The effect of perforator location on epigastric perforator flap survival: an experimental and stereological study in guinea pigs.

One challenge most often seen in perforator-based flaps is the topographic relationship between the flap and its perforator, which determines flap design and pedicle length. Thirty female guinea pigs were used in this study. They were divided into four different groups including three experimental groups (n = 8), which were designed as central, lateral, and distal groups according to the perforator location, and one control group (n = 6). Flap survival and vessel density rates were assessed. There was no statistically significant difference ( P > 0.05) among either the surviving skin areas or the vascular density rates of the experimental groups, although all flaps were necrosed in the control group. We concluded that perforator flaps can safely be raised on the perforators located very distal or lateral to the flaps, as well as central classical location. Moreover, perforator flaps larger than suggested can safely be harvested in the same donor sites.

Management of a composite foot defect due to mine explosion using the free fibula osteocutaneous flap.

Free flaps have recently become the first preference for complex foot defects, with many advantages including ability to present suitable and adequate tissue, to enhance blood flow of the extremity, and to decrease risk of osteomyelitis. A 25-year-old male patient was referred to us with a complex injury of the left foot due to mine explosion. We successfully restored the defect with the ipsilateral free vascularized fibula osteocutaneous flap. The flap survived completely. After 8 weeks postoperatively, the patient began to walk. An adequate foot contour was achieved, and both the transverse and longitudinal arches were reestablished. Recovery of the donor site was also good. The free fibula osteocutaneous flap was able to present a composite tissue required in a defective foot, by leaving single donor site morbidity in one session. We believe that this flap may be a preferred option in complex foot defects.

Versatile use of the pedicled latissimus dorsi flap as a salvage procedure in reconstruction of complex injuries of the upper extremity.

Complex injuries of the upper limb are usually associated with massive soft tissue necrosis, infection, and exposure of the vital structures. Management is fairly problematic, requiring multiple operations and prolonged hospitalization. We herein present a versatile use of the pedicled latissimus dorsi flap as a salvage procedure, and its advantages. In 6 patients with such injuries, all known variations of the flap have been successfully used as a musculocutaneous, pure muscle, and pure skin (thoracodorsal artery perforator) flap. The mean follow-up time was 11.8 months. All flaps survived completely. The donor sites were closed primarily, with acceptable linear scars in all cases. Variants of the pedicled latissimus dorsi flap may be suitable to address complex defects of the upper extremity, including forearm and hand, which have little chance for free flap. Content of the flap to be used should be determined depending on requirements in the recipient site.

The retroangular flap revisited.

BACKGROUND: To date, the retroangular flap has been used only for reconstruction of defects of the nose and the glabella. OBJECTIVE: The objective was to expand the indications of the retroangular flap in facial reconstruction. MATERIALS AND METHODS: We repaired the facial defects of 11 patients using 12 retroangular flaps. These defects were located on the nose in 4 patients, the lower eyelid in 4 patients, the upper eyelid in 2 patients, and the cheek in 1 patient. RESULTS: The mean follow-up time was 13.2 months. All of the flaps survived, and no revisional procedures were required. Cosmetic and functional outcomes were satisfactory in all patients. CONCLUSION: The retroangular flap is a valuable alternative for the management of small- to moderate-sized defects of the midface. We strongly suggest extending the use of this flap to include reconstruction of nasal, eyelid, and cheek defects.

