Retrospective study of freestyle perforator-based peninsular flaps: A simple, fast, and safe technique for pressure sore reconstruction.

This study aimed to present a simple, fast, and safe technique, called freestyle perforator-based peninsular flap (FPBPF), for pressure sore reconstruction.Among the 21 patients who underwent pressure sore reconstruction between May 2013 and October 2016, 12 patients (Group A) and 9 patients (Group B) were subjected to perforator-based island flap (PBIF) and FPBPF, respectively. We retrospectively reviewed and statistically analyzed the data of both groups.All flaps completely survived in both groups. No significant differences were found in patient demographics, complications, hospital stay, and follow-up period. The mean arc of rotation (102.50 ±â€Š17.645° vs 83.33 ±â€Š14.142°; P = .01), mean flap harvest time (35.83 ±â€Š2.552 minutes vs 20.88 ±â€Š1.763 minutes; P < .001), and mean operative time (145.41 ±â€Š6.788 minutes vs 131.66 ±â€Š10.770 minutes; P = .002) were significantly decreased in Group B compared with Group A.The FPBPF is a simpler and faster technique than the PBIF. FPBPF is a good modality with a few complications for sore reconstruction.

Perineal reconstruction with multiple perforator flaps based on anatomical divisions.

PURPOSE: Reconstruction of perineal defects remains a challenge because such defects can be extensive, complex, and three-dimensional. This report presents a retrospective review of our past 5 years of experience in perineal reconstruction, and suggests a simple algorithmic approach according to anatomical divisions with multiple pedicled perforator flaps for extensive perineal defects. METHODS: From January 2011 to December 2015, 16 patients, including 5 men and 11 women, underwent reconstruction of extensive perineal defects. The defect size varied from 11 × 10 cm2 to 23 × 28 cm2 . A total of 37 perforator flaps were used in 16 cases, which included Fournier's gangrene in 4 cases, extramammary Paget's disease in 4, and skin cancer in 8. The defects were categorized according to anatomical location, and were covered by multiple pedicled perforator flaps using the closest perforators based on the perforasome theory. RESULTS: All of the defects achieved tension-free primary closure. An average of 2.31 flaps (range, 2-3 flaps) was used for each patient. All of the flaps survived without partial or total loss, though temporary flap congestion occurred in three patients and minor wound dehiscence occurred in one case. There were no donor-site complications. During an average follow-up of 11.06 months (range, 10-12 months), the reconstructed areas achieved good functional and aesthetic outcomes. CONCLUSIONS: Multiple pedicled perforator flaps could supply sufficient dimension to cover extensive perineal defects and achieve tension-free closure. In addition, our simple algorithmic approach according to anatomical divisions could be easily applied to extensive perineal defects. © 2017 Wiley Periodicals, Inc. Microsurgery 37:394-401, 2017.

Capsicum plaster at the Hegu point reduces postoperative analgesic requirement after orthognathic surgery.

BACKGROUND: Capsicum plaster at classical Chinese acupoints is an alternative to acupuncture, which has been used as an effective method for preventing postoperative nausea and vomiting, sore throat, and pain. In this study, we investigated the postoperative analgesic efficacy of capsicum plaster at Hegu (LI 4) acupoints in patients after bilateral sagittal split ramus osteotomy. METHODS: A double-blind, sham-controlled study was conducted with 84 patients undergoing orthognathic surgery, and who were randomly assigned to three treatment regimens (n = 28 each): Hegu group = capsicum plaster at Hegu acupoints and placebo tape on the shoulders as a nonacupoint; sham group = capsicum plaster on the shoulders and placebo tape at Hegu acupoints; and control group = placebo tape at Hegu acupoints and on the shoulders. The capsicum plaster was applied before induction of anesthesia and maintained for 8 h per day for 3 postoperative days. RESULTS: The total amount of patient-controlled analgesia, containing 6.5 microg/mL fentanyl and 1.2 mg/mL ketorolac, administered in the first 24 h after the operation was decreased in the Hegu group (26.8 +/- 3.4 mL) compared with the control (44.2 +/- 7.3 mL) and sham (42.1 +/- 6.9 mL) groups (P < 0.01). The incidence of postoperative nausea and vomiting and the need for rescue medication were reduced, and the overall satisfaction score was greater in the Hegu group compared with other groups (P < 0.01). CONCLUSION: The capsicum plaster at the Hegu acupoints decreased the postoperative opioid requirements and opioid-related side effects in patients after orthognathic surgery.