Diaphragmatic Flap: Technique of Preparation and Indications for Use

Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for reconstructive procedures in the chest has many advantages. Yet, despite the excellent reported results, the use of DF has not been widespread. Some factors for the less widespread use of DF have been, concern about diaphragmatic function, hesitation to use such a vital muscle for reconstructive purposes, and most importantly, the technical aspects for the preparation of the flap. Methods: Using a cadaveric model, the vascular anatomy of the diaphragm and the steps for the preparation of the DF was defined and illustrated for both the right and left hemidiaphragm. Results: No perioperative mortality with the use of DF has been recorded. Function of the native diaphragm has not been impaired. Bronchopleural fistulas and pericardial defects have healed in all instances. Excellent repair has been achieved in all patients with esophageal lesions. The disruption of the repaired native diaphragm and visceral herniation has been reported but it has been attributed to the learning curve and the technique of repair. Conclusion: With a better understanding of the vascular anatomy of the diaphragm and a formal methodical approach to harvesting the DF, more surgeons will be encouraged to use DF with excellent results.

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。

Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction

Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants respectively. The main reasons for failure of the dental proliferation. The fibula flap presents many advantages for implant-supported prosthetic rehabilitation difficult. placed into the fibula bone grafts were 95% and 87%, replants were infection, tumor recurrence and soft tissue implant placement, but its limited height sometimes makes Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.

The evolution of lower extremity reconstruction

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection.The introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal defects.With the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex problems.As these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function.The purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.