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Vascular Endothelium Growth Factor, Surgical Delay, and Skin Flap Survival
Lineaweaver, William C.; Lei, Man-Ping; Mustain, William; Oswald, Tanya M.; Cui, Dongmei; Zhang, Feng
Objective: Cytokines may be a mechanism by which surgical delay can increase flap survival. We previously found that preoperative vascular endothelium growth factor (VEGF) administration in the rat transverse rectus abdominis myocutaneous (TRAM) flap could improve skin paddle survival. In this study, we used partial elevation of the rat TRAM flap as a surgical delay to assess endogenous cytokine expression and tissue survival comparable to undelayed TRAM flaps. Methods: In Part I, TRAM flaps underwent surgical delay procedures; 7 days later, the flaps were completely elevated and reinset. At the same time, other flaps were raised and reinset without delay. Skin paddle survival in both groups was evaluated at 7 days. In Part II, skin biopsies from TRAM zones I to IV were taken at the time of delay and at intervals of 12, 24, 48, and 72 hours. Specimens were assessed for selected cytokine gene expression by reverse transcription-polymerase chain reaction analysis (TR-PCR). Results: Surgical delay significantly (P < 0.001) increased skin paddle survival in the delayed TRAM flaps (16.14 ± 1.53 cm, 81.9%) compared with undelayed flaps (7.68 ± 3.16 cm, 40.9%). TGF-β and PDGF expressions were not changed by surgical delay, but basic fibroblast growth factor (bFGF) and VEGF expressions increased significantly (P < 0.05 and P < 0.01) after delay. Conclusions: In the rat TRAM model, surgical delay resulted in increased VEGF expression and increased skin paddle survival. These results correlate with previous studies showing the preoperative injection of VEGF increases skin paddle survival. VEGF may be an important element in the delay phenomenon and may be an agent for pharmacological delay. PMID:15166966
Effects of calcitriol on random skin flap survival in rats.
Zhou, Kai-liang; Zhang, Yi-hui; Lin, Ding-sheng; Tao, Xian-yao; Xu, Hua-zi
Calcitriol, a metabolite of vitamin D, is often used in osteoporosis clinics. However, the material has other bioactivities; for example, it accelerates angiogenesis, has anti-inflammatory properties, and inhibits oxidative stress. We investigated the effects of calcitriol in a random skin flap rat model. "McFarlane flap" models were established in 84 male Sprague Dawley rats, divided into two groups. One group received intraperitoneal injections of calcitriol (2 μg/kg/day) whereas control rats received intraperitoneal injections of saline. The percentage flap survival area and tissue water content were measured 7 days later, which showed that calcitriol improved flap survival area and reduced tissue edema. It also increased the mean vessel density and upregulated levels of VEGF mRNA/protein, both of which promote flap angiogenesis. Moreover, it decreased leukocyte and macrophage infiltration, reduced the inflammatory proteins IL1β and IL6, increased SOD activity, decreased MDA content, and upregulated the level of autophagy. Overall, our results suggest that calcitriol promotes skin flap survival by accelerating angiogenesis, having anti-inflammatory effects, reducing oxidative stress, and promoting autophagy. PMID:26732750
Effects of calcitriol on random skin flap survival in rats
Zhou, Kai-liang; Zhang, Yi-hui; Lin, Ding-sheng; Tao, Xian-yao; Xu, Hua-zi
Calcitriol, a metabolite of vitamin D, is often used in osteoporosis clinics. However, the material has other bioactivities; for example, it accelerates angiogenesis, has anti-inflammatory properties, and inhibits oxidative stress. We investigated the effects of calcitriol in a random skin flap rat model. "McFarlane flap" models were established in 84 male Sprague Dawley rats, divided into two groups. One group received intraperitoneal injections of calcitriol (2 μg/kg/day) whereas control rats received intraperitoneal injections of saline. The percentage flap survival area and tissue water content were measured 7 days later, which showed that calcitriol improved flap survival area and reduced tissue edema. It also increased the mean vessel density and upregulated levels of VEGF mRNA/protein, both of which promote flap angiogenesis. Moreover, it decreased leukocyte and macrophage infiltration, reduced the inflammatory proteins IL1β and IL6, increased SOD activity, decreased MDA content, and upregulated the level of autophagy. Overall, our results suggest that calcitriol promotes skin flap survival by accelerating angiogenesis, having anti-inflammatory effects, reducing oxidative stress, and promoting autophagy. PMID:26732750
Effects of vinpocetine on random skin flap survival in rats.
Xiao-Xiao, Tao; Sen-Min, Wu; Ding-Sheng, Lin
The effect of vinpocetine on flap survival, vascular endothelial growth factor (VEGF) expression, and superoxide dismutase (SOD) and malondialdehyde (MDA) contents were evaluated in this study. The McFarlane flap model was established in 20 rats and evaluated within two groups. Postoperative celiac injection was given for 7 days in the two groups: vinpocetine was applied in Group 1, and the same volume of saline was applied in Group 2. Flap necrosis was measured on day 7 by cellophane in all groups. VEGF expression was determined using immunohistochemical methods on tissue samples taken after 7 days of injections. SOD and MDA contents were examined according to the Kit (reagent instructions). Vinpocetine significantly reduced necrosis area in Group 1 (p < 0.05). VEGF expression and SOD contents were significantly increased in Group 1 compared with Group 2 (p < 0.01), whereas MDA level was reduced (p < 0.05). This experimental study demonstrates that vinpocetine improves survival of random skin flaps, promotes neovascularization, and increases VEGF expression. Meanwhile, vinpocetine has a protective effect against ischemia-reperfusion injury by improving SOD vitality and decreasing MDA value. PMID:23588551
Edmund Prince Fowler Award Thesis. Evaluation of random skin flap survival in a porcine model.
Pratt, M F
The pathophysiology of random skin flap necrosis in the pig model was studied the effects of several drugs on skin flap survival were examined. The investigated drugs included acetylsalicylic acid (ASA), pentoxifylline (PTX), prostaglandin E2 (PGE2), and an experimental 21-aminosteroid, U-74389G. Each drug altered different parameters known to be associated with tissue necrosis. Demonstrated mechanisms of skin flap failure included the alteration of erythrocyte flexibility and platelet function and the activation of neutrophils with resultant accumulation of damaging oxygen-free radicals. Random skin flap survival did not improve with ASA but did improve significantly with PTX, PGE2, and U-74389G. The results of this study underscore the importance of neutrophil-mediated necrosis in the pathophysiology of skin flap failure. The data further demonstrate the need to develop drugs aimed at reversing or preventing the tissue damage from oxygen-free radicals in order to enhance the survival of random skin flaps. PMID:8656954
Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models.
Foroglou, Pericles; Karathanasis, Vasileios; Demiri, Efterpi; Koliakos, George; Papadakis, Marios
The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adipose-derived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals. PMID:27022440
Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models
Foroglou, Pericles; Karathanasis, Vasileios; Demiri, Efterpi; Koliakos, George; Papadakis, Marios
The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adipose-derived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals. PMID:27022440
Chlorogenic Acid Enhances Abdominal Skin Flap Survival Based on Epigastric Artery in Nondiabetic and Diabetic Rats.
Bagdas, Deniz; Etoz, Betul Cam; Gul, Zulfiye; Ozyigit, Musa Ozgur; Cinkilic, Nilufer; Inan, Sevda; Buyukcoskun, Naciye Isbil; Ozluk, Kasim; Gurun, Mine Sibel
Previous studies showed that chlorogenic acid (CGA) accelerates wound healing via its antioxidant activity. We aimed to investigate the effect of CGA in an experimental epigastric abdominal skin flap model in nondiabetic and diabetic rats. Rats were firstly divided into 2 groups: nondiabetic and diabetic. Diabetes was induced by streptozotocin. Then, 4 subgroups were created for each group: vehicle as well as 0.2 mg/0.5 mL, 1 mg/0.5 mL, and 5 mg/0.5 mL CGA treatments. Right epigastric artery-based abdominal skin flaps were elevated and sutured back into their original position. Chlorogenic acid or vehicle was injected once into the femoral arteries by leaving the epigastric artery as the single artery feeding the flaps during the injection. On postoperative day 7, flap survivals were evaluated, and the rats were killed. Distal flap tissues were collected for histopathological and biochemical assays. Chlorogenic acid showed greater flap survival in both nondiabetic and diabetic rats. Capillary density was increased, and necrosis was reduced in the CGA-treated rats. Chlorogenic acid decreased malondialdehyde levels as well as increased reduced glutathione and superoxide dismutase levels in the flap tissues. This study showed that CGA significantly improved flap survival by its antioxidant activities with intra-arterial local injections. PMID:25356637
Effects of diammonium glycyrrhizinate on random skin flap survival in rats: An experimental study
Lv, Qing-Bo; Gao, Xiang; Lin, Ding-Sheng; Chen, Yun; Cao, Bin; Zhou, Kai-Liang
Partial necrosis of skin flaps continues to restrict the survival of local skin flaps following plastic and reconstructive surgeries. The aim of the present study was to investigate the effects of diammonium glycyrrhizinate (DG), a salt of glycyrrhetinic acid that has been widely used in the therapy of chronic hepatitis and human immunodeficiency virus infection, on random skin flap survival in rats. McFarlane flaps were established in 60 male Sprague-Dawley rats randomly divided into three groups. Group I served as the control group and was injected with saline (10 mg/kg) once per day. Group II and group III were the experimental groups, and were injected with 10 mg/kg DG once and twice per day, respectively. On day 7, the survival area of the flap was measured. Tissue samples were stained with hematoxylin and eosin and immunohistochemically evaluated. Tissue edema, neutrophil density, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were evaluated. The mean survival areas of the flaps of group II were significantly larger when compared with those of group I (P<0.05), and the rats of group III exhibited significantly higher survival areas than group II (P<0.05). Histologic and immunohistochemical evaluation showed that microvessel development and the expression level of vascular endothelial growth factor were higher in the two experimental groups than in the control group. Furthermore, SOD activity was significantly increased (P<0.05), while the neutrophil density and MDA level were significantly reduced (P<0.05) in group II when compared with group I. Significant differences between group II and group III with regard to SOD activity and MDA level were also observed (P<0.05). Thus, DG may have a dose-dependent effect on promoting the survival of random skin flaps. PMID:27588181
Effects of Bezafibrate on the Survival of Random Skin Flaps in Rats.
Lin, Bin; Lin, Yuting; Lin, Dingsheng; Cao, Bin
Background Bezafibrate is widely used in clinics for its comparable angiogenic effect. Our research is to investigate the effect of bezafibrate on random skin flap survival. Materials and Methods The "McFarlane flap" rat models were established in 30 male Sprague-Dawley rats which were divided into two groups. The treatment group was given bezafibrate (400 mg/kg/day; gavage administration), and the control group received the vehicle. The flap surviving area was measured after 7 days, and the tissue samples were taken for histological analysis and edema measurement. Vascular endothelial growth factor (VEGF) was determined using immunohistochemical methods. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were examined with kits. Results Seven days after the operation, the surviving area in the treatment group was larger than in the control group (p < 0.01). The expression of VEGF was increased in the treatment group compared with that in the control group. And the activity of SOD was lower in the treatment group compared with those in the control group (p < 0.01). However, tissue edema, inflammatory cell infiltration, and MDA level were markedly lower in the treatment group than those in the control group (p < 0.01). Conclusion Bezafibrate improves the survival of random skin flaps effectively. PMID:26872027
Effects of nebivolol on skin flap survival: A randomized experimental study in rats
Gideroglu, Kaan; Alagoz, Sahin; Uygur, Fatih; Evinc, Rahmi; Celikoz, Bahattin; Bugdayci, Guler
Background: Skin flaps are among the basic treatment options in the reconstruction of soft tissue defects. To improve skin flap survival, a variety of methods, including pharmacologic agents, have been investigated. The effectiveness of anticoagulants, antioxidants, anti-inflammatory drugs, and vasodilatory drugs in improving flap survival has been studied. Nebivolol is a new-generation selective β1-adrenoreceptor blocking agent that has vasodilatory, antithrombotic, antioxidative, and anti- inflammatory effects. Objective: The aim of this experimental study was to investigate the effects of nebivolol (50 mg/kg/d) on random pattern skin flap survival in rats. Methods: Male Wistar rats weighing 290 to 310 g were randomly divided into 2 groups—the nebivolol group and the control group. Random patterned, caudally-based, ~3 × 10-cm skin flaps were elevated on the back of each rat. In the nebivolol group, nebivolol 50 mg/kg/d (1 mL, of a racemic solution of nebivolol) was administered orally 2 days before surgery to reach steady-state drug blood concentrations and was continued for 6 days. In the control group, 1 mL/d of sterile saline solution was orally administered 2 days before surgery and was continued for 6 days. To observe the effects of nebivolol, cutaneous blood flow was examined using a laser Doppler flow-meter before and after surgery on days 1, 3, 5, and 7, and flap tissue, malondialdehyde (MDA) and glutathione (GSH) concentrations, and superoxide dismutase (SOD) activity were measured 7 days postsurgery. Flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area. Results: All 20 rats (nebivolol group, n = 10; control group, n = 10) survived throughout the study period. Mean (SD) MDA concentration was significantly lower in the nebivolol group than in the control group (69.25 [5.82] vs 77.67 [6.87] nmol/g tissue; P = 0.009). GSH concentration was significantly higher in the nebivolol group than in the control
Combination of vascular endothelial growth factor-loaded microspheres and hyperbaric oxygen on random skin flap survival in rats
The present study aimed to investigate the role of hyperbaric oxygen (HBO) and treatment with vascular endothelial growth factor (VEGF)-loaded microspheres, and HBO plus VEGF on the survival of random skin flaps in rats. The modified McFarlane flap model was established in 40 rats and evaluated within four groups: VEGF (n=10), HBO (n=10), HBO plus VEGF (n=10) and controls (n=10). Seven days following treatment, the necrotic area of the flap was measured. The specimens were stained with hematoxylin and eosin for histological analysis. Immunohistochemical staining was used to analyze the positive expression levels of VEGF. The percentages of necrosis of the skin flaps in all groups were: 49.66±2.64% in controls, 26.85±1.77% in VEGF, 28.27±2.21% in HBO and 10.44±2.48% in the combination group. Histological analysis demonstrated angiogenesis with mean vessel density per mm2 in the groups were: 16.68±2.69 in controls, 22.96±3.29 in VEGF, 24.74±3.19 in HBO and 34.81±3.93 in the combination group. The expression of VEGF of the controls, VEGF, HBO and the combination group were 28.33±4.98, 52.54±4.55, 49.32±4.62 and 78.97±4.90 integral absorbance, respectively. For all measurements, the combination group showed greater improvement in random skin flap survival than others (P<0.05). No significant difference was detected between the VEGF and HBO group. The control group exhibited lower survival rates compared with the other groups (P<0.05). Combination of VEGF and HBO improved random skin flap survival compared with the effect of VEGF or HBO alone, suggesting these two agents exhibited a synergistic effect. PMID:26622421
Effect of eletroacupuncture on DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) on the survival of Wistar rats' dorsal skin flaps.
Uema, Deise; Orlandi, Denise; Freitas, Raphael R; Rodgério, Tatiane; Yamamura, Ysao; Tabosa, Angela F
The survival of skin flaps has great interest in many areas of Medicine. In practice, one of the most important complications in the use of skin flaps is the tissue ischemia, which frequently results in widespread necrosis and failure of the proposed treatments. The objective of this study was to evaluate the possible benefits of eletroacupuncture stimulation of the points DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) over the skin flap survival of Wistar rats after 8 days of treatment. Forty male Wistar rats were allocated into four groups with 10 animals each. They were submitted to a surgical procedure in which a dorsal skin flap measuring 10 x 4 cm was elevated and then sutured back with a plastic barrier between the flap and the donor site. During the following 8 days, one group received electro stimulation in two "nonaccupoints" whereas the other one had the accupoints DU-14 (Dazhui), DU-2 (Yaoshu), and Liv-13 (Zhangmen) stimulated. After this period, the rats were killed and flaps were appraised qualitative and quantitatively. Data were evaluated with analysis of variance and to establish significance Fisher's PLSD test was used when analysis of variance showed P < .05. It was observed that electroacupuncture group presented a skin flap survival index remarkably larger than the others. It has also shown a better evolution during the 8 days PO, confirmed by the lowest rate of necrosis and absent area. In this experimental model, eletroacupuncture was an efficient method to preserve vitality and decrease dorsal skin flap necrosis on Wistar rats. PMID:18354293
Effects of Acellular Amniotic Membrane Matrix and Bone Marrow-Derived Mesenchymal Stem Cells in Improving Random Skin Flap Survival in Rats
Chehelcheraghi, Farzaneh; Eimani, Hossein; Homayoonsadraie, Seyed; Torkaman, Giti; Amini, Abdollah; Alavi Majd, Hamid; Shemshadi, Hashem
Background The necrotic skin flap represents a great challenge in plastic and reconstructive surgery. In this study, we evaluated the effect of bioscaffolds, acellular amniotic membranes (AAMs), and bone marrow-derived mesenchymal stem cells (BM-MSCs) on random skin flap (RSF) survival in rats by applying a cell-free extracellular matrix scaffold as a supportive component for the growth and proliferation of BM-MSCs on RSFs. AAM matrix scaffolds were created by incubating AMs in ethylenediaminetetraacetic acid 0.05% at 37°C, and cell scrapers were used. Objectives The aim of the present study was to assess the effect of AAM as a scaffold in TE, and combined with transplanted BM-MSCs, on the survival of RSFs and on the biomechanical parameters of the incision-wound flap margins 7 days after flap elevation. Materials and Methods BM-MSCs and AAMs were transplanted into subcutaneous tissue in the flap area. On the 7th postoperative day, the surviving flap areas were measured using digital imaging software, and the flap tissue was collected for evaluation. Forty rats were randomly divided into four groups of 10 each: group 1 received an AAM injection; group 2 underwent BM-MSC transplantation; group 3 received both AAM injection + BM-MSC transplantation; and group 4 was the control group, receiving only saline. Results The survival area in the AAM/BM-MSC group was significantly higher than in the control group (18.49 ± 1.58 versus 7.51 ± 2.42, P < 0.05). The biomechanical assessment showed no significant differences between the experimental groups and the control group (P > 0.05), and there was no correlation with flap survival. Conclusions Our findings showed that the treatment of flaps with BM-MSC and AAM transplantations significantly promoted flap survival compared to a control group. The viability of the flap was improved by combining BM-MSCs with AAM matrix scaffolds. PMID:27621924
Improved ischemic island skin flap survival with continuous intraarterial infusion of adenosine triphosphate--magnesium chloride and superoxide dismutase: a rat model.
Zimmerman, T J; Sasaki, G H; Khattab, S
Neurovascular island skin flaps are still hampered by occasional necrosis of their most distal aspect. Cells subjected to prolonged hypoxic conditions become intracellularly depleted of needed metabolic substrates and eventually die. Once hypoxic conditions are improved, ischemic tissue suffers further injury from the rapid accumulation of oxygen free radicals. This study showed 53% survival of a standard random flap constructed on the inferior epigastric neurovascular bundle of a rat. Random flap survival increased to 65% after intraarterial infusion of adenosine triphosphate--magnesium chloride (ATP-MgCl2); to 75% after superoxide dismutase infusion; and to 98% after combined ATP-MgCl2 and superoxide dismutase infusion. Neither substrate appeared to act by increasing blood flow to the ischemic tissue. PMID:3296921
Skin flaps and grafts - self-care
... Regional flaps - self-care; Distant flaps - self-care; Free flap - self-care; Skin autografting - self-care ... the dressing and area around it clean and free from dirt or sweat. Don't let the ...
Axial pattern skin flaps in cats.
Remedios, A M; Bauer, M S; Bowen, C V; Fowler, J D
The major direct cutaneous vessels identified in the cat include the omocervical, thoracodorsal, deep circumflex iliac, and caudal superficial epigastric arteries. Axial pattern skin flaps based on the thoracodorsal and caudal superficial epigastric arteries have been developed in cats. Rotation of these flaps as islands allows skin coverage to the carpus and metatarsus, respectively. The thoracodorsal and caudal superficial epigastric flaps provide a practical, one-step option in the reconstruction of large skin defects involving the distal extremities of cats. PMID:2011063
Skin flaps and grafts - self-care
... skin infection Surgery for skin cancer Venous ulcers , pressure ulcers , or diabetic ulcers that do not heal After mastectomy or amputation Donor sites for grafts and flaps are chosen ... surgery than the wound due to newly exposed nerve endings.
Platysma flap using dual skin paddles.
Mustafa, El Muiz A; Bhatia, Sunil K; Hammond, Doug E
The platysma myocutaneous flap is rarely reported as an option for reconstruction in the head and neck. In our experience it is a reliable flap that is easy to raise, has a limited risk of morbidity at the donor site, and allows for early recommencement of oral function. We report a patient with an unusually aggressive orocutaneous fistula that complicated the simple extraction of teeth. We modified the platysma flap to provide two independent skin paddles so we could reconstruct both the intraoral and cutaneous defects simultaneously with a good clinical outcome. PMID:26947107
A study of the pharmacologic control of blood flow to acute skin flaps using xenon washout. Part I
Hendel, P.M.; Lilien, D.L.; Buncke, H.J.
This study was undertaken to understand the control mechanisms differentiating circulation to normal skin and acute skin flaps. The approach was to compare the effects of systemic vasoactive drugs on skin blood flow in rats in acute skin flaps and identical areas of control skin. With this model it was felt that systemic changes would affect both areas equally and any difference in response would be due to vascular control mechanisms unique to the flap. Xenon washout by percutaneous injection was chosen to measure blood flow. The results of over 8000 observations in these studies were: 1. Vasodilation enhances blood flow and flap survival. 2. Vasoconstriction decreases blood flow. 3. Depletion of sympathetic nerve terminals enhances blood flow and flap survival. 4. The acute flap is less sensitive to systemic alpha-agonists than control skin. 5. The acute flap is less sensitive to vasodilators acting at the receptor-site level than control skin. 6. Total sympathetic denervation does not occur. 7. Biologic increases in area of flap survival did occur in drug dose ranges predicted by xenon washout measurements in this model. These findings indicate that the vessels in an acutely raised skin flap have a greater vasospastic tone than is optimal for maximum nutrient blood flow. One explanation consistent with these findings is offered in which the mechanism responsible for this tone is the release of catecholamines from the sympathetic nerve terminals after the flap has been raised.
