enrolled.Retrospective data were obtained on patient demographics, cause, defect location, defectsize, flap dimension, originating artery, pedicle length, pedicle rotation, complication, andpostoperative result. The raw surface created following the flap elevation was covered with asplit thickness skin graft.Results Posterior tibial artery-based perforator flaps were used in five cases and peronealartery-based perforator flaps in three cases. The mean age was 54.3 and the mean period offollow-up was 6 months. The average size of the flaps was 63.8 cm2, with a range of 18 to135 cm2. There were no major complications. No patients had any newly developed functionaldeficit of the lower leg.Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modalityfor covering pretibial defects as a simple, safe and versatile procedure.
Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty
Konstantinos Papaioannou, Stergios Lallos, Andreas Mavrogenis, Elias Vasiliadis, Olga Savvidou, Nikolaos Efstathopoulos
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-82
Abstract: Sixteen consecutive patients with a mean age of 73,8 years (range 47 to76 years) over a 6-year period (January 2003 to December 2008) with wound dehiscence after TKA were enrolled in the present study. Unilateral or bilateral fasciocutaneous V-Y flaps that are differently oriented, depending on the local conditions of the tissues were used to reconstruct the soft tissues defects.In 15 of the 16 cases studied, the wound was successfully covered with the presented technique while in 1 patient a partial flap loss occurred, which was healed after surgical debridement and the application of vacuum system. No other complications occurred. Knee prosthesis was salvaged in all the patients with a good functional and esthetical outcome.The presented reconstructive technique is a simple, quick, versatile and reliable solution for the coverage of soft tissue defects following TKA, more than 2 cm width and grade 1 and 2 according to Laing classification, provided the V-Y flaps are applied early in the postoperative period and no complex defects are involved.The potentially disastrous complication of an infection after total knee arthroplasty (TKA) often is heralded by the delay of wound healing or soft tissue necrosis, and may jeopardize the prosthesis. The exposed knee prosthesis poses a challenge to the orthopaedic surgeon. The incidence of severe wound problems after TKA that is, those requiring a second return to the operating room ranges from 0,33% to 5,3% [1]. Wound problems could be a superficial skin loss or more severe necrosis of large areas of skin and subcutaneous tissues with implant exposure, which may go on to deep infection of the prosthesis [2-5]. Some form of immediate operative intervention may then be indicated [6].Several predisposing factors such as immuno-suppression, malnutrition, diabetes mellitus, steroid use, rheumatoid arthritis, previous incisions, smoking, obesity and vascular disease can be involved in the onset of wound complications, as well as l
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