[Longitudinal gracilis musculocutaneous flaps with a crossing boundary blood supply from the obturator artery].

OBJECTIVE: The traditional gracilis musculocutaneous flap is supplied by a branch of deep femoral artery, which enters the muscle in between the upper and middle third of it. So the flap barely reaches the pelvis and perineum region for reconstruction. By exploring the blood supply pattern we tried to rotate the flap Upon at the higher point starting at the obturator foramen in order to let it cover a bigger area. METHODS: anatomical reviewing of the blood supply of the gracilis branches of obturator, medial femoral circumflex and deep femoral arteries. Based on this a new type of longitudinal gracilis musculocutaneous flap supported only by the obturator artery was designed to reach the pelvis, female genitalia, pubic symphysis, inguinal area easily. RESULTS: The new kind of flap has been applied to 9 patients for deformity repairing and tissue replacement in the pelvic and perineal area. All the flaps survived and achieved satisfactory result with 3 months to 3 years' follow up. CONCLUSIONS: Longitudinal gracilis musculocutaneous flaps supplied by the obturator artery can be used as regular musculocutaneous flap clinically.

[The application of forward and reversal flow axial island flap based on the superficial temporal artery in the orbital skin defects].

OBJECTIVE: To investigate the application of forward and reversal flow axial island flap in the orbital skin defects. METHODS: According to the distribution of superficial temporal artery as well as the anastomoses with the branches of supraorbital artery and supratrochlear artery, etc, the frontal, scalp, preauricular and postauricular island flaps were designed. The flaps were displaced through subcutaneous tunnel to cover all kinds of orbital skin defects. RESULTS: 13 cases of forward flow flap and 9 of reversal flow flap out of 22 cases in all were observed. One postauricular reversal flow axial island flap showed the obstruction of venous refluence in early postoperative stage, however, after active treatment, mere the distal epidermal necrosis was revealed. There were six re-operations on the postoperative flap hypertrophy. The others were in good shape and functional state. CONCLUSIONS: The superficial temporal artery is one of most vital blood supply in the upper face. It has wide anastomoses with the supraorbital artery and supratrochlear artery. As the colors and the nature of the frontal, preauricular and post auricular skin are close to orbital skin, the application of forward and reversal flow axial island flap based on the superficial temporal artery can be used in the reconstruction of all kinds of orbital skin defects.

[Repairing large alar defects by using a retro-grade auricular flap].

OBJECTIVE: To evaluate a retro-grade auricular flap for repairing large alar defects. METHODS: Twenty-nine adult cadavers were anatomically used for vascular investigation of the frontal, nasal and temporal regions by injecting a dye into the main vessels. Based on the anatomical study in these regions, a retro-grade auricular flap was designed for repairing alar defects in 16 patients. RESULTS: The blood supply of the auricle could be nourished by the inner carotid artery system from the supratrachlear artery and supraorbital artery through the frontal arterial anastomotical network into the frontal branch of the superficial temporal artery. It is then passing the main trunk of the superficial temporal artery into the ear area through the auricular branches of the superficial temporal artery. The retro-grade auricular island flap could be formed by basing the supratrachlear artery and the supraorbital artery through the vascular network between the superficial temporal artery and the supratrachlear artery or the supraorbital artery. Sixteen patients with large alar defects and half-sized nasal defects were successfully repaired by this technique. CONCLUSIONS: The retro-grade auricular island flap, based on the inner carotid artery system, could be a good and safe flap for repairing a large alar defect or half-sized nasal reconstruction.