Effects of preserving different veins on flow-through flap survival: An experimental study
Flow-through skin flap grafting is becoming widely used for the reconstruction of skin and soft tissue defects, particularly for patients with poor blood supply around the defect. However, the treatment of the veins remains controversial. In the present study, 5×2-cm skin flaps were created on the left inner thighs of rabbits in order to investigate the effects of various treatments of the veins on the survival of a flow-through skin flap. A femoral artery perforator running through the flap was preserved. Five groups were established in which no veins, one superficial vein (SV), one accompanying vein (AV), one SV plus one AV, or all trunk veins (control) were retained. The percentage of flap area survival was determined on day 10. On days 3, 5, 7 and 9, tissues were harvested from the skin flaps and immunohistochemical analysis was performed in order to count the number of microvessels. Western blot analysis was subsequently completed in order to determine the expression levels of vascular endothelial growth factor (VEGF). The flap areas in which no veins were retained demonstrated significantly reduced survival rates on day 10, as compared with those in the other four groups (P<0.01). Furthermore, flaps with the retention of a SV also demonstrated reduced survival rates, as compared with the AV, AV plus SV and all veins groups (P<0.01); however, there no significant differences were detected between the latter three groups (P>0.05). Immunohistochemical analysis on day 3 detected a greater number of microvessels in the flaps of the control group, as compared with the flaps of the other groups. Furthermore, the AV and AV plus SV groups demonstrated a greater number of microvessels, as compared with the SV and no vein groups, and he no vein group demonstrated the fewest microvessels. No significant differences were found between the AV, AV plus SV and control groups on day 5, 7 and 9. Western blot analysis on day 5 demonstrated that the expression levles of VEGF
A reverse flow cross finger pedicle skin flap from hemidorsum of finger.
Mishra, Satyanarayan; Manisundaram, S
A reverse-flow cross-finger pedicle skin flap raised from the hemidorsum has been used, which is a modification of the distally based dorsal cross-finger flap. The flap is raised from the hemidorsum at a plane above the paratenon, the distal-most location of the base being at the level of the distal interphalangeal joint. Thirty-two flaps were used from as many fingers of as many patients. Of these, 31 (97%) flaps survived fully; there was stiffness of finger in one (3%) patient and the two-point discrimination was 4-8mm (n=14). Follow-up period was 2 months to 3 years, the median being 1 year and 3 months. The advantages of this flap are that there is less disruption of veins and less visible disfigurement of the dorsum of the finger when compared to other pedicled cross-finger skin flaps. The disadvantage of this flap is its restricted width. It is recommended as the cross-finger pedicle skin flap of choice when the defect is not wide. PMID:19386561
Reverse Sural Artery Island Flap With Skin Extension Along the Pedicle.
Lee, Hyun Il; Ha, Sung Han; Yu, Sun O; Park, Min Jong; Chae, Sang Hoon; Lee, Gi Jun
The distally based sural flap is an efficient flap for reconstruction of soft tissues defects of lower limb. The unstable vascular pedicle, however, is prone to compression by the subcutaneous tunnel, especially when a long pedicle covers the distal area of the foot. The aim of the present study was to introduce a modified surgical technique that leaves the skin extension over the pedicle and to report the clinical results of this modification. A total of 25 consecutive patients with a mean age of 51.7 ± 14.7 years underwent surgery. We modified the conventional sural flap technique by leaving a skin extension over the entire length of the pedicle, creating a fasciocutaneous vascular pedicle. The postoperative flap survival rates, complications, and the characteristics of the flaps such as flap size, pedicle length, and the most distal area that could be covered with this modification, were reviewed. At the last clinical follow-up examination, all the flaps survived, although partial necrosis was observed in 2 (8%) cases. Four cases of venous congestion developed but healed without additional complications. The mean flap size was 5.9 ± 1.8 × 9.2 ± 2.7 cm. With this modification, the sural flap could cover the defect located in extreme distal areas, such as the medial forefoot and dorsum of the first metatarsophalangeal joint, with a longer pedicle (≤27 cm) in 7 patients (28%). A skin extension along the pedicle achieved the favorable survival rate of the sural flap and successfully extended the surgical indications to more distal areas. PMID:26810124
Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap*
Zhao, Ling; Wang, You-bin; Qin, Shi-rui; Ma, Xue-mei; Sun, Xue-jun; Wang, Ming-lian; Zhong, Ru-gang
Objective: Skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs in plastic surgery. The mechanisms of I/R injury include hypoxia, inflammation, and oxidative damage. Hydrogen gas has been reported to alleviate cerebral I/R injury by acting as a free radical scavenger. Here, we assessed the protective effect of hydrogen-rich saline (HRS) on skin flap I/R injury. Methods: Abdominal skin flaps of rats were elevated and ischemia was induced for 3 h; subsequently, HRS or physiological saline was administered intraperitoneally 10 min before reperfusion. On postoperative Day 5, flap survival, blood perfusion, the accumulation of reactive oxygen species (ROS), and levels of cytokines were evaluated. Histological examinations were performed to assess inflammatory cell infiltration. Results: Skin flap survival and blood flow perfusion were improved by HRS relative to the controls. The production of malondialdehyde (MDA), an indicator of lipid peroxidation, was markedly reduced. A multiplex cytokine assay revealed that HRS reduced the elevation in the levels of inflammatory cytokines, chemokines and growth factors, with the exception of RANTES (regulated on activation, normal T-cell expressed and secreted) growth factor. HRS treatment also reduced inflammatory cell infiltration induced by I/R injury. Conclusions: Our findings suggest that HRS mitigates I/R injury by decreasing inflammation and, therefore, has the potential for application as a therapy for improving skin flap survival. PMID:23645175
Expanded retroauricular skin and fascial flap in congenital microtia reconstruction.
Zhang, Qingguo; Quan, Yuzhu; Su, Yuanda; Shi, Lei; Xie, Yangchun; Liu, Xinhai
The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction. Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. Inflation of saline volume increased up to 60 to 80 mL, and skin flap was expanded for 2 to 3 months postoperatively. In the second surgical stage, removal of tissue expander, formation of retroauricular skin flap, elevation of retroauricular fascia flap, and pedicles of both flaps in remnant ear side were performed. Costal cartilage was harvested from ipsilateral side chest to the ear for reconstruction. The 3D ear framework was sculpted with stabilization of structure, contour and erection. Simultaneously, intermediate full thickness skin graft of 4 x 8 cm was obtained from previous incision site from where costal cartilage was harvested. Cartilage ear framework was anchored between skin flap and fascia flap, and fixed it symmetrically to the opposite normal ear, inferior portion of the ear framework was wrapped by remnant ear lobule, expanded skin flap covered the anterior portion of the framework, fascial flap was draped to the posterior side of framework and helical rim, then fascial flap was surfaced by intermediate full thickness skin graft. Suction drain was inserted and coated between skin flap and framework, drain was removed fifth postoperative day. Tragus construction and conchal excavation with skin graft was performed in the third stage of microtia reconstruction. Between October 2000 and October 2007, 426 cases were diagnosed as unilateral microtia patients and 22 cases were bilateral microtia patients. Therefore, 448 microtia ears were treated with tissue expander and autogenous costal cartilage. In 262 cases, structure of the helix, tragus, conchal excavation
Dynamic Change of CD34 Level during the Survival Process of Narrow Pedicle Flap
Wu, Lijun; Zhao, Tianlan; Yu, Daojiang; Chen, Qi; Han, Wenya; Yu, Wenyuan; Sun, Wei
Objective To evaluate the dynamic change of CD34 level during the survival process of narrow pedicle flaps. Methods Twenty-five white pigs were randomly and equally divided into 5 experimental groups. Five different type of narrow pedicle with different length-to-width ratio were employed, and each type of narrow pedicle was covered with 5 different size random flaps and which was classified into A, B, C, D and E for 5 groups. Group A was control group. Each type narrow pedicle with 5 different skin flaps were implanted onto the back of the pigs along the midline of back with a reverse direction. A 0.3 cm×0.3 cm full thickness skin flap in the middle of distal segment was collected and on 3rd, 5th, 7th and 14th days of post-operation. The expression of CD34 was measured by immunohistochemistry and enzyme-linked immunosorbent (ELISA). Results Histological examination showed that with the increasing of length-to-width ratio of the narrow pedicle skin flaps, the expression of CD34 increased in the skin flaps. Increased level of CD34 was found on 3rd day post-operation, and the peak expression was found on 7th day. Persistent high level of CD34 was found until 14th day. Conclusion Increased CD34 level in the distal skin flap, there is the association between CD34 level and ischemia injury. Moreover, CD34 expression plays an important role during the repair processes of pedicle flaps. PMID:26561392
Metabolic adaptations in delayed skin flaps. Glucose utilization and hexokinase activity.
Im, M J; Su, C T; Hoopes, J E
The distribution of glucose and hexokinase activity was determined in the epithelial tissue of delayed bipedicled skin flaps in guinea pigs. The periods of "delay" were 1, 3, 7, 14, or 21 days. The flap survival was maximal (100% of the flap) when the flap elevation was performed either 7 or 14 days following the "delay" procedure. When the flap elevation was performed 1, 3, or 21 days following the "delay" procedure, the result was partial necrosis. A differential distribution of epithelial glucose was found within the bipedicled flaps. The lowest glucose level (30% of normal) was at a distance of 2 to 3.5 cm from the end of the caudal pedicle during the first day after the "delay" procedure. This decreased glucose content recovered toward normal levels during the later part of the "delay" period. The bipedicled flaps exhibited increased hexokinase activity during the 3-week period of the "delay," and the responses of hexokinase activity and tissue glucose levels to the "delay" procedure were reciprocal in the caudal half of the flaps. PMID:377341
Evaluation of the Effect of Bosentan-Mediated Endothelin Receptor Blockade on Flap Survival in Rats: An Experimental Study.
Görgülü, Tahsin; Guler, Ramazan; Olgun, Abdulkerim; Torun, Merve; Kargi, Eksal
Local skin flaps are important tools for performing plastic surgery. Skin flaps are used for closure of defects after tumor excision or in tissue losses after trauma. However, problems associated with these flaps are commonly encountered, particularly in areas of marginal necrosis. Bosentan is a vasodilator that exerts its effect through endothelin receptor blockade, and has been shown to prevent ischemic tissue damage. However, no reports have addressed the effect of bosentan on skin flaps. The aim of the study was to investigate the effects of bosentan, which may be applied clinically to promote survival of ischemic skin flaps. A modified McFarlane flap was elevated in the dorsum of 20 Albino Wistar rats with a width-to-length ratio of 3 to 10 cm, respectively, with the caudal base. Perioperatively, 0.9% of physiologic NaCl and injectable distilled water of identical volume were injected into rats in Group 1 (n = 10), and 5 mg/kg bosentan was injected intraperitoneally into rats in Group 2 (n = 10). All of the rats were followed up for 7 days postoperatively. The surviving parts of the flaps were measured at the end of day 7. Acute and chronic inflammation, amount of granulation tissue, fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization present in the ischemic zones of the distal parts of the flaps were evaluated histopathologically, and results were compared statistically. The mean flap survivals were 61.1% in Group 1 and 91.1% in Group 2; the percentage of the surviving flap area in Group 2 was higher than that in Group 1 (p < 0.005). In both groups, there was significantly less acute inflammation in the ischemic zones in Group 2 than in Group 1 (p < 0.005). No significant difference was found in the amounts of chronic inflammation and granulation tissue between the two groups (p > 0.005). Fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization
AdVEGF-All6A+ Preconditioning of Murine Ischemic Skin Flaps Is Comparable to Surgical Delay
Gersch, Robert P.; Fourman, Mitchell S.; Phillips, Brett T.; Nasser, Ahmed; McClain, Steve A.; Khan, Sami U.; Dagum, Alexander B.
Background: Surgical flap delay is commonly used in preconditioning reconstructive flaps to prevent necrosis. However, staged procedures are not ideal. Pharmacologic up-regulation of angiogenic and arteriogenic factors before flap elevation poses a nonsurgical approach to improve flap survival. Methods: Male Sprague Dawley rats were divided into control (n = 16), surgical delay (Delay), AdNull, AdEgr-1, and AdVEGF (n ≥ 9/group) groups. Delay rats had a 9 cm × 3 cm cranial based pedicle skin flap incised 10 days prior to elevation. Adenoviral groups received 28 intradermal injections (109 pu/animal total) throughout the distal two thirds of the flap 1 week prior to elevation. At postoperative day (POD) 0 flaps were elevated and silicone sheeting was placed between flap and wound bed. Perfusion analysis in arbitrary perfusion units of the ischemic middle third of the flap using laser Doppler imaging was conducted preoperatively and on POD 0, 3, and 7. Clinical and histopathologic assessments of the skin flaps were performed on POD 7. Results: AdVEGF (50.8 ± 10.9 APU) and AdEgr-1 (39.3 ± 10.6 APU) perfusion levels were significantly higher than controls (16.5 ± 4.2 APU) on POD 7. Delay models were equivalent to controls (25.9 ± 6.8 APU). AdVEGF and Delay animals showed significantly more viable surface area on POD 7 (14.4 ± 1.3 cm2, P < 0.01 and 12.4 ± 1.2 cm2, P < 0.05, respectively) compared with Controls (8.7 ± 0.7 cm2). Conclusions: AdVEGF preconditioning resulted in flap survival comparable to surgical delay. Adenoviral preconditioning maintained perfusion levels postoperatively while surgical delay did not. PMID:26495207
The "open book" flap: a heterodigital cross-finger skin flap and adipofascial flap for coverage of a circumferential soft tissue defect of a digit.
Tadiparthi, S; Akali, A; Felberg, L
A case of circumferential digital skin loss with exposed tendons from the proximal phalanx to the distal interphalangeal joint is presented. This was treated with a two-layer heterodigital cross-finger ("open book") flap from the adjacent digit, utilising a skin-only cross-finger flap to cover the palmar defect and an adipofascial flap to cover the dorsal defect. PMID:19129359
Acute effects of cigarette smoke exposure on experimental skin flaps
Nolan, J.; Jenkins, R.A.; Kurihara, K.; Schultz, R.C.
Random vascular patterned caudally based McFarlane-type skin flaps were elevated in groups of Fischer 344 rats. Groups of rats were then acutely exposed on an intermittent basis to smoke generated from well-characterized research filter cigarettes. Previously developed smoke inhalation exposure protocols were employed using a Maddox-ORNL inhalation exposure system. Rats that continued smoke exposure following surgery showed a significantly greater mean percent area of flap necrosis compared with sham-exposed groups or control groups not exposed. The possible pathogenesis of this observation as well as considerations and correlations with chronic human smokers are discussed. Increased risks of flap necrosis by smoking in the perioperative period are suggested by this study.
Epidural Blood Patch Using Manometry for Sinking Skin Flap Syndrome.
Turner, James D; Farmer, Justin L; Dobson, Sean W
We describe here a 55-year-old male patient with a medical history significant for chronic back pain and substance abuse with cocaine who sustained a traumatic subarachnoid hemorrhage after a fall from a roof while acutely intoxicated on cocaine requiring decompressive hemicraniectomy and cranioplasty that was complicated by an epidural abscess requiring a repeat craniectomy. He was diagnosed with sinking skin flap syndrome consistent with altered mental status and a sunken skin flap with increased midline shift. Despite treatment with Trendelenburg positioning and appropriate fluid management, the patient continued to decline, and an epidural blood patch was requested for treatment. After placement of the epidural blood patch using manometry in the epidural space, the patient's neurologic status improved allowing him to ultimately receive a cranioplasty. The patient is now able to perform several of his activities of daily living and communicate effectively. PMID:27075425
Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction.
Narushima, Mitsunaga; Iida, Takuya; Kaji, Nobuyuki; Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hara, Hisako; Kikuchi, Kazuki; Araki, Jun; Yamashita, Shuji; Koshima, Isao
For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, superthin flap with the advantages of both skin graft and perforator flaps. PMID:27085610
Tadalafil significantly reduces ischemia reperfusion injury in skin island flaps
Kayiran, Oguz; Cuzdan, Suat S.; Uysal, Afsin; Kocer, Ugur
Introduction: Numerous pharmacological agents have been used to enhance the viability of flaps. Ischemia reperfusion (I/R) injury is an unwanted, sometimes devastating complication in reconstructive microsurgery. Tadalafil, a specific inhibitor of phosphodiesterase type 5 is mainly used for erectile dysfunction, and acts on vascular smooth muscles, platelets and leukocytes. Herein, the protective and therapeutical effect of tadalafil in I/R injury in rat skin flap model is evaluated. Materials and Methods: Sixty epigastric island flaps were used to create I/R model in 60 Wistar rats (non-ischemic group, ischemic group, medication group). Biochemical markers including total nitrite, malondialdehyde (MDA) and myeloperoxidase (MPO) were analysed. Necrosis rates were calculated and histopathologic evaluation was carried out. Results: MDA, MPO and total nitrite values were found elevated in the ischemic group, however there was an evident drop in the medication group. Histological results revealed that early inflammatory findings (oedema, neutrophil infiltration, necrosis rate) were observed lower with tadalafil administration. Moreover, statistical significance (P < 0.05) was recorded. Conclusions: We conclude that tadalafil has beneficial effects on epigastric island flaps against I/R injury. PMID:23960309
Skin Flap Necrosis by Bone Marking with Methylene Blue in Cochlear Implantation.
Kim, Yeon Hoo; Cho, Sung Il
One of surgical complications in cochlear implantation is the necrosis of the skin flap above the receiver-stimulator coil. We present a case of 55-year-old woman who underwent cochlear implantation and developed a bluish skin necrosis due to bone marking. The planned position for the receiver-stimulator was marked using methylene blue through skin to bone. She did not undergo skin flap thinning and underwent successful implantation with complete electrode insertion. Few weeks postoperatively, the patient developed bluish discoloration with progressive thick, blue eschar formation and skin flap necrosis. She subsequently underwent wound debridement and skin flap closure. Cochlear explantation was not necessary. Timely diagnosis and management about this complication is necessary to prevent further skin breakdown and subsequent device extrusion. This report identifies the marking using methylene blue as another possible source of skin flap necrosis in cochlear implantation, and surgeons should be aware of this potential complication. PMID:26413579
Transdermally administered nitric oxide by application of acidified nitrite increases blood flow in rat epigastric island skin flaps.
Gribbe, Orjan; Gustafsson, Lars E; Wiklund, N Peter
Surgical flaps are commonly used in the reconstruction of tissue defects after tumour surgery and trauma. Flap failure continues to be a clinical problem and the underlying causes are not fully understood. In the present study a system that generates nitric oxide (NO) in a non-enzymatic fashion was created through the acidification with vitamin C of a cream containing increasing concentrations (0.125%, 0.25%, 0.5%, 1.25% and 2.5%) of nitrite (NO(2)(-)). The cream was applied for 30 min to a modified epigastric island skin flap in the rat. Blood flow in the supplying artery was measured by transit-time ultrasound flowmetry throughout the experiment and superficial skin blood flow was measured by laser Doppler perfusion imaging before and after treatment. Mean arterial blood pressure was also monitored. NO and the gas nitrogen dioxide (NO(2)), which is formed when NO reacts with atmospheric oxygen, were measured above the cream using chemiluminescence. In flaps treated with the NO generating cream, a concentration-dependent increase in blood flow in the supplying artery and flap skin of up to 130% was observed. Cream base alone or cream base acidified with vitamin C had no effect on blood flow. Also, concentration-dependent formation of both NO and NO(2) was seen. NO increases both supplying artery blood flow and superficial cutaneous blood flow in an epigastric island skin flap model in the rat indicating that NO is of importance in flap physiology and possibly also for flap survival. PMID:17976572
Treatment of postburn ear defect with expanded upper arm flap and consequent expansion without skin grafting.
Hu, Jintian; Liu, Tun; Zhou, Xu; Zhang, Yong-Biao; Zhang, Qingguo
Total ear reconstruction in the postburn auricle is one of the most challenging procedures for plastic surgeons. Adverse factors associated with these procedures include reduced or damaged blood supply, poor elasticity of scar tissue, increased risk of infection, and the possible destruction of skin, temporoparietal fascia, or retroauricular fascia. In cases where patients are severely burned, free flaps, such as radial forearm flaps, contralateral temporoparietal fascial flaps, or omental flaps, can be used as framework envelopes. In this work, we introduced a novel method of expanded upper arm flap transfer, followed by an expansion method of total ear reconstruction without skin grafting. PMID:24589517
Usage of the Bi-Unilobed Cutaneous Flap Model for Maxillofacial Skin Defect Reconstructions.
Emsen, Ilteris M
There are many methods on skin defects and their reconstructions. The basic rule for reconstruction of these defects is to perform with the most easy and simple method. Local flaps are one of the most convenient for skin defects. Free flaps, interpolation flaps are usually can not preferred because of no time saving, and need the second operation to delay. For this reason, local flap methods have been always popular methods for the reconstruction of small to large skin defects.10 patients were included to this study. All patients were operated by one senior author. Average follow-up was 10.9 months (1-26 months). Four of patients were female, and others were male.There was no seen any flap ischeamia at follow up. Histopathologic review of removed masses was reported as malignant skin tumor for 7 patients, and as benign skin tumor for 3 patients. Even at the early postoperative period, no distal flap ischeamia was observed. Additionally, no any wound infection, dehiscence and other problems related to wound healing process were seen. In conclusion, our proposed technique that named "bi-unilobed cutaneous flap " has more superior properties than the other local flap methods including: easy planning, no need wide dissection, and has more less donor area morbidity. This suggested method is a different and a good alternative for small to large skin defect according to the standard local flaps such as banner, VY, advancement, transposition, Limberg, and other modified local flaps. PMID:26080262
Repair of a canine forelimb skin deficit by microvascular transfer of a caudal superficial epigastric flap.
Lewin, G A; Smith, J H
Extensive skin loss from the forelimb of a Border collie was repaired by a microvascular caudal superficial epigastric flap, with secondary meshing of the flap to increase coverage. The caudal superficial epigastric artery and vein were anastomosed to the brachial artery and vein. End-to-end anastomosis to the brachial artery and vein did not compromise peripheral blood flow, and no flap necrosis was observed after subsequent limited meshing of the flap. PMID:20070493
Application of Normobaric Hyperoxygenation to an Ischemic Flap and a Composite Skin Graft
Araki, Jun; Kato, Harunosuke; Doi, Kentaro; Kuno, Shinichiro; Kinoshita, Kahori; Mineda, Kazuhide; Kanayama, Koji
Background: Hyperbaric oxygenation has been used for various purposes, but its clinical application is limited due to its pulmonary toxicity. We evaluated the therapeutic value of normobaric hyperoxygenation (NBO) for vascularized and nonvascularized tissue transplantation. Methods: Tissue oxygen partial pressure (PtO2) was measured for various organs in mice under inspiratory oxygen of 20%, 60%, or 100%. A rectangular skin flap (1 × 4 cm) or a composite skin graft (2 × 2 cm) was made on the back of mice, which were housed under 20% or 60% oxygen for the first 3 days after surgery. Cell survival was also examined in organ culture skin samples. Results: PtO2 varied among tissues/organs, but increased depending on inspiratory oxygen concentration in all tissues/organs. Although NBO with 100% O2 was toxic, NBO with 60% O2 was safe even when used continuously for a long period. NBO did not significantly improve survival of the rectangular skin flap. On the other hand, in the composite skin graft model, the engraftment area increased significantly (52 ± 10 at 20% vs 68 ± 5.1 at 60%) and contraction decreased significantly (42 ± 8.0 at 20% vs 27 ± 5.7 at 60%). Organ culture of a composite skin sample showed significant cell death under lower oxygen concentrations, supporting the data in vivo. Conclusions: The composite graft was maintained until revascularization by plasmatic diffusion from surrounding tissues, in which PtO2 was improved by NBO. NBO may be an effective adjunct therapy that can be performed readily after nonvascularized tissue grafting. PMID:25289345
The possibility for use of venous flaps in plastic surgery
NASA Astrophysics Data System (ADS)
Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.
