Reconstrucción de defecto de órbita con colgajo prelaminado de fascia temporal superficial / Orbit defect reconstruction with pre-laminated temporal superficial fascia flap

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado

The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction.

Background The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.

Establishing the rabbit dorsal prefabricated flap model with lead oxide microangiography / 中华整形外科杂志

Objective@#This study aims to establish a model of prefabricated flaps on the back of rabbits, with the purpose to explore the optimal concentration of lead oxide suspension for microangiography.@*Methods@#Twenty clean grade male New Zealand white rabbits, with the weigh at 3.5-4.0 kg, were selected for the prefabricated flap model, pedicled with thoracodorsal vascular bundles, through 2-staged surgeries. Traditional flap model was established on the back of 2 rabbits. Small pieces of flap were taken for HE stain at 7th and 14th day after initial surgery. The time of second operation was determined by this result. Prefabricated flap models were established on the remained 18 rabbits, and divided into 9 groups. Nine different concentrations of lead oxide suspension (60%, 50%, 40%, 37%, 33%, 30%, 27%, 23%, and 20%) were injected through the aorta for each group, on 7 days after the 2nd surgery. The microangiographic results of gross specimen and prefabricated flap were observed by X-ray imaging.@*Results@#Microvascular lumens were observed by HE stain, on 14 days after the initial surgery. The number of microvessels in each 200× high power field, increased from 1-2 on day 7 to 10-20 on day 14. The vascularization process was mature. These suggest the prefabricated flap is ready for second surgery. Lead oxide perfusion angiography showed that there was non-development of tertiary arteries at 60% and 50% concentration. Tertiary arteries were not well developed at 40%, 37% or under 30% concentration. Clear arteriole development could only be obtained at 33% and 30% concentrations.@*Conclusions@#In this study, a rabbit model of prefabricated flap pedicled with thoracodorsal vascular bundles was successfully constructed by 2-staged surgeries. The microvasculature of the flap could be clearly displayed using lead oxide suspension with the concentration of 30%-33%.

Advances in the revascularization of prefabricated flap / 中华整形外科杂志

The principle of prefabricated flap is to establish a new blood supply system, in order to supply the free flap or random flap. The key to produce a prefabricated flap is the establishment of blood supply. Currently, a series of methods could be used to promote vascular regeneration and flap survival, including chemical stimulation, stem cell transplantation, hyperbaric oxygen therapy, biomaterials application, nerve implantation, tissue expansion and microsurgical technique. The reasonable combination of multiple methods could better promote the angiogenesis of the prefabricated flap, and ultimately realize the survival of the flap, thus create a new way for the repairment of complex tissue defects.

Prelaminated extended temporoparietal fascia flap without tissue expansion for hemifacial reconstruction.

BACKGROUND: Disfigurement of the face caused by postburn scars, resected congenital nevi and vascular malformations has both functional and psychological consequences. Ideal reconstruction of the facial components requires producing not only function but also the better appearance of the face. The skin of the neck, supraclavicular or cervicothoracic regions are the most commonly used and the most likely source of skin for facial reconstruction in those techniques which prefabrications with tissue expansion are used. This retrospective cohort study describes the two staged prelaminated temporoparietal fascia flap which eliminates the usage of tissue expansion by using skin graft harvested from the neck and occipital region and the application of this flap for the lower three-fourths of the face. METHOD: 5 patients received prelaminated temporoparietal fascia flap without tissue expansion for facial resurfacing. The mean age at surgery was 39, 2 years (range, 17-60 years). The average follow up was 21.6 months (range, 10-48 months). RESULT: The size of the raised prelaminated temporoparietal fascia flaps ranged from 9 × 8 cm to 14 × 10 cm. All flaps survived after second stage. Varied degrees of venous congestion were observed after flap insets in all cases but none required any further treatment for the congestion. The entire lesion could not be resected due to the large size of the lesion in all patients. CONCLUSION: Two stage prelaminated temporoparietal fascia flap with skin graft is an effective technique for the reconstruction of partial facial defects in selected patients. It is simple, quick, safe and reliable, and requires no expansion of skin or no microsurgery.

Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique.

Phalloplasty is indicated in various conditions of penile loss or absence. There are numerous techniques for phalloplasty including the pedicle and free flaps with the ultimate goal of micturition in standing position, attaining adequate size, aesthesis and sensations for sexual intercourse. Radial forearm phalloplasty is the gold standard flap to achieve above results but gives a very bad scar on the forearm. We present a technique of using prefabricated thigh flap to reduce the morbidity of donor area. The descending branch of lateral circumflex femoral pedicle was placed in a subcutaneous plane over tissue expander. After attaining an adequate size of flap with tissue expansion, it was delayed 3 weeks before phalloplasty. Prefabricated flap was thin and of large size replicating the radial forearm flap used for phalloplasty. Whole forearm defect was covered with the thigh flap, and the thigh could be closed primarily. This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in the whole procedure.

Pre-expanded, Prefabricated Monoblock Perforator Flap for Total Facial Resurfacing.

In this article, we present the pre-expanded, prefabricated supercharged cervicothoracic monoblock perforator flap for total or subtotal facial resurfacing. This technique can be a reliable reconstruction option for extensive facial skin defect with undamaged muscles and deep structures, which could provide excellent aesthetic and functional outcomes with acceptable complications. Our approach may replace a conventional "skin-only" face allotransplantation in selected patients.

Laryngotracheal reconstruction with a prefabricated fasciocutaneous free flap for recurrent papillary thyroid carcinoma.

BACKGROUND: Prefabricated composite free flaps have been described as a technique for reconstruction of laryngotracheal defects. METHODS: We present a 74-year-old woman with recurrent papillary thyroid carcinoma (PTC) who was initially treated with thyroidectomy, tracheal resection, and subsequent vocal cord medialization. The patient's recurrent disease was treated with partial laryngectomy and reconstruction using a prefabricated composite free flap. A 2-stage procedure was performed using conchal cartilage to create a prefabricated radial forearm free flap. RESULTS: The patient's airway was successfully reconstructed with preservation of speech and swallow function. CONCLUSION: This case provides further evidence supporting the use of prefabricated free flaps in airway reconstruction and the ability to obtain successful outcomes in a patient with multiple prior surgeries in the operative field and requiring adjuvant external beam radiation therapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2512-E2514, 2016.

Integrating Image-Based Design and 3D Biomaterial Printing to create Patient Specific Devices within a Design Control Framework for Clinical Translation.

Despite significant advances in 3D biomaterial printing, the potential of 3D printing for patient specific implants and tissue reconstruction has not been fully exploited. This is due in part to the lack of integration of image-based patient specific design with 3D biomaterial printing within a relevant regulatory framework, namely design control, required by the FDA. In this manuscript, we describe the integration of image-based, multi-scale patient specific design with 3D biomaterial printing within a design control framework for clinical translation. Specifically, we define design inputs for patient specific implants and scaffolds, and utilize image-based patient specific design to achieve these design inputs. We then illustrate realization of these topology designed patient specific implants by laser sintering of polycaprolactone (PCL). Finally, we present initial results in large animal models using 3D printed PCL implants addressing two challenging problems in tissue reconstruction: 1) designing and 3D printing implantable devices to allow growth in pediatric airway applications and 2) utilizing 3D printed scaffolds as foundations for pre-fabricated flaps to obtain vascularization and bone formation for large volume bone/soft tissue reconstruction. We illustrate these challenging problems as they need to be incorporated in design control, but as of yet there is little data to direct how growth and vascularization should be utilized in design control.

Sparing surgery with the use of TiNi-based endografts in larynx cancer patients.

