Repairing small wounds around ankle by medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus

Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle

Supraclavicular artery island flap for reconstruction of hypopharynx and upper esophagus defects:A case report and literature review

We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.

Keystone design perforator island flap in facial defect reconstruction

Facial defect coverage is a common subject in the field of reconstructive surgery.There are many methods for facial defect reconstruction,and reconstructive surgeons should choose the most appropriate method on a case-by-case basis to achieve both functional and aesthetic improvement.Among various options for facial reconstruction,the local flap technique is considered the best reconstructive modality to provide good tissue matches of color and texture,which is consistent with the ideal goal of reconstruction(replacement of like-with-like).Keystone design perforator island flap(KDPIF),devised by Behan in 2003,has been applied to various fields of reconstructive surgery in the past decade due to its design simplicity,robust vascular supply,and reproducibility.Several studies have reported KDPIF reconstruction of facial defects,such as large parotid defects,small-to-moderate nasal defects,and eyelid defects.However,KDPIF has been used relatively less in facial defects than in other body regions,such as the trunk and extremities.The purpose of this review is to provide an organized overview of facial KDPIF reconstruction including the classification of KDPIF,modifications,physiology,mechanism of flap movement,consideration of facial relaxed skin tension lines and aesthetics,surgical techniques,clinical applications,and precautions for successful execution of KDPIF reconstruction.

Subcutaneous island pedicle flap for aesthetic reconstruction of the face

Objective:To investigate the outcomes of subcutaneous island pedicle flap for reconstruction of the medium-sized facial skin defects. Methods: Eighty nine cases of facial defects within one cosmetic unit following removal of skin tumors or scars were reconstructed with advancement or transposition island pedicle flaps. Patient records and postoperative photographs were reviewed retrospectively. Both patients and other surgeons were asked to assess outcome variables. Results: All flaps survived with primary healing postoperatively. Patients and surgeons judged excellent or good overall outcomes in 95. 5% and 92. 7% of all evaluated cases, respectively. Conclusion: The subcutaneous island pedicle flap may be an extremely versatile and reliable method for aesthetic reconstruction of medium-sized facial defects in the patients of all time of life.

One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

Objective To report the treatment of perineal hypospadias with one - stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the cprona and the urethral plate to correct chordee. A U - shaped skin incision was then made surrounding the meatus。

Efficacy comparison between Mathieu combined urethral plate incision and onlay island flap urethroplasty for distal hypospadias in patients with urethral plate stenosis

The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.

Versatility of Reverse Sural Fasciocutaneous Flap for Reconstruction of Distal Lower Limb Soft tissue Defects

Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.

Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap

Background Traditional techniques used for harvesting the pectoralis major myocutaneous （PMMC） flap have accompanying disadvantages,such as the necessity for an upper chest skin incision,the bulkiness of myocutaneous tissue at the pedicle of the flap,and the risk of total or partial necrosis of flap tissue.The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.Methods Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects,including 21 cases in the treatment group and 20 cases in the control group.In the treatment group,ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles,as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap.A line,from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery,was drawn to determine the axis of the PMMC flap.In the control group,PMMC island flaps were designed according to conventional methods without using ultrasonography.Results According to the ultrasonic marks,the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was （5.1±1.2） cm.The time from designing to transferring the island flap was significantly shorter in the treatment group （（51.0±10.5） minutes） compared with the control group （（78.0±13.9） minutes,P 〈0.01）.The rate of partial necrosis was 4.7% （1/21） in the treatment group and 35.0% （7/20） in the control group.There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.Conclusion Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.

Applied anatomy of the submental island flap and its clinical application in the repair of defects following hypopharyngeal carcinoma resection

Objective: To explore the feasibility of the submental island flap in the repair of hypopharyngeal defects.Methods: We collected wet specimens of fresh cadaveric heads from the Han Chinese adult population for applied anatomy of the submental island flap, and followed five patients with pyriform sinus carcinoma after reconstruction surgery using submental island flaps.Results: We found that the average length and width of the submental island flaps were (65.20 ± 11.69) mm and (46.70 ± 6.59) mm, respectively.The skin flap in all five patients survived after surgery, and tracheal tubes and gastric tubes were removed 7-36 days after surgery.Patients were followed up for 24-42 months, pharyngeal flaps grew well, and speech and swallowing functions were satisfactory.Conclusion: The submental island flap is a preferred material for the repair of hypopharyngeal defects after hypopharyngeal carcinoma resection, because of good blood supply, easy harvesting, and high survival rate.

The keystone-design perforator-based flap for leg defects: a synthesis of philosophies

Aim:The classical keystone-design flap,although elegantly employed for various trunk defects,has limited movement on the leg.This study aims to modify the keystone–design flaps for leg defects.Methods:A keystone-design flap,in which perforators are identified and dissected,is described specifically for elliptical defects overlying the tibia.Results:It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy.Conclusion:The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.