The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.
The possibility for use of venous flaps in plastic surgery
Baytinger, V. F. Kurochkina, O. S. Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.
The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.
Nasal-skin-fold transposition flap for upper lip reconstruction in a French bulldog
Benlloch-Gonzalez, Manuel; Lafarge, Stéphanie; Bouvy, Bernard; Poncet, Cyrill
Upper-lip reconstruction after mast-cell tumor-resection in a French bulldog was achieved by using a transposition flap from the nasal-skin-fold and an oral mucosal flap. The new technique is an alternative for reconstruction of extensive upper-lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. PMID:24155421
Nasal-skin-fold transposition flap for upper lip reconstruction in a French bulldog.
Benlloch-Gonzalez, Manuel; Lafarge, Stéphanie; Bouvy, Bernard; Poncet, Cyrill
Upper-lip reconstruction after mast-cell tumor-resection in a French bulldog was achieved by using a transposition flap from the nasal-skin-fold and an oral mucosal flap. The new technique is an alternative for reconstruction of extensive upper-lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. PMID:24155421
Skin friction on a flapping plate in uniform flow.
Ehrenstein, Uwe; Marquillie, Matthieu; Eloy, Christophe
To calculate the energy costs of swimming or flying, it is crucial to evaluate the drag force originating from skin friction. This topic seems not to have received a definite answer, given the difficulty in measuring accurately the friction drag along objects in movement. The incoming flow along a flat plate in a flapping normal motion has been considered, as limit case of a yawed cylinder in uniform flow, and applying the laminar boundary layer assumption it is demonstrated that the longitudinal drag scales as the square root of the normal velocity component. This lends credit to the assumption that a swimming-like motion may induce a drag increase because of the compression of the boundary layer, which is known as the 'Bone-Lighthill boundary-layer thinning hypothesis'. The boundary-layer model however cannot predict the genuine three-dimensional flow dynamics and in particular the friction at the leeward side of the plate. A multi-domain, parallel, compact finite-differences Navier-Stokes solution procedure is considered, capable of solving the full problem. The time-dependent flow dynamics is analysed and the general trends predicted by the simplified model are confirmed, with however differences in the magnitude of the friction coefficient. A tentative skin friction formula is proposed for flow states along a plate moving at steady as well as periodic normal velocities. PMID:24936007
Effects of some pharmacological agents on the survival of unipedicled venous flaps: an experimental study.
Askar, I; Saray, A; Gurlek, A; Sevin, K; Sabuncuoglu, B T
Clinical and experimental studies have been conducted to improve the survival of venous flaps. As a result of these studies, although various survival mechanisms were raised, none obtained satisfactory information. Venous stasis, and the resultant venous thrombosis, is a factor that decreases the survival of venous flaps. In this study, we evaluated the effects of two antiinflammatory agents, etodolac and etofenamate, on the survival of unipedicled venous flaps. In this study, 35 male New Zealand white rabbits (3,500-4,000 g) (70 ears) were used. Perichondrocutaneous flaps, 3 x 4.5 cm in size, were designed and raised, keeping the central veins intact in the middle of venous flap. Central arteries and nerves were ligated and transected both proximally and distally, to prepare unipedicled venous flaps. A silicone sheet was placed between the cartilage tissue and flap, to prevent blood flow and revascularization beneath. The subjects were divided into seven groups, consisting of five rabbits (10 ears). In the negative control group (group I), the single vascular pedicle of venous flaps, central veins were ligated and flaps sutured into their own place as the composite graft. In the positive control group (group II), after venous flaps were prepared, normal saline, 0.2 mL, was given subcutaneously. In the first of five experimental groups (group III), unfractionated heparin (100 U/day) was given subcutaneously. In the second experimental group (group IV), etodolac (5 mg/kg/day) was given subcutaneously. In the third experimental group (group V), etophenamate (5 mg/kg/day) was given orally through a feeding tube. In the fourth experimental group (group VI), parnaparin (5 anti-Xa U/kg/day) was given subcutaneously. In the fifth experimental group (group VII), nadroparin (5 anti-Xa U/kg/day) was given subcutaneously, about 7 days postoperatively. At the eighth postoperative day, surviving areas of venous flaps were measured, and the results were evaluated by Kruskal
The revascularization of pedicle skin flaps in pigs: a functional and morphologic study
Young, C.M.
Functional and morphologic changes occurring during the revascularization of pedicle flaps have been investigated in the skin of pigs. The skin flaps, 16 cm long by 4 cm wide, were based on a row of segmental vessels arising from the internal mammary artery. Comparative measurements were made in flapped and normal skin. The inherent blood supply in the pedicle of the flap was unable to maintain the whole of the flap in a viable state. Flap viability was ascertained at surgery by the use of the intravital dye Disulphine blue. Injections of the dye after surgery gave a less accurate prediction of viability than when dye was injected prior to surgery. Revascularization between the flap and surrounding skin was evident 3 to 4 days postoperatively at the distal, most hypoxic part of the viable flap. The whole flap had a collateral vascular supply 7 to 10 days after surgery. Isotope clearance studies showed that the greatest functional changes occurred in the distal third of the viable flap, where, after initially slowing, the clearance rate became faster than in normal skin (day 5). Potassium extraction studies indicated similar changes. However, an increase in the red-cell volume on day 1 suggested that vascular shunting was occurring. The results of the morphologic studies indicated a correlation between the number of blood vessels per unit area, the thickness of the dermis, and the recorded functional changes. Seven days after surgery, when isotope clearance rates were very rapid, there was a significant increase in the vascular density and dermal thickness.
Experience in Reconstruction for Small Digital Defects With Free Flaps.
Hung, Min-Hsiang; Huang, Kuo-Feng; Chiu, Haw-Yen; Chao, Wai-Nang
Traumatic injuries to the digits resulting in soft tissue or bone loss require reconstruction. Traditionally, local flaps, such as homodigital flaps, heterodigital flaps, pedicled flaps, or distant flaps, are used for digital resurfacing. However, free tissue transfers can be used in selected patients. In this study, we present the use of different free flaps including groin skin flaps, groin osteocutaneous flaps, groin chimeric flaps, second dorsal metacarpal artery flaps, and partial toe flaps for digital reconstruction. A total of 19 digits were treated with 16 free flaps in our hospital. Of the flaps used, 5 were free groin skin flaps, 4 were free partial toe flaps, 3 were free groin chimeric flaps, 2 were free groin osteocutaneous flaps, and 2 were free second dorsal metacarpal artery flaps. The average flap size was 4.7 × 2.0 cm (range, 1.5 × 1 to 5 × 4 cm), and the average operative time was 6.0 hours (range, 4-9 hours). All flaps survived without partial or total necrosis. In conclusion, the free flap is a reliable and safe alternative for digital reconstruction. Moreover, the free groin flap provides not only a chimeric pattern for multiple fingers coverage but also an osteocutaneous pattern for thumb lengthening. The free second dorsal metacarpal artery flap provides a tenocutaneous pattern for tendon reconstruction and soft tissue coverage simultaneously, and the free partial toe flap is an excellent alternative for pulp reconstruction in terms of aesthetic appearance and functional outcome. PMID:26808771
A new use of scrotal septal skin flap in repairing hypospadias.
Liu, Xinhai; Li, Yangqun; Li, Senkai; Tang, Yong; Li, Qiang
In our study, we introduce the use of a scrotal septal skin flaps in repair of hypospadias. Between June 2006 and October 2008, 30 patients were treated by using a penile local flap to reconstruct the urethra, and a scrotal septal skin flap to cover the wound located on the ventral side of the penis. Of 30 patients, 4 presented with urine leakage, but this condition healed spontaneously after 2 to 4 weeks. Urine leakage healed without problem in the remaining patients, and they had unobstructed urinary flow. Additionally, they all were satisfied with genital appearance after the reconstruction. We conclude that our method is a convenient means to cover the wound at the ventral side of the reconstructed urethra by using a scrotal septal skin flap during hypospadias repair. This procedure provides good urinary function and satisfactory appearance to the patients. In addition, this method solves the problem of very limited local tissue for urethral reconstruction in the hypospadias patient. PMID:21407073
Hydrogen clearance: Assessment of technique for measurement of skin-flap blood flow in pigs
Thomson, J.G.; Kerrigan, C.L. )
The hydrogen clearance technique has been used for many years by investigators to determine brain blood flow and has been partially validated in this setting using other methods of blood flow measurement. The method has been modified to allow blood flow measurements in skin, but the accuracy of H2 clearance for measuring skin blood flow has not been determined. Multiple blood flow measurements were performed using H2 clearance and radioactive microspheres on skin flaps and control skin in pigs. On 12 pigs, a total of 117 flap and 42 control skin measurements were available for analysis. There was no significant difference between the two techniques in measuring mean control skin blood flow. In skin flaps, H2 clearance was significantly correlated to microsphere-measured blood flow, but it consistently gave an overestimate. Sources of error may include injury to the tissues by insertion of electrodes, consumption of H2 by the electrodes, or diffusion of H2 from the relatively ischemic flap to its well-vascularized bed. Further studies are necessary to determine the cause of this error and to measure the technique's accuracy in skeletal muscle and other flaps.
Enhancement of flap survival and changes in angiogenic gene expression after AAV2-mediated VEGF gene transfer to rat ischemic flaps.
Wang, Xiao Tian; Avanessian, Bella; Ma, Qiangzhong; Durfee, Heather; Tang, Yu Qing; Liu, Paul Y
Necrosis of surgically transferred flaps due to ischemia is a serious wound problem. We evaluated the improvement of flap survival and changes in angiogenic gene expression profiles after transfer of the VEGF gene by means of adeno-associated virus type 2 (AAV2) vector to rat ischemic flaps. Thirty rats were divided into one experimental group, one AAV2-GFP group, and one saline group. AAV2-VEGF or AAV2-GFP were injected intradermally into the rat dorsum in the AAV2-VEGF or AAV2-GFP group. The saline group received saline injection. A 3 × 10 cm flap was raised in each rat two weeks post-injection. One week after surgery, flap viability was evaluated. Angiogenesis real-time PCR array was performed to analyze the expression of angiogenesis-associated genes. The AAV2-VEGF treatment significantly improved flap survival (p<0.05). Immunohistochemical staining showed increased VEGF expression in AAV2-VEGF treated flaps. The PCR array identified remarkable changes in 6 out of the 84 angiogenesis-associated genes in AAV2-VEGF treated flaps. Particularly, EGF, PDGF-A and VEGF-B genes were up-regulated in these flaps. In contrast, FGF2 gene expression was down-regulated. In conclusion, AAV2-VEGF improves flap survival and affects the expression of a series of endogenous growth factor genes, which likely play critical roles in the enhancement of ischemic flap survival. PMID:21649787
Microscopic and immunohistochemical analysis of the skin changes of free forearm flaps in intraoral reconstruction.
Rubino, Corrado; Dessy, Luca A; Farace, Francesco; Ena, Pasquale; Mazzarello, Vittorio
In the literature, few studies based on clinical and histological evaluation analyze skin structural changes after transplantation to the oral cavity. Ten patients affected by squamous cell carcinoma of the oral cavity who were reconstructed with a free forearm flap were included in the current study to analyze skin alterations. The authors performed a histological and ultrastructural evaluation of skin samples from the free forearm flap before transplantation and 18 months after intraoral reconstruction. They analyzed cytokeratin and involucrin distribution, which represent markers of maturation and differentiation of epithelia. The aim of this study was to demonstrate whether skin "mucosalization" occurs. They found that the skin undergoes some morphological changes induced by the intraoral environment. Cytokeratin and involucrin distribution is mostly unchanged. This aspect is in favor of skin structure preservation. Thus, they found that "mucosalization" of the skin is not evident after 18 months. PMID:12370640
BCL-2 and Bax Expression in Skin Flaps Treated with Finasteride or Azelaic Acid
Ayatollahi, Seyyed Abdulmajid; Ajami, Marjan; Reyhanfard, Hamed; Asadi, Yasin; Nassiri-Kashani, Mansour; Rashighi Firoozabadi, Mehdi; Davoodi, Sayed Hossein; Habibi, Esmaeil; Pazoki-Toroudi, Hamidreza
Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between – to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein (p < 0.05) and decrease the expression of bax protein (p < 0.05). These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult. PMID:24250563
Predictive Capability of Near-Infrared Fluorescence Angiography in Submental Perforator Flap Survival
Matsui, Aya; Lee, Bernard T.; Winer, Joshua H.; Laurence, Rita G.; Frangioni, John V.
Background Perforator flaps have become increasingly popular in reconstructive surgery as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, our laboratory described the intraoperative use of near-infrared (NIR) fluorescence angiography for patient-specific perforator-flap design. This study evaluates the predictive capability of NIR fluorescence angiography for flap survival in submental flap reconstruction. Methods NIR angiography was performed using indocyanine green at 0, 0.5, 24, 48, and 72 h post-surgery after flap creation in 12 pigs. A single perforator artery was preserved during flap creation based on location (central or non-central) and dominance (dominant or non-dominant). Venous drainage, arterial perfusion, and perfused area as percentage of total flap were analyzed. Clinical assessments of perfusion were compared with those made using NIR imaging and histology. Results Use of NIR fluorescence angiography immediately after flap creation accurately predicted areas of perfusion at 72 h (p = 0.0013), compared to the initial clinical assessment (p = 0.3085). Identification of necrosis by histology at 72 h correlated with NIR findings of insufficient arterial perfusion immediately after flap creation. No statistically significant differences in perfusion metrics were detected based on location or dominance of the preserved perforator; however, flaps containing central perforators had a higher percent perfused area than those with non-central perforators. Conclusions The use of NIR angiography immediately after flap creation can predict areas of perfusion at 72 h. This predictive capability may permit intraoperative revision of compromised flaps that have a high likelihood of failure. PMID:21042109
Cheek-neck advancement-rotation flaps following Mohs excision of skin malignancies.
Katz, A E; Grande, D J
The cheek-neck advancement-rotation flap has proved extremely useful for delayed reconstruction of the face following the microscopically controlled surgical excision (MCSE) of skin malignancies. We have recently used these flaps successfully to repair combined defects of the cheek and nose in eight patients, isolated cheek defects in six patients, combined defects of the cheek and lips in two patients, and isolated defects of the nose, temple, and an antral cutaneous fistula in each of three patients. Defects as large as 6.0 X 10.0 cm have been closed in one stage with this flap. This flap is extremely hearty and its scars can be well concealed. It is especially valuable in the elderly patient and should always be considered as one of the options for reconstruction of the face following MCSE of skin malignancies. PMID:3745621
Histological changes in radial forearm skin flaps in the oral cavity.
Sinclair, A; Johnston, E; Badran, D H; Neilson, M; Soutar, D S; Robertson, A G; McDonald, S W
We reported previously that skin flaps transplanted to the oral cavity in reconstructive surgery for oral cancer frequently acquired the gross appearance of buccal mucosa. The changes were shown to be reactive in nature. The "changed" flaps generally had a heavier infiltration of leukocytes in the dermis and appeared to have thicker epithelium. The present study quantifies these parameters, as well as the numbers of intraepithelial leukocytes. The flaps that had acquired the gross appearance of oral mucosa had significantly thicker epithelium, larger numbers of dermal leukocytes, and more intraepidermal inflammatory cells per unit length than flaps that retained the gross appearance of thin skin. No correlation was found between these changes and radiotherapy. PMID:15042571
Successful reconstruction after resection of malignant skin tumor on triangular fossa using anterior auricular bilobed flap.
Fujioka, Masaki; Hayashida, Kenji; Morooka, Sin; Saijo, Hiroto
Reconstruction of surgical defects is challenging, especially when they are localized in an anterior surface. The authors present two patients with a malignant skin neoplasm localized in the triangular fossa. Each tumor was removed and the cartilage-exposing wound was reconstructed using an anterior auricular bilobed flap. The donor site of the flap was primarily closed. The viability of the flap was favorable without complications and with excellent esthetic results. There are various surgical procedures for reconstruction of the anterior auricle. Among them, an anterior auricular bilobed flap can be performed quickly, has minimal associated morbidity and yields a favorable outcome. We believe that this technique is an effective option, especially for the triangular fossa skin defect resurfacing. PMID:25893369
Prevention of skin flap necrosis by a course of treatment with vasodilator drugs.
Finseth, F; Adelberg, M G
Large island skin flaps, comprising the entire abdominal covering in rats, were raised on one neurovascular pedicle in the groin. A standard area of necrosis was produced on the other side from the pedicle. However, when the animals were treated with certain vasodilator drugs for 15 days before and 7 days after the flaps were raised, there was little or no necrosis. The effect of the drug therapy was the same as a surgical delay. PMID:347479
Assessment of microsphere technique for measurement of capillary blood flow in random skin flaps in pigs
Pang, C.Y.; Neligan, P.; Nakatsuka, T.
In this technical paper, we reviewed the theory and methodology of the radioactive microsphere technique for determination of cardiac output and regional blood flow. Furthermore, we described two experiments conducted to assess this technique for measurement of capillary blood flow in skin-flap research. Our experimental data thus far indicated that the radioactive microsphere technique provided highly reproducible measurements for determination of capillary blood flow in 4 X 10 cm acute and delayed random skin flaps constructed in pigs. The advantages and disadvantages of this laboratory technique were also discussed.
Perfusion and Oxygenation of Random Advancement Skin Flaps Depend More on the Length and Thickness of the Flap Than on the Width to Length Ratio
Memarzadeh, Khashayar; Sheikh, Rafi; Blohmé, Jonas; Torbrand, Christian
Objective: The aim was to investigate the relationship between the dimensions (length, width, and thickness) of random advancement skin flaps and retained tissue perfusion and oxygenation. Methods: Flaps were raised on the flanks of pigs. The flaps were either 0.5 or 1.0 cm wide, thin (dissected halfway through the subcutaneous tissue) or thick (dissected down to the muscle fascia). Tissue perfusion was measured by laser Doppler velocimetry, and tissue oxygenation (pO2) was measured using a Licox system, every 0.5 cm along the flaps' length. Tissue temperature was visualized by high-resolution infrared camera. Results: Perfusion and oxygenation decreased gradually from the base to the tip of the flap, reaching approximately 40% of presurgical values (2.0 cm) and approximately 20% (2.5 cm) from the base of the flap. There was virtually no blood flow, nor oxygen tension, 3.0 cm from the base of the flap. The width to length ratio of the flap did not determine blood flow or oxygenation, being approximately 30% in a 0.5 cm wide and 2 cm long flap, and 0% in a 1.0 cm wide and 4 cm long flap, both with a width to length ratio of 1:4. Blood flow and oxygenation were preserved to a greater extent in the thick flaps (∼40%) than in the thin flaps (∼20%), in a 0.5 cm wide and 2 cm long flap. Conclusions: The dissection of a random advancement flap results in hypoperfusion and oxygenation that cannot be predicted by the width to length ratio but depend on the length and thickness of the flap. PMID:26958105
Paradoxical effects of heme arginate on survival of myocutaneous flaps
Czopek, Alicja; Wigmore, Stephen J.; Kluth, David C.
Ischemia reperfusion injury (IRI) contributes to partial flap and solid organ transplant failure. Heme-oxygenase 1 (HO-1) is an inducible, cytoprotective enzyme which protects against IRI in solid organ transplant models. Heme arginate (HA), a HO-1 inducer, is a promising, translatable, preconditioning agent. This study investigated the effects of preconditioning with HA on the clinical outcome of a myocutaneous IRI model. Forty male Lewis rats were randomized to intravenously receive 1) Control-NaCl, 2) HA, 3) HA and tin mesoporphyrin (SnMP), a HO-1 inhibitor; and 4) SnMP alone. Twenty-four hours later, an in situ transverse rectus abdominis myocutaneous flap was performed under isoflurane anesthesia. Viability of flaps was measured clinically and by laser-Doppler perfusion scanning. In vitro work on human epidermal keratinocytes (HEKa) assessed the effects of HA, SnMP, and the iron chelator desferrioxamine on 1) cytotoxicity, 2) intracellular reactive oxygen species (ROS) concentration, and 3) ROS-mediated DNA damage. In contrast to our hypothesis, HA preconditioning produced over 30% more flap necrosis at 48 h compared with controls (P = 0.02). HA-containing treatments produced significantly worse flap perfusion at all postoperative time points. In vitro work showed that HA is cytotoxic to keratinocytes. This cytotoxicity was independent of HO-1 and was mediated by the generation of ROS by free heme. In contrast to solid organ data, pharmacological preconditioning with HA significantly worsened clinical outcome, thus indicating that this is not a viable approach in free flap research. PMID:24089372
Paradoxical effects of heme arginate on survival of myocutaneous flaps.
Edmunds, Marie-Claire; Czopek, Alicja; Wigmore, Stephen J; Kluth, David C
Ischemia reperfusion injury (IRI) contributes to partial flap and solid organ transplant failure. Heme-oxygenase 1 (HO-1) is an inducible, cytoprotective enzyme which protects against IRI in solid organ transplant models. Heme arginate (HA), a HO-1 inducer, is a promising, translatable, preconditioning agent. This study investigated the effects of preconditioning with HA on the clinical outcome of a myocutaneous IRI model. Forty male Lewis rats were randomized to intravenously receive 1) Control-NaCl, 2) HA, 3) HA and tin mesoporphyrin (SnMP), a HO-1 inhibitor; and 4) SnMP alone. Twenty-four hours later, an in situ transverse rectus abdominis myocutaneous flap was performed under isoflurane anesthesia. Viability of flaps was measured clinically and by laser-Doppler perfusion scanning. In vitro work on human epidermal keratinocytes (HEKa) assessed the effects of HA, SnMP, and the iron chelator desferrioxamine on 1) cytotoxicity, 2) intracellular reactive oxygen species (ROS) concentration, and 3) ROS-mediated DNA damage. In contrast to our hypothesis, HA preconditioning produced over 30% more flap necrosis at 48 h compared with controls (P = 0.02). HA-containing treatments produced significantly worse flap perfusion at all postoperative time points. In vitro work showed that HA is cytotoxic to keratinocytes. This cytotoxicity was independent of HO-1 and was mediated by the generation of ROS by free heme. In contrast to solid organ data, pharmacological preconditioning with HA significantly worsened clinical outcome, thus indicating that this is not a viable approach in free flap research. PMID:24089372
Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy
Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan
Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point. PMID:26977363
Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy.
Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan
Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point. PMID:26977363
Microcirculatory Evaluation of the Abdominal Skin in Breast Reconstruction with Deep Inferior Epigastric Artery Perforator Flap
Tønseth, Kim Alexander; Pripp, Are Hugo; Tindholdt, Tyge Tind
Background: No studies have assessed the perfusion of the undermined abdominal skin in breast reconstruction with deep inferior epigastric artery perforator flap. A greater understanding of the procedure's impact on the perfusion of the abdominal skin can be valuable in predicting areas susceptible to necrosis. Methods: Microcirculatory changes were monitored in the abdominal skin of 20 consecutive patients undergoing breast reconstruction with a deep inferior epigastric artery perforator flap. Quantitative mapping was performed with laser Doppler perfusion imaging at 7 set intervals. Measurements were taken and recorded within 4 standardized zones covering the skin between the xiphoid process and the upper incisional boundary of the flap (zones 1–4; cranial to caudal). Results: Before commencing surgery, a significantly higher perfusion was registered in zones 3 and 4 when compared with zone 1. After undermining the abdominal skin, the perfusion in zones 1–3 increased significantly. After the abdominal closure, the perfusion dropped in all 4 zones and only the perfusion level in zone 1 remained significantly higher than preoperative mean. Postoperatively, the perfusion of each zone stabilized at a significantly higher level compared with preoperative values. No tissue necrosis was observed in any of the zones. Conclusions: Although perforators are divided during undermining of the abdominal skin, there seems to be a reactive hyperemia that exceeds the blood supply delivered by the perforators. Thus, due to microcirculatory mechanisms, the undermining of the abdomen during the procedure does not seem to present any great risk of tissue necrosis. PMID:27014545
Ex Vivo Prefabricated Rat Skin Flap Using Cell Sheets and an Arteriovenous Vascular Bundle
Fujisawa, Daisuke; Sekine, Hidekazu; Okano, Teruo; Sakurai, Hiroyuki
Background: Recently, research on tissue-engineered skin substitutes have been active in plastic surgery, and significant development has been made in this area over the past several decades. However, a regenerative skin flap has not been developed that could provide immediate blood flow after transplantation. Here, we make a regenerative skin flap ex vivo that is potentially suitable for microsurgical transplantation in future clinical applications. Methods: In rats, for preparing a stable vascular carrier, a femoral vascular pedicle was sandwiched between collagen sponges and inserted into a porous chamber in the abdomen. The vascular bed was harvested 3 weeks later, and extracorporeal perfusion was performed. A green fluorescent protein positive epidermal cell sheet was placed on the vascular bed. After perfusion culture, the whole construct was harvested and fixed for morphological analyses. Results: After approximately 10 days perfusion, the epidermal cell sheet cornified sufficiently. The desquamated corneum was positive for filaggrin. The basement membrane protein laminin 332 and type 4 collagen were deposited on the interface area between the vascular bed and the epidermal cell sheet. Moreover, an electron microscopic image showed anchoring junctions and keratohyalin granules. These results show that we were able to produce native-like skin. Conclusions: We have succeeded in creating regenerative skin flap ex vivo that is similar to native skin, and this technique could be applied to create various tissues in the future. PMID:26180725
Using a Distant Abdominal Skin Flap to Treat Digital Constriction Bands
Zhang, Mingzi; Song, Kexin; Ding, Ning; Shu, Chang; Wang, Youbin
Abstract In this study, a Vohwinkel syndrome case is presented where in 5th digit constriction bands in the right hand were reconstructed using a distant abdominal skin flap. Vohwinkel syndrome, or keratoderma hereditarium mutilans, is a rare, autosomal dominant genetic skin condition that causes palmoplantar hyperkeratosis and constricts finger and/or toe bands. In a typical manifestation, the finger and toe constriction bands lead to progressive strangulation and autoamputation, which requires immediate clinical treatment. Topical keratolytics and systemic retinoids have been used to treat hyperkeratosis but without consistent results. Only 1 effective approach for autoamputation has been accepted, reconstructive surgery. Applying a distant abdominal skin flap produced satisfying postoperative effects at the 18-month follow-up. PMID:26871826
Designing Flaps for Closure of Circular and Semicircular Skin Defects
Summary: Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved. PMID:27104106
SU-E-T-560: Commissioning An HDR Freiburg Flap Applicator for Skin Lesion Treatment
Dou, K; Li, B; Lerma, F; Aroumougame, V; Sarfaraz, M; Laser, B; Jacobs, M
Purpose: Flexible Freiburg flap used with high dose rate afterloaders is easy to cut into any size for any body site and to dwell with a precise source position, conforms to curved skin surface and then to the planned target. However, unlike intracavity or interstitial situations, incomplete scatter environment due to flap applicators exposed to air might lead to dose difference between the delivered and planned. This research is focused on the dose deviation of incomplete scatter versus full scatter. Methods: A 12x12 cm of Freiburg flap applicator was used for the validation. A Nucletron Oncentra Brachy Ver. 4.3 treatment planning system (TPS) was used for treatment planning. However, no heterogeneity correction incorporated into the brachytherap TPS needs to be considered. A Philips Brilliance CT Big Bore was employed for CT scan. Radiation was delivered using a Nucletron HDR remote afterloader system. A 10cm bolus was used to cover the flap for obtaining a full scatter. An OSL, ion chamber, and Gafchromic EBT2 film were used for commissioning the flap applicator. Results: The applicator calibration at 5mm depth was performed using an OSL dosimeter. Applicator source dwelling positions with 1D and 2D array exposed to and recorded by Gafchromic EBT2 film showed an agreement within 1mm. 1D array of Freiburg flap exhibited 4.2% cooler in dose with incomplete scatter than full scatter. 2D array showed 7.1% lower in dose for incomplete scatter than full scatter. The deviation was found more than 10% beyond 8cm in depth. Conclusion: Significant dose deviation caused by the incomplete scatter environment was found to be 7.1% at 1cm depth. This deviation was increased with increasing depth. The inaccuracy resulted from the incomplete scatter can be fixed by either placing a bolus on the top of the flap or making the plan at least 7% hotter.
Modified Byars' flaps for securing skin closure in proximal and mid-penile hypospadias
Objective: The objective of this study was to describe a modification for skin closure combined with tubularized incised plate (TIP) urethroplasty in the repair of proximal and mid-penile hypospadias. Patients and methods: The study included 47 patients with nondistal hypospadias who underwent a primary TIP procedure from September 2007 to May 2010. Meatal position was mid-shaft (n = 20), penoscrotal (n = 20), and scrotal (n = 7). The patients in the study were divided into two groups according to a modification in the technique of skin closure, which involved incising the prepuce vertically into two halves, then harvesting the dartos flap for covering the repair from one half, leaving the other preputial half to reconstruct the ventral skin without compromising its blood supply. Results: In the standard procedure (n = 19 patients), complications included glanular dehiscence (10.5%), glanular fistula (5%), urethrocutaneous fistula (10.5%), and skin complications (21%). In the modified procedure (n = 28 patients), complications included glanular dehiscence (7%) and glanular fistula (3.6%), but no skin complications or urethrocutaneous fistulae occurred. Conclusion: The modified Byars' flaps is a useful alternative for skin closure during proximal and mid-shaft TIP urethroplasty, with fewer complications and acceptable cosmetic outcome. PMID:22164194
Survival of the fastest: Evolving wings for flapping flight
NASA Astrophysics Data System (ADS)
Ramananarivo, Sophie; Mitchel, Thomas; Ristroph, Leif
To optimize flapping flight with regard to wing shape, we use an evolutionary or genetic algorithm to improve the forward speed of 3d-printed wings or hydrofoils that heave up-and-down and self-propel within water. In this scheme, ``genes'' are mathematical parameters specifying wing shape, and ``breeding'' involves the merging and mutation of genes from two parent wings to form a child. A wing's swimming speed is its ``fitness'', which dictates the likelihood of breeding and thus passing on its genes to the next generation. We find that this iterative process leads to marked improvements in relatively few generations, and several distinct shape features are shared among the fastest wings. We also investigate the favorable flow structures produced by these elite swimmers and compare their shape and performance to biologically evolved wings, fins, tails, and flippers.
Hyperbaric oxygen preconditioning promotes neovascularization of transplanted skin flaps in rats
Liu, Xuehua; Yang, Jing; Li, Zhuo; Yang, Lin; Wang, Cong; Gao, Chunjin; Liang, Fang
To determine whether Hyperbaric oxygen preconditioning (HBO-PC) promotes neovascularization by increasing Stromal cell derived factor-1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) in transplanted skin flaps of rats. The epigastric pedicle skin flap was established in a rat model. Rats were randomly assigned to the following five groups: 1) sham-operated group (SH); 2) ischemia followed by reperfusion 3 days postoperatively group (IR3d); 3) ischemia followed by reperfusion 5 days postoperatively group (IR5d); 4) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 3 days postoperatively group (HBO-PC3d); and 5) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 5 days postoperatively group(HBO-PC5d). For the groups receiving HBO-PC, animals underwent 1 hour of HBO at 2.0 ATA in 100% O2 twice per day for 3 days consecutively prior to surgery. After perfusion, Laser Doppler perfusion imaging (LDPI) was performed, and skin flap tissue samples were harvested for histological evaluation and western blot analysis. Perfusion was significantly improved in the HBO-PC groups compared with the IR groups on postoperative 3 and 5. Microvessel density (MVD) was significantly increased by HBO-PC compared with IR groups postoperatively. Western blot analysis revealed that SDF-1 and CXCR4 expression in the HBO-PC groups was significantly increased compared with IR groups. HBO-PC promoted neovascularization via increasing expression levels of SDF-1 and CXCR4 in transplanted skin flaps of rats. PMID:25197344
Modified osteomyocutaneous iliac crest flaps transplantation.
Liu, Jun; Song, Dajiang; Li, Jinsong; Xu, Jian; Lv, Hongbin
The paper aims to improve the operative technique of osteomyocutaneous iliac crest flap harvesting, further minimise morbidity of donor site, and improve the effect of recipient site reconstruction. From March 2005 to March 2011, 55 cases of osteomyocutaneous iliac crest flap harvested by different methods were performed to reconstruct the defects of the extremities. Twenty-nine cases were reconstructed with a traditional deep circumflex iliac artery osteomusculocutaneous flap. Twenty-six cases were repaired with modified osteomyocutaneous iliac crest flaps. In 29 cases with a traditional DCIA osteomusculocutaneous flap, two cases showed the injured lateral femoral cutaneous nerve. Flapnecrosis was significant in two cases. Arterial compromise occurred in one case 5 days after operation completion and led to flap failure. Three flaps developed postoperative venous congestion, but only one flap received re-exploration. In the other two cases, some stitches were removed for decompression. All three flaps survived. In two cases, marginal flap necrosis occurred, but no secondary skin grafting was required. In 26 cases with modified flap transplantation, one case showed the injured lateral femoral cutaneous nerve. All flaps survived totally. Osseous integration was achieved in all 55 cases in 3 ∼ 9 months after operation. The modified osteomyocutaneous iliac crest flap technique enhances flap safety, provides the additional advantages of reducing donor-site morbidity, and improves the recipient-site contour. PMID:25001367
The effects of botulinum toxin A on survival of rat TRAM flap with vertical midline scar.
Park, Tae Hwan; Rah, Dong Kyun; Chong, Yosep; Kim, June-kyu
The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used in various reconstructive surgeries. Recently, there have been reports regarding the positive effect of botulinum toxin A (BoTA) on flap survival. We hypothesized that pretreatment with BoTA could augment the survival of pedicled TRAM flaps with a vertical midline scar. Twenty-four Sprague-Dawley rats were randomly divided into 2 groups, namely, control group and BoTA group. Five days after a vertical midline incision, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Ten days after the initial incision, the TRAM flap was harvested. We evaluated the gross flap survival and analyzed the overall histologic change, lumen area of pedicle, and microvessel density with immunohistochemistry. Reverse transcription polymerase chain reaction was performed for the evaluation of angiogenesis-related factors. In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral and contralateral sides (P < 0.001). In the BoTA group, a significant increase in pedicle lumen area was observed (P < 0.001). In the control group, mild to moderate epidermal necrosis was seen; microvessels were relatively small compared with those of the BoTA group. According to immunohistochemistry, the number of CD31 positively stained vessels was significantly higher on the contralateral side in the control group compared to that in the BoTA group (P < 0.001). The relative messenger RNA (mRNA) expression of CD31 was significantly lower in the BoTA group than that in the control group on both ipsilateral and contralateral sides (P < 0.001). Meanwhile, the relative mRNA expression of VEGF was significantly higher in the BoTA group than in the control group on both ipsilateral and contralateral sides (P < 0.001).We believe that preoperative BoTA therapy is a feasible method to improve circulation of the rat TRAM flap
Ulnar Para-metacarpal Flap for Recurrence of Dupuytren's Disease with Skin Ulcer: A Case Report
SUGIYAMA, Yoichi; NAITO, Kiyohito; IGETA, Yuka; KANEKO, Kazuo; OBAYASHI, Osamu
Introduction: In a patient with recurrent Dupuytren's disease, we performed dermofasciectomy including the diseased skin and soft tissue, and covered the soft tissue defect using an ulnar parametacarpal flap. Case Report: A 65-year-old man had undergone invasive aponeurectomy for Dupuytren's contracture of the right 5th finger 3 years before, but showed recurrence about 1 year after surgery. Since a skin ulcer was noted at the site of recurrence, dermofasciectomy including the scarred skin was performed on the palmar side of the 5th finger, and the skin defect was covered with an ulnar parametacarpal flap. No recurrence has been noted for the 6 months since the surgery. Conclusion: The ulnar parametacarpal flap, in which the vascular pedicle is easy to identify, is useful for covering a skin defect on the palmar side of the 5th finger if used as an island flap. However, a disadvantage of this flap is that it is likely to develop congestion due to poor venous return. PMID:27299006
4-Phenylbutyrate protects rat skin flaps against ischemia-reperfusion injury and apoptosis by inhibiting endoplasmic reticulum stress
4-phenylbutyrate (4-PBA) is a low molecular weight fatty acid, which has been demonstrated to regulate endoplasmic reticulum (ER) stress. ER stress-induced cell apoptosis has an important role in skin flap ischemia; however, a pharmacological approach for treating ischemia-induced ER dysfunction has yet to be reported. In the present study, the effects of 4-PBA-induced ER stress inhibition on ischemia-reperfusion injury were investigated in the skin flap of rats, and transcriptional regulation was examined. 4-PBA attenuated ischemia-reperfusion injury and inhibited cell apoptosis in the skin flap. Furthermore, 4-PBA reversed the increased expression levels of two ER stress markers: CCAAT/enhancer-binding protein-homologous protein and glucose-regulated protein 78. These results suggested that 4-PBA was able to protect rat skin flaps against ischemia-reperfusion injury and apoptosis by inhibiting ER stress marker expression and ER stress-mediated apoptosis. The beneficial effects of 4-PBA may prove useful in the treatment of skin flap ischemia-reperfusion injury. PMID:26648447
Clinical outcomes of suture delay in forehead flap.
Isik, Daghan; Kiroglu, Faruk; Isik, Yasemin; Goktas, Ugur; Atik, Bekir
The delay phenomenon is a surgical procedure performed to raise a wider skin flap and to improve the survival of skin flaps. Surgery, chemicals, sutures, and lasers can be used for the delay procedure. In this study, delayed forehead flaps created by suturing were used for coverage of nasal skin defects in eleven patients. In 7 patients, the cross-paramedian forehead flap was used to increase the extent of flap lengthening. In the first session, suture delay was performed on both sides of the forehead flap margin. In the second session, the flap was elevated and sutured to its new position, 7 to 10 days after the initial surgery. All flaps were completely viable, and patient satisfaction was optimal in all cases. The positive effect of surgical delay on flap survival has been shown in experimental and clinical studies. However, experimentally, suture delay or chemical delay procedures have been shown to be beneficial in flap survival only. Suture delay seems to be an inexpensive, effective, easily performed, atraumatic, and safe technique, especially among patients with systemic diseases such as diabetes or cardiovascular diseases, smoking patients who may lose the flap, or patients who need very wide and long flaps. PMID:22337378
Long-term survival after chest-wall reconstruction with musculocutaneous flaps
Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. )
Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures.
Off-Pump CABG in a Patient with Laryngectomy and Permanent Tracheostomy Utilizing Low Midline Skin Incision with Transverse Skin Flaps and Manubrium Sparing Sternotomy.
Freeland, Kristofer T; Davies, James E
Patients that have undergone previous laryngectomy with permanent stoma placement are at increased risk of wound infection, mediastinitis, and tracheal injury when undergoing coronary artery bypass grafting (CABG) via standard skin incision and sternotomy. We present a case of off-pump CABG via a low midline skin incision with transverse skin flaps and a manubrium sparing sternotomy. doi: 10.1111/jocs.12771 (J Card Surg 2016;31:439-440). PMID:27246671
[Scapular/parascapular double skin-paddle free flap for transfixing blast injuries of the hand. A case report].
Colson, T; Pozetto, M; Gibert, N; Dautel, G
Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction. PMID:24268067
Clinical experience of multiple flaps for the reconstruction of dorsal digital defects
Jiao, Hongsheng; Ding, Xiaoheng; Liu, Yujie; Zhang, Hongxun; Cao, Xuecheng
Objective: In this report, we present our experience with reconstruction of the skin defects on the dorsum of the digits using multiple flaps. Methods: Between November 2010 and March 2013, 45 patients with dorsal digital defects underwent reconstruction using homodigital dorsal digital fasciocutaneous flap (n = 17), heterodigital dorsal digital fasciocutaneous flap (n = 14), dorsal metacarpal artery fasciocutaneous flap (n = 8) and free venous flaps (n = 6). The average flap size was 1.5 × 1.5 cm to 2.0 × 2.5 cm. Donor sites were covered with full-thickness skin graft. Results: All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 18 weeks. During the follow up period, 7 patients treated with reverse homodigital fasciocutaneous flaps developed swelling in the distal portion of flaps, 3 patients treated with reverse dorsal metacarpal artery fasciocutaneous flaps developed mild swelling in the distal portion of flaps but survive well, and 4 patients treated with free venous flaps experienced venous congestion. Of the 14 patients treated with heterodigital fasciocutaneous flaps, there were 11 cases with a retrograde pedicle and 3 cases with a direct pedicle. No full-thickness graft necrosis was noted. Conclusion: Multiple options are available for the repair of skin defects on the dorsum of the digits. Besides, the use of a heterodigital fasciocutaneous flap was a simple, safe, and less invasive regimen for repairing dorsal digital skin defects. PMID:26770401
Morphological study of rat skin flaps treated with subcutaneous dimethyl sulfoxide combined with hyperbaric oxygen therapy.
Almeida, K G; Oliveira, R J; Dourado, D M; Filho, E A; Fernandes, W S; Souza, A S; Araújo, F H S
This study investigated the effects of hyperbaric oxygen therapy (HBOT) and dimethyl sulfoxide (DMSO) in tissue necrosis, genotoxicity, and cell apoptosis. Random skin flaps were made in 50 male Wistar rats, randomly divided into the following groups. Control group (CT), wherein a rectangular skin section (2 x 8 cm) was dissected from the dorsal muscle layer, preserving the cranial vessels, lifted, and refixed to the bed; distilled water (DW) group, in which DW was injected into the distal half of the skin flap; DMSO group, wherein 5% DMSO was injected; HBOT group, comprising animals treated only with HBOT; and HBOT + DMSO group, comprising animals treated with 100% oxygen at 2.5 atmospheres absolute for 1 h, 2 h after the experiment, daily for 10 consecutive days. A skinflap specimen investigated by microscopy. The percentage of necrosis was not significantly different between groups. The cell viability index was significantly different between groups (P < 0.001): 87.40% (CT), 86.20% (DW), 84.60% (DMSO), 86.60% (DMSO + HBO), and 91% (HBO) (P < 0.001), as was the cell apoptosis index of 12.60 (CT), 12.00 (DW), 15.40 (DMSO), 9.00 (HBO), and 12.00 (DMSO + HBO) (P < 0.001). The genotoxicity test revealed the percentage of cells with DNA damage to be 22.80 (CT), 22.60 (DW), 26.00 (DMSO), 8.80 (DMSO + HBO), and 7.20 (HBO) (P < 0.001). Although the necrotic area was not different between groups, there was a significant reduction in the cellular DNA damage and apoptosis index in the HBOT group. PMID:26782463
Extended thoracodorsal artery perforator flap for breast reconstruction.
Angrigiani, Claudio; Rancati, Alberto; Escudero, Ezequiel; Artero, Guillermo
A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction. PMID:26645006
Using a Distant Abdominal Skin Flap to Treat Digital Constriction Bands: A Case Report for Vohwinkel Syndrome.
Zhang, Mingzi; Song, Kexin; Ding, Ning; Shu, Chang; Wang, Youbin
In this study, a Vohwinkel syndrome case is presented where in 5th digit constriction bands in the right hand were reconstructed using a distant abdominal skin flap. Vohwinkel syndrome, or keratoderma hereditarium mutilans, is a rare, autosomal dominant genetic skin condition that causes palmoplantar hyperkeratosis and constricts finger and/or toe bands. In a typical manifestation, the finger and toe constriction bands lead to progressive strangulation and autoamputation, which requires immediate clinical treatment. Topical keratolytics and systemic retinoids have been used to treat hyperkeratosis but without consistent results. Only 1 effective approach for autoamputation has been accepted, reconstructive surgery.Applying a distant abdominal skin flap produced satisfying postoperative effects at the 18-month follow-up. PMID:26871826
Reconstruction with cutaneous flap after resection for breast cancer's skin metastases in a chemoresistant patient.
Varricchio, Antonio; Di Libero, Lorenzo; Iannace, Carlo
We reported a case of a breast cancer's skin metastases in a patient that had sustained 3 lines of chemotherapy. At first she received surgical treatment with Madden's mastectomy with dissection of axillary limphnodes and positioning of an expander. After that she underwent to chemo- and radiotherapy. The schedules we performed were: FEC, TC,Vinorelbine and Capecitabine. Only after the FEC there was a clinical remission just for 1 year. After that she underwent to surgery for the removal of a lozenge of skin on the right hemithorax, including also the subcutaneous tissue, a strip of muscular tissue, and a residue of the breast implant. The histology showed a multiple-nodules infiltration involving the dermis, the hypodermis, and the muscle. This pattern was valuated as a G3 breast cancer recurrence with ER 70%, PgR<5%, Ki67 50% Her2neu-. During the second line chemotherapy with TC she developed an high grade LCIS with lymphovascular infiltration on the left breast; on the right hemithorax there were cutaneous metastases with dermis' infiltration. Surgery with local excision was performed, and a cutaneous flap was realized. PMID:23685463
The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction
Mat Saad, A. Z.; Khoo, T. L.; Dorai, A. A.; Halim, A. S.
Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome. PMID:19881027
Leavens, Teresa L.; Monteiro-Riviere, Nancy A.; Inman, Alfred O.; Brooks, James D.; Oldenburg, Steven J.; Riviere, Jim E.
Nanomaterials increasingly are playing a role in society for uses ranging from biomedicine to microelectronics; however pharmacokinetic studies, which will be necessary for human health risk assessments, are limited. Currently the most widely used nanoparticle in consumer products is silver (Ag). The objective of this study was to quantify the local biodistribution of two types of Ag nanoparticles, Ag-citrate and Ag-silica, in the isolated perfused porcine skin flap (IPPSF). IPPSFs were perfused for 4 h with 0.84 μg/ml Ag-citrate or 0.48 μg/ml Ag-silica followed by a 4-h perfusion with media only during a washout phase. Arterial and venous concentrations of Ag were measured in the media by ICP-OES. Venous concentrations of Ag for both types of nanoparticles were best fit with a two compartment model. The normalized volumes of distribution estimated from the noncompartmental analysis of the venous concentrations indicated distribution of Ag greater than the vascular space, however, because total Ag was measured, the extravascular distribution could be attributed to diffusion of Ag ions. The estimated clearance for both types of Ag nanoparticles was 1 ml/min, which was equal to the flap perfusion rate, indicating no detectable elimination of Ag from the system. By 4 hrs following infusion of the Ag nanoparticles, the recovery of Ag in the venous effluent was 90 ± 5.0% and 87 ± 22 % of the infused Ag for Ag-citrate and Ag-silica, respectively. PMID:22760951
Davis flap: the glory still present
El-Sabbagh, Ahmed Hassan
Background: Upper third defects of the ear are too large to be closed primarily without distorting the auricle. Full thickness defects can be reconstructed with local flaps. In this article, Davis flap was used to fill the upper third defects of the ear with some modifications. Patients and methods: Eight patients underwent reconstruction of full thickness auricular defects with Davis flaps from July 2012 to December 2014. The posterior surface of the flap and the raw area of conchal area were covered by full thickness graft taken from posterior surface of ear. Results: All flaps survived. No congestion was noted. The donor sites and skin grafts healed uneventfully. Conclusion: Davis flap is a simple and reproducible tool for reconstruction of upper third of ear. PMID:27274439
[Therapeutic evaluation of the polylactic acid gel (PLA-G) used for preventing skin flap adhesion in modified radical mastectomy].
Chen, Guojing; Liu, Tao
The present preliminary study was to observe the feasibility of the use of polylactic acid gel (PLA-G) in modified radical mastectomy and the ability of the PLA-G in the prevention of flap adhesion after operation. Sixty-eight patients were diagnosed with breast cancer, and received modified radical mastectomy from Jan. 2004 to Dec. 2006. The patients were divided randomly into a treatment group and a control group (with 34 cases each). The PLA-G was used under the surface of the auxiliary operative wound in the treatment group, and nothing was used in the control group. The wound healing, the wound complication, the amount of drainage solution, the indwelling time of the drainage tube and the auxiliary skin adhesion were evaluated after operation in both groups. There were no statistical difference on wound healing between the first intension (29:27) and the second intention (5:7), and the wound dehiscence after taking the stitches out (0:0) between the two intensions, the hematoma (0:1) and the effusion of the wound (5:6), and the flap necrosis (1:2) between two groups. There were also no statistical difference on the amount of drainage solution per day (6 +/- 3) and indwelling time of the drainage tube (6 +/- 4) after operation between the two groups (P > 0.5). After the operation, the case load with no flap adhesion in the treatment group was significant higher compared with the control group (22:8). The case load with complete acquired skin flap adhesion in the treatment group was visibly lower than in the control group (3:19), which proved that there was a significant statistical difference between the two groups (P < 0.05). This study suggested that the using of PLA-G in the breast cancer modified radical mastectomy could prevent skin flap adhesion without any harmful effects in the wound healing. PMID:24645611
Clinical Efficacy of a Modified Nagata Method That Retains the Fascia Pedicle of the Mastoid Skin Flap in Auricular Reconstruction of Chinese Microtia Patients.
Wang, Wang-Shu; Yan, Dong-Mei; Chen, Jun-Yang; Zhang, Duo; Shao, Ying; Peng, Wei-Hai
The purpose of this study was to search for an enhanced blood supply in the distal edge of the skin at the mastoid area in total auricular reconstruction. The authors modified the Nagata method by reserving a subcutaneous fascia pedicle (diameter, 3 to 5 mm) at the intersection of the point 11 to 13 mm from the residual ear tragus (or tragus projection) and 8 to 10 mm from the lowest point of the residual ear lobe. Compared with the traditional Nagata method group, the modified Nagata method group that retained the fascia pedicle of the mastoid skin flap had higher rates of excellent and good flaps (p < 0.05). Auricular reconstruction with the modified Nagata method, retaining the fascia pedicle of the mastoid skin flap, had a reduced incidence of skin flap necrosis. PMID:26910682
[A Patient with Sinking Skin Flap Syndrome who Underwent Perfusion MRI before and after Cranioplasty].
Kato, Akihito; Morishima, Hiroyuki; Nagashima, Goro
Background:Sinking skin flap syndrome(SSFS)manifests as subjective symptoms, such as headache, dizziness, and undue fatigability, in addition to neurologic symptoms, such as hemiplegia, aphasia, and perceived failure, when the skin over a bone defect sinks in the weeks or months following a decompressive craniectomy. Indeed, these symptoms can improve after a cranioplasty. Case presentation:A 58-year-old woman presented with a disturbance of consciousness. She was found to have a subarachnoid hemorrhage due to a ruptured right middle cerebral artery aneurysm. She underwent a craniotomy with clipping of the affected artery and a decompressive craniectomy on the same day. Post-operatively, the disturbance of consciousness improved, but the left-sided paralysis persisted. She complained of intractable headaches, was disoriented, and a lack of spontaneity emerged as the skin over the bone defect sank. She underwent cranioplasty on the 43rd day after admission, and the symptoms resolved promptly after surgery. Rehabilitation was canceled at the onset of symptoms, but resumed after the symptoms improved. Based on perfusion MRI, the cerebral blood flow(CBF):cerebral blood volume(CBV)ratio of the affected side increased before and after surgery compared with the healthy side. A lumboperitoneal shunt was placed on the 52nd day after admission to manage the hydrocephalus. She was discharged from the hospital with higher brain dysfunction and a mild state of paralysis. Conclusion:The timing of cranioplasty in patients with SSFS has not yet been established, but surgery should be performed before symptoms appear because SSFS impairs rehabilitative efforts. PMID:27605477
Skin self-examination and long-term melanoma survival.
Paddock, Lisa E; Lu, Shou En; Bandera, Elisa V; Rhoads, George G; Fine, Judith; Paine, Susan; Barnhill, Raymond; Berwick, Marianne
To evaluate the effect of skin self-examination (SSE) on melanoma mortality, we estimated the survival for individuals performing SSE compared with those who did not. Participants were from a previously carried out case-control study, who were newly diagnosed melanoma cases in 1987-1989. A 20-year survival analysis was carried out using death (event) and other causes of death (competing). Cumulative incidence functions were evaluated using Gray's test and proportional subdistribution hazards regression models were fitted to study the effect of SSE and other covariates on melanoma survival. Forty-five percent of patients died, with 48.4% melanoma deaths. Individuals who did not perform SSE experienced a continuous increase in the risk of melanoma death trending toward significance for nearly 20 years after diagnosis, whereas melanoma deaths in skin self-examiners plateaued before 10 years after diagnosis (P=0.32). Univariate analyses suggested a 25% lower risk of melanoma death for those who performed SSE [hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.43-1.32, P=0.32]. After adjusting for competing risks, the multivariate risk estimate was above one (HR=1.12, 95% CI=0.61-2.06, P=0.71). Skin awareness (HR=0.46, 95% CI=0.28-0.75, P≤0.01) was associated independently with a decreased risk of melanoma death. Although we did not find a significant association between melanoma mortality and SSE when adjusting for competing mortality and other covariates, we extended previous findings that increased skin awareness and tumor thickness are strongly inversely related to survival. Research is needed to continue developing best practices for melanoma screening and to further explore the components of SSE and long-term melanoma survival. PMID:26990272
Functional and esthetic assessment of radial forearm flap donor site repaired with split thickness skin graft.
Lee, Jong-Ho; Alrashdan, Mohammad S; Kim, Su-Gon; Rim, Jae-Seok; Jabaiti, Samir; Kim, Myung-Jin; Kim, Soung-Min
The purpose of this study was to evaluate the long-term functional and esthetic outcomes of radial forearm flap (RFF) donor site repaired with split thickness skin graft (STSG). Nineteen patients underwent surgical reconstruction of oro-facial defects by the use of RFF and their donor sites were reconstructed with STSG. The patients were followed up at least for 12 months postoperatively and the left hand was the non-dominant hand in all of them. Objective methods including pinch strength, grip strength, range of motion, current perception threshold (CPT) and two-point discrimination, and subjective methods including patients interview, visual analogue score (VAS) about function, sensitivity, pain and color match, were collectively employed for donor site assessment. Our data revealed some degree of reduction in motor function and sensation compared to the non-donor hand. The difference of pinch strength means was 9.81% and of the grip strength was 12.6%. The difference of wrist flexion means was 17.6% and of wrist extension was 13.4%. However, none of the patients had functional defects of forearm supination and pronation, wrist ulnar deviation or wrist radial deviation. Subjective evaluation showed that the donor site repaired with STSG was well accepted by the patients particularly from a functional point of view. These results demonstrate that STSG represents a favorable choice for RFF donor site repair. PMID:20589506
Profunda artery perforator based V-Y rotation advancement flap for total vulvectomy defect reconstruction--A case report and literature review.
Chen, Yen-Chou; Scaglioni, Mario F; Kuo, Yur-Ren
Reconstruction of total vulvectomy defect represents a challenge, and reconstructive methods include skin graft, local skin flap, musculocutanous flap, and pedicled perforator flap. We report a case of a 63-year-old patient affected by extramammary Paget's disease of vulva who underwent total vulvectomy receiving reconstruction with bilateral profunda artery perforator based V-Y rotation advancement flap. The literature about vulva reconstruction was reviewed. This innovative flap design combined the classic rotation flap and V-Y advancement flap with inclusion of the profunda artery perforators to augment the flap blood supply. Besides, the internal pudendal nerve was preserved to maintain the sensation of the neo-uvula. The flap survived completely without major post-operative complications with 9-months follow-up. Profunda artery perforator based V-Y rotation advancement flap may represent a valuable option in total vulvectomy defect reconstruction. PMID:26402576
Canine lateral thoracic fasciocutaneous flap: an experimental study.
Trinh, Cao Minh; Hoàng, Văn Lu'o'ng; Pham, Thi Ngoc; Hoàng, Manh An
For the purpose of reconstructive surgery training and research, we have developed a new skin flap model: canine lateral thoracic fasciocutaneous flap. Anatomical study found that the lateral thoracic arteries in dogs have similar anatomical characteristics to human's ones. Based on these vessels, if a skin flap was designed within the vessels territory (size 5 x 8 cm) it could survive completely, whereas, if designed beyond the vessels territory (size 5 x 14 cm) would result in partial necrosis of the flap. This fasciocutaneous flap model closely simulates the human surgery and could be valuable for training and research. Furthermore, this flap could be applied in the veterinary practice for reconstruction of canine forelimbs and cervical area. PMID:19638323
The Vasodilator Effect of a Cream Containing 10% Menthol and 15% Methyl Salicylate on Random-Pattern Skin Flaps in Rats
Dölen, Utku Can; Sungur, Nezih; Koca, Gökhan; Ertunç, Onur; Bağcı Bosi, Ayşe Tülay; Koçer, Uğur
Background It is still difficult to prevent partial or full-thickness flap necrosis. In this study, the effects of a cream containing menthol and methyl salicylate on the viability of randompattern skin flaps were studied. Methods Forty female Sprague-Dawley rats were divided into two equal groups. Caudally based dorsal random-pattern skin flaps were elevated, including the panniculus carnosus. In the study group, 1.5 mL of a cream containing menthol and methyl salicylate was applied to the skin of the flap, and saline solution (0.9%) was used in the control group. Upon completion of the experiment, flap necrosis was analyzed with imaging software and radionuclide scintigraphy. Histopathological measurements were made of the percentage of viable flaps, the number of vessels, and the width of the panniculus carnosus muscle. Results According to the photographic analysis, the mean viable flap surface area in the study group was larger than that in the control group (P=0.004). According to the scintigrams, no change in radioactivity uptake was seen in the study group (P>0.05). However, a significant decrease was observed in the control group (P=0.006). No statistically significant differences were observed between the groups in terms of the percentage of viable flaps, the number of vessels, or the width of the panniculus carnosus muscle (P>0.05). Conclusions Based on these results, it is certain that the cream did not reduce the viability of the flaps. Due to its vasodilatory effect, it can be used as a component of the dressing in reconstructive operations where skin perfusion is compromised. PMID:26618115
Aesthetic reconstruction of a defect in the skin of the upper lip using a hatchet flap.
Kuwahara, Masamitsu; Yurugi, Satoshi; Mashiba, Kumi; Iioka, Hiroshi; Niitsuma, Katsunori; Noda, Taichi; Manago, Eri
Reconstruction of the upper lip requires symmetrical reconstruction of the free border according to the aesthetic principle. We have reconstructed this area with a hatchet flap, so that the scars match the subunit line as far as possible by rotation and advancement of the flap. We operated on six patients. The lower pedicled flap was used in 4 cases and the upper pedicled flap in 2, who also needed reconstruction of the vermillion. In one patient the scar did not match the nasolabial fold. For the upper pedicled cases, scars made on the vermillion were not conspicuous. However, trap door deformity occurred in half, which was a disadvantage. We think that our flap is useful, because it leaves a minimal scar in an inconspicuous area. PMID:22471254
Coverage of Amputation Stumps Using a Latissimus Dorsi Flap With a Serratus Anterior Muscle Flap: A Comparative Study.
Kim, Sang Wha; Jeon, Seung Bae; Hwang, Kyu Tae; Kim, Youn Hwan
Amputation of the extremities is a definitive reconstructive option, and surgeons should aim to preserve maximum overall function. If the exposed bone cannot be adequately covered using local tissues, the stump can be reconstructed using a number of well-described free flap transfer techniques. Between January 2002 and December 2011, 31 patients with severe injuries to the lower extremities underwent above-the-knee, below-the-knee, and Chopart and Ray amputations. Bony stumps were covered using latissimus dorsi myocutaneous flaps alone (group 1), or together with serratus anterior muscle flaps (group 2). The groups were compared with respect to age, flap survival, skin flap size, immediate complications, wound sloughing, deep ulceration, need for bone amputation, limb visual analog scale score, time to prosthesis, and follow-up duration. The mean area of the latissimus dorsi skin flap was 255.9 cm, and immediate complications occurred in 8 (25.8%) patients. In the double-padding group, there were fewer cases of deep ulceration than in the single-flap group, and prostheses could be worn sooner. There were no statistically significant differences in other parameters. Successful reconstruction of amputation stumps requires an adequate, durable, weight-bearing, and well-contoured soft tissue cover. A latissimus dorsi musculocutaneous flap together with a serratus anterior muscle flap provides well-vascularized muscle tissue and a durable skin paddle, leading to less ulceration than conventional flap techniques. PMID:25003415
Pectoralis myocutaneous flap for salvage of necrotic wounds
Price, J.C.; Davis, R.K.; Koltai, P.J.
The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. The authors conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.
Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: experience in 13 cases.
Minami, A; Ogino, T; Itoga, H
We have carried out 13 vascularized iliac osteocutaneous flaps (VIOF) based on the deep circumflex artery (DCIA) and accompanying veins for cases with compound skin and bone defects. Ten of 13 cases obtained bony union at both ends of the iliac crest with only VIOF. Two of the remaining 3 cases obtained bony union at one end only with the VIOF but united at another end with an additional conventional bone grafting procedure. The final case, a traumatic bone defect of the tibia, failed to obtain bony union at either end of the iliac segment. In 5 of 11 patients in which an osteocutaneous flap was used, complete skin flap survival occurred. Of the remaining 6, one flap went on to complete necrosis, and five flaps were complicated by superficial or partial necrosis. The incidence of flap complications was analysed according to the size of flap. Five flaps with complete survival averaged 6.8 x 10.6 cm in size; however, five flaps with superficial or partial necrosis averaged 10.0 x 15.8 cm. These results suggest that the maximal safe skin flap dimension from the DCIA supply alone is probably 10 x 15 cm. PMID:2671586
Locoregional use of lateral thoracic artery perforator flap as a propeller flap.
Baghaki, Semih; Cevirme, Mirza; Diyarbakirli, Murat; Tatar, Cihad; Aydin, Yagmur
Although thoracodorsal system is a fundamental source of various flaps, lateral thoracic region has not been a popular flap donor area. There is limited data on the use of lateral intercostal artery perforator flap and lateral thoracic artery perforator flap. In this case series, lateral thoracic artery perforator flap has been used in locoregional (axilla, pectoral region, and arm) reconstruction as an island or propeller flap.Eighteen patients have been operated on between September 2010 and January 2013. The age of the patients ranged between 16 and 68 years with a median of 38 years. A thorough chart review has been performed with preoperative and postoperative photographs. Duration of hospitalization, complication rate and long term results have been documented.Nine patients had severe burn contracture of axilla, 7 patients had axillary hidradenitis suppurativa, 1 patient had giant neurofibroma of arm, and 1 patient had malignant peripheral nerve sheath tumor of pectoral area. Seventeen flaps survived totally, and in 1 flap, distal superficial slough of skin has been observed. No recurrence in hidradenitis or peripheral nerve sheath tumor has been observed. Donor site scar is well hidden in anatomical position. The range of motion of affected extremities returned to normal after reconstruction.Lateral thoracic area provides a reliable flap option with a wide arc of rotation when lateral thoracic artery perforators are used. PMID:25875722
The role of pre-ischaemic application of the nitric oxide donor spermine/nitric oxide complex in enhancing flap survival in a rat model.
Küntscher, M V; Juran, S; Menke, H; Gebhard, M M; Erdmann, D; Germann, G
Spermine/nitric oxide complex (Sper/NO) is a new nitric oxide (NO) donor with a long half-life providing controlled biological release of NO in vivo. The purpose of this study was to determine whether flap survival could be improved by pre-ischaemic or post-ischaemic intravenous administration of Sper/NO. We divided 37 male Wistar rats into four experimental groups. An extended epigastric adipocutaneous flap was raised in each animal. The mean area of flap necrosis was assessed for all groups on the fifth postoperative day, using planimetry software. The average area of flap necrosis was mean +/- s.d. = 68.2%+/-18.1% in the control group, and 29.7% +/- 13.3% in the non-ischaemic controls. The group with pre-ischaemic application of Sper/NO demonstrated an average flap necrosis of mean+/-s.d. = 11.2%+/-5.9%, whereas this increased to 59.2%+/-14.4% in the group receiving Sper/NO 5 min prior to reperfusion. The group with pre-ischaemic application of Sper/NO showed a significantly lower area of flap necrosis than either of the control groups or the group receiving Sper/NO just prior to reperfusion (P < 0.05). The group receiving Sper/NO just prior to reperfusion demonstrated a significantly higher mean area of flap necrosis than the non-ischaemic controls (P < 0.05), but did not differ significantly from the control group. Our data show that pharmacological preconditioning and enhancement of flap survival can be achieved by intravenous administration of Sper/NO. The application of Sper/NO at the end of the ischaemia period or in the early reperfusion period provides no protection against ischaemia-reperfusion injury. PMID:12372374
[Falciform anemia and Plasmodium falciparum malaria: a threat to flap survival?].
Mariéthoz, S; Pittet, B; Loutan, L; Humbert, J; Montandon, D
Plasmodium falciparum malaria, a parasitic disease, and sickle cell anemia, a hereditary disease, are two diseases affecting erythrocyte cycle, occurring with a high prevalence in tropical Africa. They may induce microthrombosis inducing vaso-occlusion, organ dysfunction and flap necrosis. During the acute phase of Plasmodium falciparum malaria, destruction of parasitized and healthy erythrocytes, release of parasite and erythrocyte material into the circulation, and secondary host reaction occur. Plasmodium falciparum infected erythrocytes also sequester in the microcirculation of vital organs and may interfere with microcirculatory flow in the flap during the postoperative period. The lower legs of homozygous sickle cell anemia patients are areas of marginal vascularity where minor abrasions become foci of inflammation. Inflammation results in decreased local oxygen tension, sickling of erythrocytes, increased blood viscosity and thrombosis with consequent ischemia, tissue breakdown and leg ulcer. Tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg although flaps may become necrotic. The aim of this study is to analyse circumstances predisposing to surgical complications and to define preventive and therapeutic measures. A review of the literature will describe the current research and the new perspectives to treat sickle cell anemia, for example hydroxyurea and vasoactive substances (pentoxifylline, naftidrofuryl, buflomedil). PMID:10188298
Development of in vitro isolated perfused porcine skin flaps for study of percutaneous absorption of xenobiotics. Annual report, 30 September 1985-29 September 1986
Riviere, J.E.; Carver, M.P.; Monteiro-Riviere, N.A.; Bowman, K.F.
Interspecies comparisons of cutaneous anatomy and physiology suggest that the weanling pig is a suitable surrogate for human skin; however, very few investigations of percutaneous absorption phenomena have been conducted in pigs. This study examined the radiolabel excretion patterns after intravenous (IV) and topical administration of six /sup 14/C-labeled compounds in weanling Yorkshire sows. These data were required as a baseline to compare xenobiotic absorption in the isolated perfused procine skin flap (IPPSF) fully described in the first Annual Report (Riviere, J. E., Bowman, K. F., and Monteiro-Riviere, N. A., Development of In Vitro Isolated Perfused Porcine Skin Flaps for Study of Percutaneous Absorption of Xenobiotics, USAMRDC, DAMD17-84-C-4103, November 1, 1986).
Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.
Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Zhu, Shan; Ding, Qiang; Liu, Yuanbo
Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. Our purpose is to use various intercostal artery perforator propeller flaps for trunk oncologic reconstruction. Between November 2013 and July 2014, nine intercostal artery perforator propeller flaps were performed in seven patients to reconstruct the defects following sarcoma resection in different regions of the trunk, including the back, lumbar, chest, and abdomen. Two perforators from intercostal arteries were identified for each flap using Doppler ultrasound probe adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel. An elliptical flap was raised and rotated in a propeller fashion to repair the defects. There were one dorsal intercostal artery perforator flap, four dorsolateral intercostal artery perforator flaps, three lateral intercostal artery perforator flaps, and one anterior intercostal artery perforator flap. The mean skin paddle dimension was 9.38 cm in width (range 6-14 cm) and 21.22 cm in length (range 13-28 cm). All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps. PMID:25801799
Development of the isolated perfused porcine skin flap for in vitro studies of percutaneous absorption pharmacokinetics and cutaneous biotransformation
Carver, M.P.