Temporal flap variations for craniofacial reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the anatomy of the temporal region. 2. Identify the types and possible indications of the temple group flaps to be selected depending on the defects, and then raise the flap safely for reconstruction. 3. Predict and manage successfully the potential complications of surgery. BACKGROUND: Good harmony of color and texture with surrounding tissues, thinness and adequate pliability, good alignment, obliteration of the cavities, and minimal donor-site morbidity are the main features of an ideal flap to be used in the reconstruction of craniofacial defects. Despite the numerous local, regional, and free flaps that have been described, to date, there has not yet been an ideal flap. The authors discuss the reconstruction alternatives presented by the temporal site and its outcomes. METHODS: The temporal group flaps can be raised using one or more tissues based on the superficial temporal artery and its branches, depending on the defect site and nature. They can be designed as axial skin flaps consisting of transposition or V-Y island flaps, composite flaps including more than one tissue, and chimeric flaps involving both the temple skin and temporal fascia based on the two distal branches of the superficial temporal artery. RESULTS: The temporal region is a good donor site for closure of craniofacial defects, by means of its rich vascular network and almost all types of tissue, including skin, fascia, muscle, galea, calvarial bone, and periosteum. The charm of this region has gradually increased as clinical experiences have advanced and its anatomy has been better understood. CONCLUSIONS: The authors discuss the history, anatomy, surgical dissection techniques, and potential complications and their management of temporal flaps.

Primary essential cutis verticis gyrata in an adult female patient: a case report.

Cutis verticis gyrata (CVG) is a very rare morphological condition of the scalp characterized by ridges and furrows resembling the surface of the brain. Primary or idiopathic CVG occurs in the absence of underlying soft-tissue abnormalities and is often associated with neuropsychiatric disorders. Secondary CVG occurs as a result of a local inflammatory or neoplastic process of the scalp or a systemic illness that produce pathologic changes in the scalp structure. The choice of treatment of CVG is surgical repair which depends on the size and location of the lesion, the underlying disorder, and the wishes of the patient, including primary repair, serial excision, skin grafting, local flaps and tissue expansion. In this case report, we describe the first female patient in the published work with primary essential CVG that appeared at 30 years of age. Because the patient had no cosmetic or functional complaint, no surgical intervention was attempted. Primary essential CVG, a very uncommon disorder, may be encountered in females after the third decade. The classification of CVG is essential to properly diagnose and treat patients who present with these unusual scalp lesions.

A new method in the treatment of postburn scar contractures: double opposing V-Y-Z plasty.

PURPOSE: Postburn scar contractures are fairly often seen in many parts of the body, and are still a considerable problem for reconstructive surgeons. Although the mild to moderate contractures can easily be managed by numerous surgical methods, serious contractures usually require more comprehensive surgical solutions including multiple Z plasties and rhomboid flaps, each of which have disadvantages. We used a new method called "double opposing V-Y-Z plasty" in this study. This technique is a combination of V-Y plasty with Z plasty in double opposing fashion, both ensuring primary donor site closure. MATERIALS AND METHODS: The technique was applied to 21 postburn scar contractures in 14 patients (9 males and 5 females). The localization most often seen was in the hand. RESULTS: The mean follow-up time was 7.6 months. All flaps healed uneventfully. An adequate lengthening and functional recovery were achieved in all cases. The donor site scars were acceptable in all cases. None of the patients developed contracture recurrence in our series. CONCLUSIONS: Double opposing V-Y-Z plasty, as a good alternative to multiple Z plasties and multiple rhomboid flaps, is a very useful technique to insure more lengthening and to prevent recurrence in the treatment of serious postburn scar contractures.

Versatile use of the VM-plasty for reconstruction of the web space.

The loss of web space may be congenital or acquired. Although local skin flaps are usually preferred, recurrence rate is fairly high. In this study, we used the VM-plasty as a versatile technique to create a web space and expanded its applications. Thirteen patients (7 males and 6 females) with 22 syndactylous webs were operated on using this technique. The web contractures were developed on scarred tissues in 9 patients, whereas only 4 cases presented with primary congenital syndactylies. The skin graft was not used in any of the patients. All the patients gained web functions with a good esthetic appearance without any recurrence. The technique is fairly versatile and can be used both in the hand and foot for congenital complete or incomplete syndactylies and acquired web space contractures. So, we advise the VM-plasty both in primary and recurrent cases with web space loss.