BACKGROUND AND OBJECTIVES: Purpose of this study was to improve a technique of sparing surgery in patients with laryngeal cancer by using TiNi-based endografts and to achieve well functional and oncological results after laryngectomy. METHODS: Totally 120 patients with laryngeal cancer were observed (T2-3 N0-1 M0 ). We have developed a method of laryngeal reconstruction using TiNi-based endografts. All endografts show the superelastic behavior recovering the shape. All patients have undergone different types of sparing surgeries with simultaneous replacement with endografts. RESULTS: Voice function was completely saved in 112 cases and partially in 8 ones. Respiratory function was fully restored in 106 patients. The protective function of the larynx was achieved in 116 patients. CONCLUSION: The technique allowed to achieve well oncological (the 5-year and overall recurrence-free survival rates of all 120 patients were 83% and 76%, respectively) and functional (larynx function was saved in 93% of cases) outcomes after extensive and subtotal resections in patients with locally distributed larynx cancer.

Monitoring the post-operative lymphedema in prefabricated flap after resurfacing for facial scar / 中华显微外科杂志

Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.

Reconstruction of the face and neck with different types of pre-expanded anterior chest flaps: a comprehensive strategy for multiple techniques.

BACKGROUND: For large defects or deformities of the face and neck, the anterior chest area appears to be an excellent donor site that provides well-matched skin colour and texture. Many flap techniques based on the anterior chest area have been reported; however, there are few reports that focus on a treatment strategy for these different flap techniques. METHODS: A retrospective study was performed to propose a treatment algorithm. A total of 69 cases were reviewed from May 2005 to July 2011, in which different types of anterior chest flaps were performed for face and neck reconstruction. The reconstructive procedures, the defect characteristics and the complications were collected and analysed. RESULTS: Thirty-three pedicled thoracic branch of the supraclavicular artery flaps (the pedicled TBSA flap), 11 pedicled internal mammary artery perforator flaps (the pedicled IMAP flap), 8 free internal mammary artery perforator flaps (the free IMAP flap), 4 supercharged TBSA flaps, 17 prefabricated flaps and 3 supercharged prefabricated flaps were performed. The applications of six types of pre-expanded anterior chest flaps were described in an algorithmic approach. CONCLUSIONS: A treatment strategy for face and neck reconstruction using six anterior chest flap techniques is proposed. It recommended a personalised flap planning according to the characteristics of deformities/defects and the regionally dominant vessels of the anterior chest area.

Complex adult laryngotracheal reconstruction with a prefabricated flap: a case series.

BACKGROUND: Laryngotracheal stenosis (LTS) can cause persistent or recurrent airway obstruction. Although there is extensive literature on surgical techniques to treat LTS at onset, there are few techniques described for complex adult LTS after failed prior airway surgery. We describe a procedure used successfully in 3 patients who required structural augmentation for complex LTS. METHODS: Patients were treated with staged reconstruction using a prefabricated composite graft consisting of auricular cartilage and a radial forearm free flap. RESULTS: All patients underwent successful reconstruction with good wound healing and are tolerating oral diets. Two patients have been successfully decannulated. CONCLUSION: A delayed prefabricated graft using auricular cartilage in a radial forearm free flap is a viable surgical intervention in patients with complex adult LTS who are not candidates for conventional approaches.

The Effective Duration of the Delay Period on the Survival and Vascularization of the Prefabricated Cutaneous Flap