The isolated perfused porcine skin flap (IPPSF) has proven to be a valuable in vitro tool for studying the physiology and biochemistry of skin and for identifying biochemical and histological markers of direct cutaneous toxicity. The present experiments were undertaken for two purposes: (1) to develop a pharmacokinetic model, based on dermal penetration in the IPPSF, which is predictive of percutaneous absorption in vivo, and (2) to examine cutaneous biotransformation of the important agricultural poison parathion (P). Dosing solutions of {sup 14}C-radiolabelled compounds representing 3 chemical classes-organic acid/base (benzoic acid (B), caffeine (C)), organophosphate (OP) pesticides, and steroid hormones, were applied topically in ethanol at 40 {mu}m cm{sup {minus}2}, both in vivo and on the IPPSF. A 3-compartment pharmacokinetic model describing mass transfer from the surface (C{sub 1}), diffusion through epidermis and dermis (C{sub 2}), and transfer into the perfusate (C{sub 3}), was developed based on flux through the IPPSF from 0-8 hr. Model simulations were predictive of percutaneous absorption in vivo for the OP's and steroids. Modification of the basic 3-compartment model to account for fast and slow tissue-release processes (B) and for flux-dependent perfusage flow increases (C), provided excellent in vivo-in vitro correlation over all 7 compounds.
Deltopectoral Flap in the Era of Microsurgery
Chan, R. C. L.; Chan, J. Y. W.
Background. Our study aimed to review the role of deltopectoral (DP) flap as a reconstructive option for defects in the head and neck region in the microvascular era. Methods. All patients who received DP flap reconstruction surgery at the Department of Surgery, Queen Mary Hospital, between 1999 and 2011 were recruited. Demographic data, indications for surgery, defect for reconstruction, and surgical outcomes were analyzed. Results. Fifty-four patients were included. All but two patients were operated for reconstruction after tumour resection. The remaining two patients were operated for necrotizing fasciitis and osteoradionecrosis. The majority of DP flaps were used to cover neck skin defect (63.0%). Other reconstructed defects included posterior pharyngeal wall (22.2%), facial skin defect (11.1%), and tracheal wall (3.7%). All donor sites were covered with partial thickness skin graft. Two patients developed partial flap necrosis at the tip and were managed conservatively. The overall flap survival rate was 96.3%. Conclusions. Albeit the technical advancements in microvascular surgery, DP still possesses multiple advantages (technical simplicity, reliable axial blood supply, large size, thinness, and pliability) which allows it to remain as a useful, reliable, and versatile surgical option for head and neck reconstruction. PMID:25374953
Bipedicled "Superthin" Free Perforator Flaps for Facial Burn Scar Reconstruction: Expanded Scope of Superthin Flaps: A Case Series
Van Anh, Tran; Tien, Nguyen Gia; Hyakusoku, Hiko; Ogawa, Rei
Background: "Superthin flap" is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients. Methods: This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively. Results: Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction. Conclusion: Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope
A propeller flap for single-stage nose reconstruction in selected patients: supratrochlear artery axial propeller flap.
Cordova, Adriana; D'Arpa, Salvatore; Massimiliano, Tripoli; Toia, Francesca; Moschella, Francesco
The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the acronym STAAP flap, to stress the axial, well known and constant, vascularization of the flap. In the past 5 years, we have been performing 25 STAAP flaps; full-thickness nasal reconstruction was performed in 11 cases. The patients were 16 males and 9 females, with a mean age of 79.5 years. All patients had multiple comorbidities. Complete flap survival was observed in 23 cases and healing was complete in 7 days. In two cases, there was a partial distal necrosis of the flap treated conservatively. Cosmetic results were good and the patient's satisfaction was significant. These results indicate that the STAAP flap is a reliable and useful technique in selected cases, as old or noncompliant patients who benefit from a one-stage technique of nose reconstruction. PMID:24918712
The radix nasi island flap: a versatile musculocutaneous flap for defects of the eyelids, nose, and malar region.
Seyhan, Tamer
A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness. PMID:19305249
Free microvascular transplantation of the trapezius musculocutaneous flap in dogs.
Philibert, D; Fowler, J D; Clapson, J B
A musculocutaneous flap based on the prescapular branch of the superficial cervical artery and including the cervical part of the trapezius muscle and overlying skin was transplanted over a defect created on the medial side of the contralateral tibia in four dogs by using microvascular technique. The donor and recipient sites in three dogs were examined clinically for 21 days, after which they were examined angiographically and histologically. All dogs were free of lameness by hour 48. Seromas formed at the donor site between days 7 and 15. One vascular pedicle was traumatized at hour 40, and the dog was euthanatized. Three flaps survived with minimal necrosis. Edema of the flaps was severe from days 5 to 11. Angiograms showed complete perfusion of the flaps, and survival was confirmed histologically. Esthetic appearance and function were good in one dog at month 7. PMID:1455645
Blue Laser Light Increases Perfusion of a Skin Flap Via Release of Nitric Oxide from Hemoglobin
Mittermayr, Rainer; Osipov, Anatoly; Piskernik, Christina; Haindl, Susanne; Dungel, Peter; Weber, Carina; Vladimirov, Yuri A; Redl, Heinz; Kozlov, Andrey V
It has recently been shown that nitrosyl complexes of hemoglobin (NO-Hb) are sensitive to low-level blue laser irradiation, suggesting that laser irradiation can facilitate the release of biologically active nitric oxide (NO), which can affect tissue perfusion. The aim of this study was to evaluate the therapeutic value of blue laser irradiation for local tissue perfusion after surgical intervention. Blood was withdrawn from a rat, exposed to NO and infused back to the same rat or used for in vitro experiments. In vitro, an increase of NO-Hb levels (electron paramagnetic resonance spectroscopy) up to 15 μM in rat blood did not result in the release of detectable amounts of NO (NO selective electrode). Blue laser irradiation of NO-Hb in blood caused decomposition of NO-Hb complexes and release of free NO. Systemic infusion of NO-Hb in rats affected neither systemic circulation (mean arterial pressure) nor local tissue perfusion (Doppler blood flow imaging system). In contrast, a clear enhancement of local tissue perfusion was observed in epigastric flap when elevated NO-Hb levels in blood were combined with local He-Cd laser irradiation focused on the left epigastric artery. The enhancement of regional tissue perfusion was not accompanied by any detectable changes in systemic circulation. This study demonstrates that blue laser irradiation improves local tissue perfusion in a controlled manner stimulating NO release from NO-Hb complexes. PMID:17515954
Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model
Ersel, Murat; Uyanikgil, Yigit; Akarca, Funda Karbek; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavusoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Cetin, Emel Oyku
Background The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of a sericin-containing gel formulation in an incision wound model in rats. Material/Methods Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9×3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. The Placebo group received placebo gel without sericin applied to the incision area once a day from day 0 to day 9. The Sericin Group 3 received 1% sericin gel applied to the incision area once a day from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied for histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase), and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area. Results Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration, and necrosis were decreased in Sericin group in comparison to the Placebo group and the Sham operated group. Malonyldialdehyde (MDA) levels were decreased, but superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were increased in the sericin group. Conclusions We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds. PMID:27032876
Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model.
Ersel, Murat; Uyanikgil, Yigit; Karbek Akarca, Funda; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavucoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Oyku Cetin, Emel
BACKGROUND The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of a sericin-containing gel formulation in an incision wound model in rats. MATERIAL AND METHODS Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9×3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. The Placebo group received placebo gel without sericin applied to the incision area once a day from day 0 to day 9. The Sericin Group 3 received 1% sericin gel applied to the incision area once a day from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied for histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase), and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area. RESULTS Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration, and necrosis were decreased in Sericin group in comparison to the Placebo group and the Sham operated group. Malonyldialdehyde (MDA) levels were decreased, but superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were increased in the sericin group. CONCLUSIONS We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds. PMID:27032876
Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap
Yadav, Prabha S.; Ahmad, Quazi G.; Shankhdhar, Vinay Kant; Nambi, G. I.; Pramesh, C. S.
Background: The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage. Materials and Methods: From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft. Result: All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance. Conclusion: Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice. PMID:21217973
Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap.
Mori, Hiroki; Uemura, Noriko; Okazaki, Mutsumi
We recently used skin-sparing mastectomy (SSM), the deep inferior epigastric artery perforator (DIEP) flap, and delayed nipple reconstruction with banked costal cartilage. Eight patients who underwent these reconstructions between 2008 and 2010 were reviewed. SSM was performed by vertical-type incision. We transferred the DIEP flap using an internal thoracic vessel and banked costal cartilage into an abdominal wound. Three to 6 months later, we removed the cartilage and cut it into a cylindrical shape. We fixed the cartilage on the dermal base of a modified C-V flap. No flap necrosis or exposure of cartilage was seen and the scar was acceptable in all cases. At a mean follow-up of 12.6 months, 59% of the nipple projection was maintained in comparison to immediately postoperatively. Our new concept is the combination of SSM, DIEP, and banked cartilage, and furthermore putting the cartilage on a dermal base. With support from the dermis, a large, complicated cartilage form is unnecessary. PMID:22246867
The platysma myocutaneous flap.
Baur, Dale A; Williams, Jonathan; Alakaily, Xena
Reconstructing defects of the oral mucosa or skin of the lower one-third of the face can be accomplished by a variety of techniques. This article presents two versions of the platysma myocutaneous flap, which is a reliable, axial pattern, pedicled flap capable of providing excellent one-stage reconstruction of such defects. As discussed herein, the superiorly based and posteriorly based versions of the flap have wide application in the oral and facial region. Also provided is a review of other uses of this flap in head and neck surgery. PMID:24958382
Perforator propeller flaps for sacral and ischial soft tissue reconstruction
Korambayil, Pradeoth M.; Allalasundaram, KV; Balakrishnan, TM
The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications. PMID:21217972
The effect of platelet rich plasma on angiogenesis in ischemic flaps in VEGFR2-luc mice.
Sönmez, Tolga Taha; Vinogradov, Alexandra; Zor, Fatih; Kweider, Nisreen; Lippross, Sebastian; Liehn, Elisa Anamaria; Naziroglu, Mustafa; Hölzle, Frank; Wruck, Christoph; Pufe, Thomas; Tohidnezhad, Mersedeh
To improve skin flap healing, one promising strategy in reconstructive surgery might be to optimize platelet rich plasma (PRP) bioactivity and the ischemia-altered expression of genes. We studied both the effect of PRP on ischemic flaps, and whether in vivo bioluminescence imaging (BLI) is a suitable method for the longitudinal monitoring of angiogenesis in surgical wounds. Axial murine skin flaps were created in four experimental groups. In vivo measurements of VEGFR2 expression levels were made every other day until the 14th day. The local VEGF level and microvessel density were quantified on the 14th day via ELISA and immunohistochemistry, and flap survival rates were measured. We demonstrated that PRP and induced ischemia have a beneficial influence on angiogenesis and flap healing. Combining the two resulted in a significantly robust increase in angiogenesis and flap survival rate that was corroborated by bioluminescence imaging of VEGFR2 activity. This study shows that angiogenic effects of PRP may be potentialized by the stimulus of induced ischemia during free flap harvesting, and thus the two procedures appear to have a synergistic effect on flap healing. This study further demonstrates that BLI of modulated genes in reconstructive surgery is a valuable model for longitudinal in vivo evaluation of angiogenesis. PMID:23352038
Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck
Li, Ning; Liu, Wen; Su, Tong; Chen, Xinqun; Zheng, Lian; Jian, Xinchun
The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck. PMID:25180680
Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap
Zhao, Feng; He, Wei; Zhang, Guoping; Liu, Shaojun; Yu, Kunlun; Bai, Jiangbo; Zhang, Hongjuan; Tian, Dehu
Background In the absence of scientific evidence regarding the effectiveness of shoulder management strategies after stage I of fingertip reconstruction, the purpose of this study was to compare the clinical outcomes of various rehabilitation procedures. Material/Methods Patients who underwent fingertip reconstruction with a random-pattern abdominal skin flap between March 2007 and February 2013 were enrolled in the study (n=95). Thirty performed only active exercise (group A), 29 performed only passive exercise (group B), and 32 received a combination of active exercise and pulsed electromagnetic field (PEMF) (group C). The mean age at the time of treatment was 30.2 years in group A, 29.6 years in group B, and 31.8 years in group C. Results At the final follow-up, there were significant differences between group A and B in terms of Constant score (P=.001), VAS (P=.047), forward flexion of the shoulder (P=0.049), and muscle strength with forward flexion and external rotation (P=0.049 and P=0.042, respectively). A higher Constant score was observed in group C compared to group A, and although there were no differences in the other evaluations between groups A and C, a trend toward better function of the shoulder was demonstrated in group C. Conclusions The most important findings in our study are that a combination of active exercise and PEME produces superior patient-reported outcomes regarding relief of shoulder signs and symptoms. Given the limitations of this study, better-designed studies with large sample sizes and long-term follow-up are required. PMID:26449682
[1984-1994: Ten years of skin flaps. Development of transfer techniques. New methods of autoplasty described during this period].
Martin, D
Ten years of flaps represent a little and a lot. It is little compared to the 2600 years since the first flap in plastic surgery: the Susruta Indian flap, but it is a lot in view of the phenomenal acceleration of this speciality since the Second World War. In 1994 alone, more than two hundred references are listed under the heading "new flaps". As it is impossible to be exhaustive, the author has chosen to focus on two main aspects: a theoretical review of new transfer techniques, dealing successively with: the principles of reverse flow flaps, venous flaps, neurocutaneous flaps, so-called "extracorporeal" transfers, reverse flow YV technique; and practical aspects based on a review of eighteen autoplasties or donor sites selected for their surgical value, their reproductibility and their innovative nature. The author's objective is not to present a technical treatise, but rather to make the reader aware of several key points or even, in some cases, the very existence of these autoplasties. This paper is designed to be didactic, with extensive references, in order to act as a practical guide. It also demonstrates, as if there were any need, to what extent plastic surgery is able to create new solutions and the essential value of continuing research. PMID:8579301
Secondary reconstruction with a transverse colon covered with a pectoralis major muscle flap and split thickness skin grafts for an esophageal defect and wide skin defects of the anterior chest wall.
Sadanaga, Noriaki; Morinaga, Keigo; Matsuura, Hiroshi
Necrosis of a reconstructed organ after esophagectomy is a rare postoperative complication. However, in case this complication develops, severe infectious complications can occur, and subsequent surgical reconstruction is quite complicated. To treat esophageal conduit necrosis after esophageal reconstruction with the terminal ileum and ascending colon, we reconstructed the esophagus using a transverse colon, which was covered with a pectoralis major muscle flap to reinforce the anastomotic site. In addition, split thickness skin grafts were applied to the wide skin defect to cover the reconstructed organs at the antesternal route. Widely extended split thickness skin grafts can adhere to the reconstructed organs without excessive tension. Therefore, this method enabled successful treatment of an esophageal defect and wide skin defects of the anterior chest wall. PMID:26943390
EASEPort NPWT System to Enhance Skin Graft Survival – A Simple Assembly
Prasetyono, Theddeus O.H.; Rini, Irena Sakura; Wibisono, Cindy
Skin graft has been known to be prone to failure. This study was aimed to make a simplification of the negative pressure wound therapy (NPWT), which follows EASEPort (effective, affordable, safe, easily handled, and portable) concept to support the take of skin graft. The design of the EASEPort-NPWT was then made and technically verified. Thereafter, an animal experimental study comparing the EASEPort-NPWT to the classic tie-over technique on skin graft over exudative wound was conducted. The EASEPort-NPWT was verified to be able to yield and sustain the subatmospheric pressure needed. In the animal study, the treatment group showed better skin graft survival rate (97.55 ± 11.18% take) than the control group (54.88 ± 19.73%) on day-7. Histopathology examination showed good quality of the skin structures taken from the treatment group, which was better than the structures of the skin in the control group. In summary, this study has been able to fulfill its objective to create a device following EASEPort concept. Subsequently, the EASEPort-NPWT was able to enhance skin graft survival rate in exudative wound. PMID:25785338
Improvement of Nasojugal Groove and Wrinkles Following a Skin-Muscle Flap Elevation Through a Subciliary Approach to the Orbital Rim.
Hwang, Kun; Choi, Jong Hwan; Kim, Joo Ho
The aim of this study is to see whether the nasojugal groove and wrinkles can be improved following a skin-muscle flap elevation through a subciliary approach to the orbital rim.Fifty-seven patients having fractures of the orbital floor, wall, or orbital rim were included. A subciliary incision was made 3 to 5 mm below the cilia. A skin-muscle flap was elevated and a 5-mm width of the periosteum of the anterior surface of the maxilla was exposed. Thereafter, the origin of the orbicularis oculi muscle was released from the underlying bony origin. An incision was made at the arcus marginalis. After reconstruction, the detached arcus marginalis was sutured to the periosteum of the infraorbital rim and the subciliary incision was closed. Preoperative and postoperative photographs were analyzed with the validated assessment scales for midface.In the 57 sides operated on, the postoperative, mean assessment score was significantly lower (0.56 ± 0.66) on the operated side than on the contralateral side (0.84 ± 1.00) (P = 0.002). In the 37 sides excluding the patients in whom the initial score was 0, and the postoperative, mean assessment score was significantly lower (0.84 ± 0.65) on the operated side than on the contralateral side (1.19 ± 1.05) (P = 0.010).The skin-muscle flap elevated through the subciliary approach to reach the orbital rim improved the nasojugal groove despite the fat removal or repositioning was not performed. The reason for this improvement the authors think is orbicularis oculi muscle had been separated from its origin. PMID:27100651
Keyhole Flap Nipple Reconstruction
Cash, Camille G.; Iman, Al-Haj; Spiegel, Aldona J.; Cronin, Ernest D.
Summary: Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76). The average patient follow-up was 17 months. The design of the flap is based on a keyhole configuration. The base of the flap determines the width of the future nipple, whereas the length of the flap determines the projection. We try to match the projection of the contralateral nipple if present. The keyhole flap is simple to construct yet reliable. It provides good symmetry and projection and avoids the creation of new scars. The areola is then tattooed approximately 3 months after the nipple reconstruction.
Keyhole Flap Nipple Reconstruction.
Chen, Joseph I; Cash, Camille G; Iman, Al-Haj; Spiegel, Aldona J; Cronin, Ernest D
Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76). The average patient follow-up was 17 months. The design of the flap is based on a keyhole configuration. The base of the flap determines the width of the future nipple, whereas the length of the flap determines the projection. We try to match the projection of the contralateral nipple if present. The keyhole flap is simple to construct yet reliable. It provides good symmetry and projection and avoids the creation of new scars. The areola is then tattooed approximately 3 months after the nipple reconstruction. PMID:27579228
The essential role of annexin A1 mimetic peptide in the skin allograft survival.
Teixeira, Rodrigo Antonio Parra; Mimura, Kallyne Kioko Oliveira; Araujo, Leandro Pires; Greco, Karin Vicente; Oliani, Sonia Maria
Immunosuppressive drugs have a critical role in inhibiting tissue damage and allograft rejection. Studies have demonstrated the anti-inflammatory effects of the annexin A1 (AnxA1) in the regulation of transmigration and apoptosis of leucocytes. In the present study, an experimental skin allograft model was used to evaluate a potential protective effect of AnxA1 in transplantation survival. Mice were used for the skin allograft model and pharmacological treatments were carried out using either the AnxA1 mimetic peptide Ac2-26, with or without cyclosporine A (CsA), starting 3 days before surgery until rejection. Graft survival, skin histopathology, leucocyte transmigration and expression of AnxA1 and AnxA5 post-transplantation were analysed. Pharmacological treatment with Ac2-26 increased skin allograft survival related with inhibition of neutrophil transmigration and induction of apoptosis, thereby reducing the tissue damage compared with control animals. Moreover, AnxA1 and AnxA5 expression increased after Ac2-26 treatment in neutrophils. Interestingly, the combination of Ac2-26 and cyclosporine A showed similar survival of transplants when compared with the cyclosporine A group, which could be attributed to a synergistic effect of both drugs. Investigations in vitro revealed that cyclosporine A inhibited extracellular-signal-regulated kinase (ERK) phosphorylation induced by Ac2-26 in neutrophils. Overall, the results suggest that AnxA1 has an essential role in augmenting the survival of skin allograft, mainly owing to inhibition of neutrophil transmigration and enhancement of apoptosis. This effect may lead to the development of new therapeutic approaches relevant to transplant rejection. PMID:23897745
Optimal administration routes for adipose-derived stem cells therapy in ischaemic flaps.
Lee, Dong Won; Jeon, Yeo Reum; Cho, Eul Je; Kang, Jong Hwa; Lew, Dae Hyun
Improvement of flap survival represents an ongoing challenge in reconstructive surgery. The angiogenic potential of adipose-derived stem cells (ASCs) offers a promising approach to improve the viability of random pattern flaps. Recently, to maximize the therapeutic effects of ASCs, increasing focus is being placed on how to deliver the stem cells to target lesions. The purpose of the present study was to compare the effectiveness of different administration routes of ASCs to improve the viability of the random pattern skin flap. ASCs labelled with PKH26 were applied via four methods to the cranially-based random pattern skin flaps of rats: (a) intravenous injection; (b) subcutaneous injection; (c) application with collagen sponge seeding; and (d) application with fibrin glue seeding. ASCs led to a significant increase in flap viability in the subcutaneous injection group and the collagen sponge group. Cutaneous blood flow was increased in the intravenous injection, subcutaneous injection and collagen sponge groups. Capillary density in the intravenous injection group and collagen sponge group was significantly greater than in the control group (no treatment). PKH26-positive cells via the collagen sponge were distributed more densely within the flap than in other groups. This study demonstrated that the collagen sponge method delivered ASCs most effectively within the flap and increased flap vascularity. The clinical therapeutic effects of ASCs can therefore be maximized when the optimal delivery route is chosen. PMID:22782932
A study of the pharmacologic control of blood flow to delayed skin flaps using xenon washout. Part II
Hendel, P.M.; Lilien, D.L.; Buncke, H.J.
These experiments indicate that there are two components to the delay phenomenon. The first component is passive vasodilation owing to loss in the acute flaps originating from the sympathetic nerve terminals. The second component is active vasodilation not involving loss of a second vasoconstrictor mechanism or sensitization of the beta-receptors. Overall, the increase in blood flow associated with the delay phenomenon was seen to begin near the base of the flap and proceed distally. While the second component could not be identified, its characteristics suggest that its site of action is directly at the smooth-muscle or vascular-architecture level without involving the beta-receptors for vasodilation.