This study was designed to investigate the effective duration of delay period, and to study what changes were induced in the vasculatures of the prefabricated cutaneous flap. Abdominal skin flaps in six groups were fabricated by the subcutaneous implantation of a skeletonized saphenous pedicle using fourty-eight male Sprague-Dawley rats. Forty flaps were elevated at six weeks after fabrication, based solely on the implanted pedicle. Group 1 was used as the control without delay. A surgical delay was carried out at 24, 48, 72 hours, and 7 days prior to flap elevation in the group 2, 3, 4, and 5, respectively. Eight flaps of the group 6 were elevated without delay at 8 weeks after fabrication. Three days later, the flap viability and the numbers of vessels were analyzed quantitatively, and the flap vasculature was evaluated with microangiograms. Flap viabilities of the group 3(95.3+/-7.04) and 4(98.5+/-2.90) were higher than that of the control(83.4+/-11.17, p<0.05). In microangiographic study, the connection between dilated large vessels via choke vessels is dominant finding during the first 24 hours after delay. Dilatations of preexisting small choke vessels started to be appear at 48 hour after delay, and vascular networks of small vessels were progressively developed over the whole flap at 72 hours after delay. The number of vessel, in the flap itself, was increased after 72 hours of delay(p<0.05), but new vessels around the pedicles were more developed at 48 hours after delay(p<0.05). In conclusion, the delay procedure enhances the viability of the prefabricated flap, and the optimal duration is 48 - 72 hours to obtain maximal survival in rats.

Área viável e vascularização, pós autonomização cirúrgica, de retalho pré-fabricado por implante vascular em ratos

The aim of this study was to evaluate the effect of delay procedure on the survival and vasculature of a skin prefabricated flap with mean area rate of the 48.2cm² in a rat abdominal wall donnor site model. The skin flap was prefabricated by implantation of a distally ligated femoral pedicle into subdermal layer of the skin. Skin of the abdominal wall donnor site of 25 Wistar rats were compared in three groups of flaps receiving (A) pedicle implantation with no delay and (B) and (C) delay performed at the time of pedicle implantation. Three weeks later, the flaps in the group A and B were raised as an island flap, based on the implanted pedicle. In the group C, the implanted pedicle was severed when the flaps were raised. Seven days later, survival area in groups A, B and C were marked and the percentage survival area, with regard to whole flap area, calculated by Auto Cad R-14. The vascular density around the implanted pedicle, in groups A and B, was assessed by histological study. The mean percentage survival rate of the skin flap was 9.6 percent in the nondelayed group, 44.8 percent in the delayed group and 0.3percent in the group with implanted pedicle severed. The results of this study showed that delay procedure significantly increased (p 0.01, two-tailed Mann-Whitney test) the percentages survival of the flap and was found to have no influency over vascular density (p=0.307 two-tailed Mann-Whitney test) developed around the pedicle implantation three weeks after prefabrication.

Os objetivos do presente estudo foram avaliar os efeitos da autonomização cirúrgica sobre a extensão da área viável e da vascularização de retalhos cutâneos pré-fabricados com área média de 48,2cm² na parede abdominal de ratos. Os retalhos de pele eram pré-fabricados por implante de um pedículo femoral ligado distalmente e implantado diretamente na camada subdérmica. A pele da parede abdominal de 25 ratos Wistar foi comparada em três grupos de retalhos: grupo A, implante vascular sem autonomização e grupos B e C, implante vascular com autonomização no mesmo tempo cirúrgico. Três semanas após, os retalhos dos grupos A e B foram elevados como retalhos em ilha, nutridos pelo pedículo implantado. No grupo C, o pedículo implantado foi seccionado no momento da elevação do retalho. Sete dias após, a extensão das áreas viáveis nos grupos A, B e C foi delimitada e o percentual da área viável, em relação à área total do retalho, calculado por meio do Auto Cad R 14. A densidade vascular em torno do pedículo implantado, nos grupos A e B, foi avaliada por estudo histológico. O valor médio do percentual de área viável dos retalhos de pele foi de 9,6% no grupo onde os retalhos não foram autonomizados, 44,8% no grupo onde os retalhos foram autonomizados e 0,3% no grupo onde o pedículo implantado foi seccionado. Os resultados mostraram que o procedimento de autonomização aumentou significativamente (p 0,01, teste bicaudal de Mann - Whitney) os percentuais de área viável e não alterou estatisticamente (p = 0,307, teste bicaudal de Mann - Whitney) a densidade vascular em torno do pedículo, três semanas após o mesmo ter sido implantado.