Survival of Cold-Stressed Campylobacter jejuni on Ground Chicken and Chicken Skin during Frozen Storage
Bhaduri, Saumya; Cottrell, Bryan
Campylobacter jejuni is prevalent in poultry, but the effect of combined refrigerated and frozen storage on its survival, conditions relevant to poultry processing and storage, has not been evaluated. Therefore, the effects of refrigeration at 4°C, freezing at −20°C, and a combination of refrigeration and freezing on the survival of C. jejuni in ground chicken and on chicken skin were examined. Samples were enumerated using tryptic soy agar containing sheep's blood and modified cefoperazone charcoal deoxycholate agar. Refrigerated storage alone for 3 to 7 days produced a reduction in cell counts of 0.34 to 0.81 log10 CFU/g in ground chicken and a reduction in cell counts of 0.31 to 0.63 log10 CFU/g on chicken skin. Declines were comparable for each sample type using either plating medium. Frozen storage, alone and with prerefrigeration, produced a reduction in cell counts of 0.56 to 1.57 log10 CFU/g in ground chicken and a reduction in cell counts of 1.38 to 3.39 log10 CFU/g on chicken skin over a 2-week period. The recovery of C. jejuni following freezing was similar on both plating media. The survival following frozen storage was greater in ground chicken than on chicken skin with or without prerefrigeration. Cell counts after freezing were lower on chicken skin samples that had been prerefrigerated for 7 days than in those that had been prerefrigerated for 0, 1, or 3 days. This was not observed for ground chicken samples, possibly due to their composition. C. jejuni survived storage at 4 and −20°C with either sample type. This study indicates that, individually or in combination, refrigeration and freezing are not a substitute for safe handling and proper cooking of poultry. PMID:15574906
Transfer of free vascular cutaneous flaps by microvascular anastomosis. Results in six dogs.
Fowler, J D; Miller, C W; Bowen, V; Johnston, G H
Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases. PMID:3507179
Scrotal reconstruction with modified pudendal thigh flaps.
Mopuri, Nabil; O'Connor, Edmund Fitzgerald; Iwuagwu, Fortune C
Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We used a modified pudendal thigh flap to reconstruct scrotal defects in five patients. This study describes the vascularity of the flap, technique of elevation and the inset of the flap. The elevation and particularly the insetting make it different from other flaps raised on this vascular network for scrotal reconstruction. This pedicled flap is robust, reliable, resilient and produces a neo-scrotum that looks natural in appearance, offers good-quality skin cover and cushion to the testes as well as protective sensation. PMID:26774357
[Reconstruction of the thumb using a forearm osseofasciocutaneous reverse flap].
Jevtović, Dobrica; Dordević, Boban; Gacević, Milomir; Sijan, Goran
This paper presents the experiences of the thumb reconstruction with osteofasciocutaneous reverse flap (OFCR flap). In the period between 1987 and 2000 the OFCR flap was used in 15 patients. The youngest of them was 18 and the oldest was 38 years of age. The average age was 25.4. All the patients had posttraumatic amputations. Defects on proximal phalangae and a part of metacarpal bone occurred in two cases. In one case there was an amputation on the base level of proximal phalanx and the metacarpophalangeal (MPH) joint was preserved. In all cases of reconstruction the OFCR flap was used, which included antebrachial skin nervs that were anastomosed with digital nerv. The flap nutrition was carried out through the reverse circulation of a. radialis, and the venous drainage through the comitant vein of a. radialis. Superficial veins were not anastomosed. Secondary defects were covered with a free skin graft. All the flaps survived. The bone graft was healed in the period of eight weeks. The sensibility of this flap was regained in the period of three to six months after the surgery. The distance of two-point discrimination (TPD) was increased for 30% compared to the same region on the other hand after six months. The opposition of the reconstructed thumb to the other fingers was possible, as well as abduction, adduction and normal grasp. The method of reconstruction of the amputated thumb with the OFCR flap was better than other classical methods because it allowed the reconstruction of all the structures in one surgical operation. The sensibility that was regained represented good protection from injuries. There were no functional damages on the secondary defect. The esthetic result was not good due to the lack of a fingernail. PMID:12557617
Distally based sural artery flap without sural nerve.
Motamed, Sadrollah; Yavari, Masood; Mofrad, Hamid Reza Hallaj; Rafiee, Reza; Shahraki, Feaz Niazi
The distal third of the tibia, ankle and heel area is difficult to reconstruct. For small to medium size defects, local flaps are often an easier alternative than free flap. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. The distally based superficial sural artery flap, first described as a distally based neuro skin flap by masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. The main disadvantage of distally based sural artery flap is sacrifice of the sural nerve because it is described the concept of neurocutaneus island flap. We describe one case of reverse sural flap without sural nerve .The aim of this paper is to establish the reliability of this flap even without sural nerve. PMID:21133008
Treatment of nasal microcystic adnexal carcinoma with an expanded rotational forehead skin flap: A case report and review of the literature
Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive adenocarcinoma with low-grade malignancy. The present study describes the first reported case and treatment of a Chinese male with a MAC located on the nasal dorsum and nosewing. A 44-year-old man presented with a nasal deformity caused by local repeated infections following an accidental injury to the nose 20 years previously. The nose had been injured by a brick, and treatment at a local hospital 12 years previously had resulted in a nasal scar and a gradually enlarging mass. A physical examination revealed a hypertrophic deformity of the nose and an indurated scar plaque, measuring 2.0×2.0 cm, on the nasal dorsum and nosewing. Microscopic examination revealed a tumor consisting of solid cell nests and a cystic structure with a capsular space. In addition, ductal cells of an adnexal cell origin were visible in the outer epithelium. The medial portion exhibited a microductal structure and invasion of deeper tissues without evident atypia. The tumor cells presented normal nuclear to cytoplasmic ratios and minimal mitotic activity. Pathological examination verified that the tumor was a MAC of low-grade malignancy. A complete surgical resection was performed via Mohs micrographic surgery (MMS), and reconstruction was achieved using an expanded rotational forehead skin flap. No tumor recurrence was detected after a three-year follow-up period. Therefore, for effective treatment of similar MAC cases, complete surgical resection using MMS is recommended, and successful reconstruction may be achieved using an expanded skin flap. PMID:26622465
Posterior Thigh Flap Pedicled on the Cutaneous Vessels Arising From the Popliteo-posterior Intermediate Artery: A Report of 5 Cases.
Sun, Xi-Guang; Gong, Xu; Song, Liang-Song; Cui, Jian-Li; Yu, Xin; Liu, Bin; Lu, Lai-Jin
Surgical repair of soft tissue defects of the knee and leg remains challenging. Using a case study approach, the anatomy of the popliteo-posterior intermediate cutaneous artery was examined, and a reverse island flap method was developed and implemented. After obtaining informed consent, 5 patients (1 woman, 4 men, age range 31 to 57 years) underwent the experimental use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery to repair soft-tissue defects of the knee and leg. The defects were caused by burned skin below the knee (n = 1), progressive skin necrosis in the knee after fracture surgery (n = 2), and skin infections associated with diabetes mellitus (n = 2). Skin defect sizes ranged from 15 cm x 5 cm to 30 cm x 12 cm. These large defects did not heal spontaneously; wound duration ranged from 1 week to 1 year, and all patients had refused defect repair with free flaps. Patients received posterior thigh flaps pedicled on the popliteo-posterior intermediate artery with areas ranging from 17 cm x 6 cm to 25 cm x 12 cm. All patients were treated with antibiotics and local dressings (iodoform and alcohol) changed daily post surgery, and blood supply was monitored by assessing the texture and color of the flap and venous regurgitation (ie, vein drainage disturbance). Four (4) of the five flaps survived completely. In 1 patient, partial survival of the flap, which had a good blood supply despite a venous circulation disorder, occurred: in this case, complete survival was achieved after treatment with a retrograde fascial flap and skin grafting. The appearance and texture of all flaps were satisfactory (ie, patients underwent only 1 operation, healing time was approximately 2 weeks, flap quality was close to normal skin, the donor site closed directly, and the shape and function of the knee and leg recovered well). No donor site abnormality was observed, and no postsurgical
Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap
Han, Fengshan; Wang, Guangnan; Li, Gaoshan; Ping, Juan; Mao, Zhi
Background Our aim was to summarize the treatment of degloving injury involving multiple fingers using combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap. Patients and methods Each degloved finger was debrided under microscopic guidance and embedded in the superficial layer of the abdominal fascia. The abdominal skin was sutured to the skin on the back and side of the hand to promote circumferential healing. After removal, the only remaining injured region was on the flexor surface, and this was repaired by multiple dorsal toe flaps, toe-web flaps, and dorsalis pedis flaps to provide blood vessels and sensory nerves. All fingers had proper flap thickness 3–6 months after surgery, and required only lateral Z-plasty modification with web deepening and widening to narrow the fingers and extend their relative length. Results We completed flap-graft and finger narrowing for 25 fingers in eight patients. Abdominal skin flaps and dorsal toe flaps were grafted, and resulted in both firmness and softness, providing finger flexibility. The dorsal toe flap provided good blood circulation and sensory nerves, and was used to cover the finger-flexor surface to regain sensation and stability when holding objects. During the 1–8 years of follow-up, sensation on the finger-flexor side recovered to the S3–4 level, and patient satisfaction based on the Michigan Hand Outcomes Questionnaire was 4–5. Flap ulcers or bone/tendon necrosis were not observed. Conclusion Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap was effective and reliable. PMID:26229479
Cholecystectomy after breast reconstruction with a pedicled autologous tram flap. Types of surgical access.
Graczyk, Magdalena; Kostro, Justyna; Jankau, Jerzy; Bigda, Justyna; Skorek, Andrzej
The number of breast reconstruction procedures has been increasing in recent years. One of the suggested treatment methods is breast reconstruction with a pedicled skin and muscle TRAM flap (transverse rectus abdominis muscle - TRAM). Surgical incisions performed during a cholecystectomy procedure may be located in the areas significant for flap survival. The aim of this paper is to present anatomical changes in abdominal walls secondary to pedicled skin and muscle (TRAM) flap breast reconstruction, which influence the planned access in cholecystectomy procedures. The authors present 2 cases of cholecystectomy performed due to cholelithiasis in female patients with a history of TRAM flap breast reconstruction procedures. The first patient underwent a traditional method of surgery 14 days after the reconstruction due to acute cholecystitis. The second patient underwent a laparoscopy due to cholelithiasis 7 years after the TRAM procedure. In both cases an abdominal ultrasound scan was performed prior to the operation, and surgical access was determined following consultation with a plastic surgeon. The patient who had undergone traditional cholecystectomy developed an infection of the postoperative wound. The wound was treated with antibiotics, vacuum therapy and skin grafting. After 7 weeks complete postoperative wound healing and correct healing of the TRAM flap were achieved. The patient who had undergone laparoscopy was discharged home on the second postoperative day without any complications. In order to plan a safe surgical access, it is necessary to know the changes in the anatomy of abdominal walls following a pedicled TRAM flap breast reconstruction procedure. PMID:25337177
Technology Transfer Automated Retrieval System (TEKTRAN)
To better predict risk of Salmonella infection from chicken subjected to temperature abuse, a study was undertaken to develop a predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin with native micro flora. For model development, chicken skin portions were inocula...
The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.
Ibrahim, Amir; Atiyeh, Bishara; Karami, Reem; Adelman, David M; Papazian, Nazareth J
Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications. PMID:26854779
SIRT1 regulates MAPK pathways in vitiligo skin: insight into the molecular pathways of cell survival
Becatti, Matteo; Fiorillo, Claudia; Barygina, Victoria; Cecchi, Cristina; Lotti, Torello; Prignano, Francesca; Silvestro, Agrippino; Nassi, Paolo; Taddei, Niccolò
Vitiligo is an acquired and progressive hypomelanotic disease that manifests as circumscribed depigmented patches on the skin. The aetiology of vitiligo remains unclear, but recent experimental data underline the interactions between melanocytes and other typical skin cells, particularly keratinocytes. Our previous results indicate that keratinocytes from perilesional skin show the features of damaged cells. Sirtuins (silent mating type information regulation 2 homolog) 1, well-known modulators of lifespan in many species, have a role in gene repression, metabolic control, apoptosis and cell survival, DNA repair, development, inflammation, neuroprotection and healthy ageing. In the literature there is no evidence for SIRT1 signalling in vitiligo and its possible involvement in disease progression. Here, biopsies were taken from the perilesional skin of 16 patients suffering from non-segmental vitiligo and SIRT1 signalling was investigated in these cells. For the first time, a new SIRT1/Akt, also known as Protein Kinase B (PKB)/mitogen-activated protein kinase (MAPK) signalling has been revealed in vitiligo. SIRT1 regulates MAPK pathway via Akt-apoptosis signal-regulating kinase-1 and down-regulates pro-apoptotic molecules, leading to decreased oxidative stress and apoptotic cell death in perilesional vitiligo keratinocytes. We therefore propose SIRT1 activation as a novel way of protecting perilesional vitiligo keratinocytes from damage. PMID:24410795
Benefit of HSP90α intervention on ischemia-reperfusion injury of venous blood-congested flaps
In order to decrease the incidence of flap necrosis after reconstructive surgeries, new approaches are required. In the present study, a model of venous congested flaps in rats was established to test the heat shock protein (HSP) 90α, 'F-5', protein as an intervention therapy to alleviate ischemia-reperfusion injury. A recombinant plasmid pET15b-F-5 carrying the HSP90α gene was constructed and the induced protein was purified from bacterial cell cultures. The rats in the study were divided into three different intervention groups: group A rats were treated with normal saline prior to flap establishment, group B rats were treated with HSP90α, 'F-5', protein prior to flap establishment, and group C rats were treated with the same 'F-5' protein after the surgical procedure. Additionally, the reperfusion time-points, ischemia for 6 or 8 h (5 rats each), were established in each group. After set periods of time, the flaps were observed for skin appearance, blood flow, survival rate and histological changes including neovascularization and re-epithelialization. The results showed that the flaps in the rats pre-treated with 'F-5' protein performed better than the flaps of rats in the other two groups: the blood flow was higher, flap survival rate was increased, inflammatory cell infiltration was decreased and angiogenesis increased, and new skin structure was better completed by the end of the experiment. The parameters examind were improved for all the groups when the ischemia time was 6 h instead of 8 h. In conclusion, HSP90α intervention prior to flap establishment was shown to be beneficial in the model of ischemia-reperfusion injury in venous-congested flaps. PMID:27347036
A Modified Technique to Improve Reliability of Distally Based Sural Fasciocutaneous Flap for Reconstruction of Soft Tissue Defects Longitudinal in Distal Pretibial Region or Transverse in Heel and Ankle.
Wei, Jian-Wei; Ni, Jiang-Dong; Dong, Zhong-Gen; Liu, Li-Hong; Yang, Ying
Partial flap loss is a common complication of the distally based sural fasciocutaneous flap. We present a modified technique of a sloped skin island design to improve the reliability of the flap when used to reconstruct a longitudinal distal pretibial defect or transverse heel and ankle defect. Thirty-one flaps with the slope-designed skin island were used to reconstruct such defects in 30 patients. In the modified technique, the skin island was rotated toward the vascular axis of the flap. The defects were located in the distal pretibial region in 7 cases and the ankle and heel region in 24. The horizontal dimension of the skin island decreased by an average of 5.6 (range 2.5 to 14.8) cm with the sloped design, and the rotation angle varied from 42° to 90° (mean 69°). Of the 31 flaps, 29 survived, 1 developed marginal necrosis, and 1 developed lateral partial necrosis. The sloped design of the skin island is applicable to reconstruction of longitudinal distal pretibial or transverse heel and ankle defects. The modified technique can decrease the horizontal dimension and increase perfusion of the skin island, thus improving the reliability of the flap. PMID:27066868
Nrf2 Activation Promotes Keratinocyte Survival during Early Skin Carcinogenesis via Metabolic Alterations.
Rolfs, Frank; Huber, Marcel; Kuehne, Andreas; Kramer, Stefan; Haertel, Eric; Muzumdar, Sukalp; Wagner, Johanna; Tanner, Yasmine; Böhm, Friederike; Smola, Sigrun; Zamboni, Nicola; Levesque, Mitchell P; Dummer, Reinhard; Beer, Hans-Dietmar; Hohl, Daniel; Werner, Sabine; Schäfer, Matthias
Pharmacologic activation of the transcription factor NRF2 has been suggested to offer a strategy for cancer prevention. In this study, we present evidence from murine tumorigenesis experiments suggesting there may be limitations to this possibility, based on tumorigenic effects of Nrf2 in murine keratinocytes that have not been described previously. In this setting, Nrf2 expression conferred metabolic alterations in keratinocytes that were protumorigenic in nature, affecting enzymes involved in glutathione biosynthesis or in the oxidative pentose phosphate pathway and other NADPH-producing enzymes. Under stress conditions, coordinate increases in NADPH, purine, and glutathione levels promoted the survival of keratinocytes harboring oncogenic mutations, thereby promoting tumor development. The protumorigenic activity of Nrf2 in keratinocytes was particularly significant in a mouse model of skin tumorigenesis that did not rely upon chemical carcinogenesis. In exploring the clinical relevance of our findings, we confirm that NRF2 and protumorigenic NRF2 target genes were activated in some actinic keratoses, the major precancerous lesion in human skin. Overall, our results reveal an unexpected tumor-promoting activity of activated NRF2 during early phases of skin tumorigenesis. PMID:26530903
Superficial ulnar artery perforator flap.
Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni
Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions. PMID:25102397
Tanshinone IIA Pretreatment Renders Free Flaps against Hypoxic Injury through Activating Wnt Signaling and Upregulating Stem Cell-Related Biomarkers
Xu, Zihan; Zhang, Zhenxin; Wu, Lijun; Sun, Yaowen; Guo, Yadong; Qin, Gaoping; Mu, Shengzhi; Fan, Ronghui; Wang, Benfeng; Gao, Wenjie
Partial or total flap necrosis after flap transplantation is sometimes clinically encountered in reconstructive surgery, often as a result of a period of hypoxia that exceeds the tolerance of the flap tissue. In this study, we determine whether tanshinone IIA (TSA) pretreatment can protect flap tissue against hypoxic injury and improve its viability. Primary epithelial cells isolated from the dorsal skin of mice were pretreated with TSA for two weeks. Cell counting kit-8 and Trypan Blue assays were carried out to examine the proliferation of TSA-pretreated cells after exposure to cobalt chloride. Then, Polymerase chain reaction and Western blot analysis were used to determine the expression of β-catenin, GSK-3β, SOX2, and OCT4 in TSA-treated cells. In vivo, after mice were pretreated with TSA for two weeks, a reproducible ischemic flap model was implemented, and the area of surviving tissue in the transplanted flaps was measured. Immunohistochemistry was also conducted to examine the related biomarkers mentioned above. Results show that epidermal cells, pretreated with TSA, showed enhanced resistance to hypoxia. Activation of the Wnt signaling pathway in TSA-pretreated cells was characterized by the upregulation of β-catenin and the downregulation of GSK-3β. The expression of SOX2 and OCT4 controlled by Wnt signaling were also found higher in TSA pretreated epithelial cells. In the reproducible ischaemic flap model, pretreatment with TSA enhanced resistance to hypoxia and increased the area of surviving tissue in transplanted flaps. The expression of Wnt signaling pathway components, stem-cell related biomarkers, and CD34, which are involved in the regeneration of blood vessels, was also upregulated in TSA-pretreated flap tissue. The results show that TSA pretreatment protects free flaps against hypoxic injury and increases the area of surviving tissue by activating Wnt signaling and upregulating stem cell-related biomarkers. PMID:25302618
Free thin paraumbilical perforator-based flaps.
Koshima, I; Moriguchi, T; Soeda, S; Tanaka, H; Umeda, N
A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained. Its critical length-to-breath ratio is considered to be 4:3. The advantages of this flap are a long and large vascular pedicle, rare postoperative abdominal herniation, little bulkiness of the flap, and a relatively large skin territory. The disadvantages are technical difficulties in dissection of the perforator and anatomical variation in the location of the perforator. We believe this flap largely overcomes the problems of the conventional rectus abdominis musculocutaneous flap. PMID:1386718
Presurgical Botulinum Toxin A Treatment Increases Angiogenesis by Hypoxia-Inducible Factor-1α/Vascular Endothelial Growth Factor and Subsequent Superiorly Based Transverse Rectus Abdominis Myocutaneous Flap Survival in a Rat Model.
Park, Tae Hwan; Lee, Song Hyun; Park, Yun Joo; Lee, Young Seok; Rah, Dong Kyun; Kim, Sung Young
To date, there have been several experimental studies to assess tissue viability of transverse rectus abdominis myocutaneous (TRAM) flaps. Botulinum toxin A (BoTA) has gained popularity in many clinical fields, for a variety of therapeutic and aesthetic purposes. In addition, there have been reports regarding the positive effect of BoTA on flap survival by various mechanisms. In this study, we hypothesized that pretreatment with BoTA could augment the survival of TRAM flaps via increased hypoxia-inducible factor (HIF)1α/vascular endothelial growth factor (VEGF)-dependent angiogenesis.Twenty-four Sprague-Dawley rats were randomly divided into 2 groups: a control group and a BoTA group. Five days before superiorly based TRAM flap elevation, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Gross flap survival rates were assessed, and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) and Western blotting were performed for the evaluation of angiogenesis-related factors (CD34, HIF-1α, and VEGF).In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral (92.78.3 ± 5.05% vs 86.8 ± 3.88%, P = 0.009) and contralateral (91.57 ± 5.79% vs 74.28 ± 11.83%, P < 0.001) sides.The relative mRNA expression of CD34 and VEGF was significantly higher in the BoTA group than that in the control group in every zone, whereas the relative mRNA expression of HIF-1α was significantly higher in the BoTA group than that in the control group on contralateral sides. The relative protein expression of CD34, VEGF, and HIF-1α was significantly higher in the BoTA group than that in the control group in every zone.In conclusion, we demonstrate that presurgical BoTA treatment might increase angiogenesis by HIF-1α/VEGF, subsequently increase superiorly based TRAM flap survival in a rat model. PMID:25695458
The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects
Karki, Durga; Narayan, R. P.
Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result. PMID:22567253
Feasibility of a deepithelialized superior gluteal artery perforator propeller flap for various lumbosacral defects.
Moon, Suk-Ho; Choi, Jang-Youn; Lee, Jung-Ho; Oh, Deuk-Young; Rhie, Jong-Won; Ahn, Sang-Tae
Skin and soft tissue defects in the lumbosacral area are commonly encountered in the field of reconstructive surgery, and it is well documented that the superior gluteal artery perforator (SGAP) flap provides excellent coverage of these defects. In this article, we describe our experience using a modified version of the SGAP propeller flap, in which the distal redundant portion of an elevated SGAP flap is deepithelialized, thereby maximizing the effect of the soft tissue augmentation. Thirteen patients with lumbosacral soft tissue defects treated between May 2010 and June 2012 were included in this study. The wound causes were pressure ulcer (n = 9), pseudomeningocele (n = 2), and hardware exposure (n = 2). In all patients, an elevated SGAP flap was rotated 180 degrees over the defect area and the extra distal portion of the flap was deepithelialized and used as a soft tissue filler or tamponade. During the follow-up period (mean, 26 months), 12 of 13 flaps survived completely. One flap was totally necrosed due to progressive venous congestion and was reconstructed with local advancement flaps. No further complications were noted. Because of the redundancy and pliability of the tissue in the gluteal area, a flap relatively wider or longer than the defect can be elevated safely. Hence, the redundant tissue volume can be tucked inside to facilitate soft tissue augmentation of the area. We propose that the deepithelialized version of the SGAP propeller flap is an effective option for the reconstruction of various lumbosacral soft tissue defects because it offers thick and healthy soft tissue from a distant site to the defect areas. PMID:24149404
Combination Nasolabial Transposition Flap and Island Pedicle Flap Following Mohs Surgery of Simultaneous Basal Cell Carcinomas Involving Both Nasal Alae
Lee, Chae Young; Lee, Yeong Kyu; Choi, Kyu Won; Lee, Chae Wook; Kim, Ki Ho
The nasal ala is a challenging area for surgical reconstruction, with thick sebaceous skin, the lack of an ample tissue reservoir, and an adjacent free margin. Numerous flaps have been reported for the repair of alae defects. A 71-year-old woman with simultaneous basal cell carcinomas involving both nasal alae was treated by Mohs micrographic surgery. The surgical defects measured 1.5×1.5 cm on the center of the right nasal ala and 1.0×1.0 cm on the left nasal ala, including the alar crease and rim. The right nasal ala was used as a nasolabial transposition flap and the left nasal ala was reconstructed by an island pedicle flap. The final shape and texture were satisfactory. The flaps survived and nasal symmetry was preserved. Combined nasolabial transposition and island pedicle flaps thus offer a superior esthetic and functional result owing to minimized tension. This may be a valuable reconstructive option in the repair of bilateral nasal alae defects.
Skin toxins in coral-associated Gobiodon species (Teleostei: Gobiidae) affect predator preference and prey survival
Gratzer, Barbara; Millesi, Eva; Walzl, Manfred; Herler, Juergen
Predation risk is high for the many small coral reef fishes, requiring successful sheltering or other predator defence mechanisms. Coral-dwelling gobies of the genus Gobiodon live in close association with scleractinian corals of the genus Acropora. Earlier studies indicated that the low movement frequency of adult fishes and the development of skin toxins (crinotoxicity) are predation avoidance mechanisms. Although past experiments showed that predators refuse food prepared with goby skin mucus, direct predator–prey interactions have not been studied. The present study compares the toxicity levels of two crinotoxic coral gobies – Gobiodon histrio, representative of a conspicuously coloured species, and Gobiodon sp.3 with cryptic coloration – using a standard bioassay method. The results show that toxin levels of both species differ significantly shortly after mucus release but become similar over time. Predator preferences were tested experimentally in an aquarium in which the two gobies and a juvenile damselfish Chromis viridis were exposed to the small grouper Epinephelus fasciatus. Video-analysis revealed that although coral gobies are potential prey, E. fasciatus clearly preferred the non-toxic control fish (C. viridis) over Gobiodon. When targeting a goby, the predator did not prefer one species over the other. Contrary to our expectations that toxic gobies are generally avoided, gobies were often captured, but they were expelled quickly, repeatedly and alive. This unusual post-capture avoidance confirms that these gobies have a very good chance of surviving attacks in the field due to their skin toxins. Nonetheless, some gobies were consumed: the coral shelter may therefore also provide additional protection, with toxins protecting them mainly during movement between corals. In summary, chemical deterrence by crinotoxic fishes seems to be far more efficient in predation avoidance than in physical deterrence involving body squamation and/or strong fin
Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps
Mayo, James L.; Allen, Robert J.
Background: In cases of bilateral breast reconstruction when the deep inferior epigastric perforator (DIEP) free flap alone does not provide sufficient volume for body-specific reconstruction, stacking each DIEP flap with a second free flap will deliver added volume and maintain a purely autologous reconstruction. Stacking the profunda artery perforator (PAP) flap with the DIEP flap offers favorable aesthetics and ideal operative efficiency. We present the indications, technique, and outcomes of our experience with 4-flap breast reconstruction using stacked DIEP/PAP flaps. Methods: The authors performed 4-flap DIEP/PAP breast reconstruction in 20 patients who required bilateral reconstruction without adequate single donor flap volume. The timing of reconstruction, average mastectomy/flap weights, and operative time are reported. Complications reviewed include fat necrosis, dehiscence, hematoma, seroma, mastectomy flap necrosis, and flap loss. Results: Twenty patients underwent 4-flap DIEP/PAP breast reconstruction. Surgical time averaged 7 hours and 20 minutes. The primary recipient vessels were the antegrade and retrograde internal mammary vessels. No flap losses occurred. Complications included 1 hematoma, 1 incidence of arterial and venous thrombosis successfully treated with anastomotic revision, 1 incidence of thigh donor site dehiscence, and 3 episodes of minor mastectomy skin flap necrosis. Conclusions: Four-flap breast reconstruction is a favorable autologous reconstructive option for patients requiring bilateral reconstruction without adequate single donor flap volume. Stacking DIEP/PAP flaps as described is both safe and efficient. Furthermore, this combination provides superior aesthetics mirroring the natural geometry of the breast. Bilateral stacked DIEP/PAP flaps represent our first choice for breast reconstruction in this patient population. PMID:26090273
Complications of surgery for radiotherapy skin damage
Rudolph, R.
Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design.
Preliminary survival studies on autologous cultured skin fibroblasts transplantation by injection.
Zhao, Yuming; Wang, Jiaqi; Yan, Xiaoqing; Li, Dan; Xu, Jun
In the correction of aesthetic impairments on the face, dermal, and superficial subcutaneous defects, adequately safe implant material is required. Cultured autologous skin fibroblasts, as a protein repair system, create a living injectable system that has been utilized effectively to treat rhytids, depressed scars, subcutaneous atrophy, acne irregularities, and laser wounds. To evaluate the new method, we have investigated the survival and collagen secretion of autologous transplanted fibroblasts. In this study, rabbit fibroblasts were cultured and expanded. Cells (8 x 10(7)/ml) were injected into the superficial and deep dermal junction of the dorsal ears. Two rabbits were injected independently with labeled [3H]TdR fibroblasts; similarly, eight rabbits were given unlabeled transplanted cells in the right ear and vehicle in the left. Each site was injected three times with the same amount of cells every 2 weeks. The grafts were evaluated for 5 months. After explantation, the samples were collected from the injected sites and stained with autoradiography, H&E, and sirius red, respectively. According to the histological observations, the [3H]TdR-labeled cells survived and large amounts of embryo fibroblasts were found in the experimental subgroup of the labeled cell group. The depth of dermis was significantly different between the experimental subgroup (701.3 +/- 31.5 microm) and the control subgroup (638.3 +/- 23.9 microm) of the unlabeled group (p < 0.01). There was also a significant difference of collagen III between the experimental subgroup (2.63 +/- 1.41 cm2) and the control subgroup (1.05 +/- 0.90 cm2) (p < 0.05). There was no significant difference of collagen I between the experimental subgroup (56.25 +/- 14.41 cm2) and the control subgroup (55.41 +/- 16.59 cm2) (p > 0.05). The results obtained demonstrate that the distinction of the depth of dermis should be interpreted by the increase of collagen III, instead of collagen I, which is produced by the
Thermal damage assessment of blood vessels in a hamster skin flap model by fluorescence measurement of a liposome-dye system
NASA Astrophysics Data System (ADS)
Mordon, Serge R.; Desmettre, Thomas; Devoisselle, Jean-Marie; Soulie-Begu, Sylvie
The present study was undertaken to evaluate the feasibility of thermal damage assessment of blood vessels by using laser-induced release of liposome-encapsulated dye. Experiments were performed in a hamster skin flap model. Laser irradiation was achieved with a 300micrometers fiber connected to a 805nm diode laser after potentiation using a specific indocyanine green (ICG) formulation. Liposomes- encapsulated carboxyfluorescein were prepared by the sonication procedure. Carboxyfluorescein was loaded at high concentration in order to quench its fluorescence. The measurements were performed after i.v. injection of DSPC liposomes and lasted 40 minutes. Fluorescence emission was measured with an ultra high sensitivity intensified camera. Three different shapes of fluorescent spots were identified depending on target and energy deposition in tissue: (i) intravascular fluorescence, (ii) transient low fluorescence circular spot and (iii) persistent high intense fluorescence spot. These images are correlated with histological data. The advantages of this liposome-dye system are (1) direct measurements can be obtained, (2) several repeated readings can be made from one injection, (3) continuous monitoring of the fluorescence can be made, (4) temperature-sensitive range can be adapted using different liposomes compositions, (5) circulation times of several hours can be achieved using DSPC liposomes (6) the tissue microcirculation and the vessel macrocirculation can be investigated simultaneously, therefore changes in response to a treatment regimen and/or ICG formulations can be detected. One main constraint exists: the fluorescent dye encapsulated into the liposomes has to be carefully chosen in order to avoid any direct absorption by the dye itself. In conclusion, one of the most significant applications of this experimental technique is the evaluation of various degrees of tissue thermal damage. It could be possible to consider the application of this technique in
Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction.
Ogawa, Rei; Akaishi, Satoshi; Huang, Chenyu; Dohi, Teruyuki; Aoki, Masayo; Omori, Yasutaka; Koike, Sachiko; Kobe, Kyoko; Akimoto, Masataka; Hyakusoku, Hiko
minimal tension on the dermis, are more effective in reducing recurrence than the three-layered sutures used by plastic surgeons. Moreover, we have found that by using skin flaps (e.g., perforator flaps and propeller flaps), which release tension on the wound, in combination with postoperative radiotherapy, huge keloids can be successfully treated. PMID:21551963
Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review.
Artiaco, Stefano; Battiston, Bruno; Colzani, Giulia; Bianchi, Pasquale; Scaravilli, Gabriele; Boux, Elena; Tos, Pierluigi
The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs. PMID:25250327
Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review
Artiaco, Stefano; Bianchi, Pasquale; Boux, Elena; Tos, Pierluigi
The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs. PMID:25250327
Inferior Gluteal Artery Perforator Flap for Sacral Pressure Ulcer Reconstruction: A Retrospective Case Study of 11 Patients.
Lin, Chin-Ta; Ou, Kuang-Wen; Chiao, Hao-Yu; Wang, Chi-Yu; Chou, Chang-Yi; Chen, Shyi-Gen; Lee, Tzu-Peng
Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon. The flap from the gluteal crease derives blood supply from the inferior gluteal artery perforator (IGAP) and reliably preserves the entire contralateral side as a donor site. To incorporate the IGAP in the reconstruction of sacral pressure ulcers, a skin paddle over the gluteal crease was created and implemented by the authors. Data from 11 patients (8 men, 3 women; mean age 67 [range 44-85] years old) whose sacral ulcers were closed with an IGAP flap between June 2006 and May 2012 were retrieved and reviewed. All patients were bedridden; 1 patient in a vegetative state with a diagnosis of carbon monoxide intoxication was referred from a local clinic, 2 patients had Parkinson's disease, and 8 patients had a history of stroke. The average defect size was 120 cm(2) (range 88-144 cm(2)). The average flap size was 85.8 cm(2) (range 56-121 cm(2)). Only 1 flap failure occurred during surgery and was converted into V-Y advancement flap; 10 of the 11 flaps survived. After surgery, the patients' position was changed every 2 hours; patients remained prone or on their side for approximately 2 weeks until the flap was healed. After healing was confirmed, patients were discharged. Complications were relatively minor and included 1 donor site wound dehiscence that required wound reapproximation. No surgery-related mortality was noted; the longest follow-up period was 24 months. In this case series, flaps from the gluteal crease were successfully used for surgical closure of sacral pressure ulcers. This flap design should be used with caution in patients with hip contractures. Studies with larger sample sizes are needed to ascertain which type of flap is best suited to surgically manage extensive pressure ulcers in a variety of patient populations. PMID:26779702
Bilateral pedicled gracilis flap for scrotal reconstruction.
Daigeler, Adrien; Behr, Björn; Mikhail, Bassem Daniel; Lehnhardt, Marcus; Wallner, Christoph
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes. PMID:27318782
Captopril Increases Survival after Whole-Body Ionizing Irradiation but Decreases Survival when Combined with Skin-Burn Trauma in Mice.
Islam, Aminul; Bolduc, David L; Zhai, Min; Kiang, Juliann G; Swift, Joshua M
Past and recent radiation events have involved a high incidence of radiation combined injury where victims often succumb to serious infections as a consequence of bacterial translocation and subsequent sepsis. The risk of infection is exacerbated in radiation combined skin-burn injury (RCI), which increase vulnerability. Furthermore, no suitable countermeasures for radiation combined skin-burn injury have been established. In this study, we evaluated captopril as a potential countermeasure to radiation combined skin-burn injury. Captopril is an FDA-approved angiotensin-converting enzyme inhibitor that was previously reported to stimulate hematopoietic recovery after exposure to ionizing radiation. Female B6D2F1/J mice were whole-body bilateral (60)Co gamma-photon irradiated (dose rate of 0.4 Gy/min) with 9.5 Gy (LD70/30 for RCI), followed by nonlethal dorsal skin-burn injury under anesthesia (approximately 15% total-body surface-area burn). Mice were provided with acidified drinking water with or without dissolved captopril (0.55 g/l) for 30 days immediately after injury and were administered topical gentamicin (0.1% cream; day 1-10) and oral levofloxacin (90-100 mg/kg; day 3-16). Surviving mice were euthanized on day 30 after analyses of water consumption, body weight and survival. Our data demonstrate that, while treatment with captopril did mitigate mortality induced by radiation injury (RI) alone (55% captopril vs. 80% vehicle; n = 20, P < 0.05), it also resulted in decreased survival after radiation combined skin-burn injury (22% captopril vs. 41% vehicle; n = 22, P < 0.05). Moreover, captopril administration via drinking water produced an uneven dosage pattern among the different injury groups ranging from 74 ± 5.4 to 115 ± 2.2 mg/kg/day. Captopril treatment also did not counteract the negative alterations in hematology, splenocytes or bone marrow cellularity after either radiation injury or radiation combined skin-burn injury. These data suggest that
The dog-ear flap as an alternative for breast reconstruction in patients who have already undergone a DIEAP flap.
Colebunders, Britt; Depypere, Bernard; Van Landuyt, Koenraad
Breast reconstruction in patients who have previously undergone deep inferior epigastric artery perforator flap (DIEAP) reconstruction or abdominoplasty is often challenging. Depending on patients' body habitus, several second-choice flaps have been described such as the transverse upper gracilis (TUG) flap, profundus femoris artery perforator (PFAP) flap, superior gluteal artery perforator (SGAP) flap, and lumbar artery perforator (LAP) flap. Patients who have undergone a DIEAP flap reconstruction or abdominoplasty occasionally present with dog ears on both sides of the abdominal scar. The adipose tissue and skin of these dog ears are supplied by perforators of the deep circumflex iliac artery (DCIA). The DCIA flap was first described in 1979 by Taylor. We introduce this abdominal "dog-ear" flap for autologous breast reconstruction. PMID:26951847
The keystone flap: expanding the dermatologic surgeon's armamentarium.
Hessam, Schapoor; Sand, Michael; Bechara, Falk G
First described in 2003, the keystone flap has become an established plastic and reconstructive surgery technique for the closure of soft tissue defects following the excision of skin tumors. Complex reconstruction procedures may thus be avoided [3]. In dermatosurgery, however, the keystone flap remains largely unknown.Compared to subcutaneous pedicle flaps, the keystone flap technique warrants better vascular supply by additional-ly preserving musculocutaneous and fasciocutaneous perforator vessels [4]. Moreover, the flap is hyperemic compared to the surrounding skin [5]. Adequate perfusion and its specific design result in high safety of the flap. According to both published data and the authors' experience, the keystone flap technique is associated with a low complication rate [1, 6].In summary, the keystone flap method yields good aesthetic and functional results by preserving shape and cont-our, avoiding differences in skin coloration and preserving sensitivity (Figure 1b). The flap is particularly well suited for deep defects with exposed bones or tendons, especially on the extremities or the trunk. Alternative closing options such as secondary intention healing, primary closure, or local flaps appear less adequate in these cases. In addition, skin grafting without long-term wound conditioning–for example negative pressure wound therapy–or expensive der-mal replacement products are not very promising. Thus, the keystone flap provides the dermatosurgeon with an effective alternative to reconstruction techniques. PMID:25640508
Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.
Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina
Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery. PMID:27140865
The clinical application of anterolateral thigh flap.
Lee, Yao-Chou; Chiu, Haw-Yen; Shieh, Shyh-Jou
The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. PMID:22567234
Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review
The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0×3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects. PMID:27123141
Flap advancement coverage after excision of large mucous cysts.
Shin, Eon K; Jupiter, Jesse B
Mucous cysts are common problems seen by hand surgeons. Surgical excision of symptomatic cysts is the most commonly accepted treatment. Removal of large mucous cysts often requires simultaneous flap coverage or skin grafting for the resulting defect. We present the use of a dorsal advancement flap to permit excellent skin coverage after cyst excision with a tension-free closure. PMID:17549023
Prospective evaluation of outcome measures in free-flap surgery.
Kelly, John L; Eadie, Patricia A; Orr, David; Al-Rawi, Mogdad; O'Donnell, Margaret; Lawlor, Denis
Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +/- 29 min) and in those that survived (92 +/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival. PMID:15356760
... This may include deep layers of skin and fat. The area is closed with stitches to place the skin back together. If a large area is biopsied, the surgeon may use a skin graft or flap to replace the skin that was ...
The infrahyoid flap: a comprehensive review of an often overlooked reconstructive method.
Deganello, Alberto; Leemans, C René
The infrahyoid flap is a myocutaneous pedicled flap mainly nourished by the superior thyroid vessels through the perforators of the infrahyoid muscles. This thin and pliable flap provides a skin island of about 7 by 4 cm from the central part of the anterior neck. The flap can be transferred on its pedicle of superior thyroid artery and vein to reconstruct medium sized head and neck defects created after cancer ablation. We have successfully used this flap in a series of 40 cases with no total flap loss and with 1 case of superficial skin necrosis. The aim of this review is to highlight the clinical usefulness of this pedicled flap even in the microvascular free flap era. A comprehensive review of the available literature reporting on the infrahyoid flap has been carried out using a web search. The history of the infrahyoid flap, the surgical technique with technical innovations, the clinical utility and limitations of this flap, are reported and discussed. Among the 7 larger series (cohort larger than 50 cases) a total of 956 flaps were performed, and the global success rate was 91.7%, with failures being mainly related to partial skin necrosis, as the rate of total (skin and muscle) flap necrosis was only 1%. This flap is reliable, easy to harvest during neck dissection, oncologically safe, it does carry a negligible donor site morbidity. This paper highlights how the infrahyoid flap can represent an excellent reconstructive solution in selected patients and head and neck sites. PMID:24856306
Aldo-keto reductase 1C subfamily genes in skin are UV-inducible: possible role in keratinocytes survival.
Marín, Yarí E; Seiberg, Miri; Lin, Connie B
Please cite this paper as: Aldo-keto reductase 1C subfamily genes in skin are UV-inducible: possible role in keratinocytes survival. Experimental Dermatology 2009; 18: 611-618.Abstract: Human skin is endowed with the capacity to synthesize and metabolize steroid hormones, a function of importance in skin physiology and pathology. It is the hormone-regulatory enzymes, including the aldo-keto reductase 1C subfamily (AKR1Cs) that are largely responsible for the local levels of active steroid hormones. AKR1C1 and AKR1C2 inactivate progesterone and 5alpha-dihydrotestosterone, respectively, whereas AKR1C3 activates oestradiol and testosterone. Here, we show that AKR1C1-3 are expressed in keratinocytes and fibroblasts, with marginal expression in melanocytes. In human primary keratinocytes, AKR1C1 and -2 were UVB-inducible in a dose-dependent manner, as shown by quantitative PCR and Western blot analyses. The induction of AKR1C1 by UVB was concomitant with the presence of an apoptotic marker, the cleavage product of poly-ADP ribose polymerase. Similarly, the activation of AKR1C1 and -2 upon UVB exposure was demonstrated in swine skin in vivo and in human skin explants. As expected, hydrogen peroxide-derived reactive oxygen species also induced AKR1C1 and -2 mRNA and protein levels in keratinocytes in a dose-dependent manner. Furthermore, down-regulation of AKR1Cs by small interfering ribonucleic acid led to significantly reduced cell viability. Based on the combined evidence of the presence of an apoptotic marker in the UVB-exposed keratinocytes with increased AKR1Cs expression and reduced cell viability in down-regulated AKR1Cs, we suggest that AKR1C subfamily genes are stress-inducible and might function as survival factors in keratinocytes. PMID:19320734
Basic Perforator Flap Hemodynamic Mathematical Model
Tao, Youlun; Ding, Maochao; Wang, Aiguo; Zhuang, Yuehong; Chang, Shi-Min; Mei, Jin; Hallock, Geoffrey G.
Background: A mathematical model to help explain the hemodynamic characteristics of perforator flaps based on blood flow resistance systems within the flap will serve as a theoretical guide for the future study and clinical applications of these flaps. Methods: There are 3 major blood flow resistance network systems of a perforator flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a perforator flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given perforator flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a perforator flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations.
Arterialized Venous Bone Flaps: An Experimental Investigation
Borumandi, Farzad; Higgins, James P.; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander
In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705
Arterialized Venous Bone Flaps: An Experimental Investigation.
Borumandi, Farzad; Higgins, James P; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander
In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705
Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle.
Koshima, I; Yamamoto, H; Hosoda, M; Moriguchi, T; Orita, Y; Nagayama, H
Chimeric composite flaps combined using microanastomoses consist of two or more flaps or tissues, each with an isolated pedicle and a single vascular source. Free combined chimeric flaps using the lateral circumflex femoral system were used to treat massive composite defects of the head and neck in 10 cases. A combined anterolateral thigh flap and vascularized iliac bone graft based on the lateral circumflex femoral system and the deep circumflex iliac system was the most commonly used combination. An anteromedial thigh flap and a paraumbilical perforator-based flap were also combined with this principal combination. The advantages of this chimeric flap over other osteocutaneous flaps are: (1) The flap is relatively thin and the pedicle vessels are up to 10 cm longer and are wider than those of other flaps for easier harvesting of the flap. (2) It is unnecessary to reposition the patient. (3) The vascular pedicle to the skin can be separated from that of the bone. (4) The donor site is not close to the recipient site. (5) The donor scar is in an unexposed area. (6) The skin territory of this flap is extremely wide. (7) A combined anterolateral and anteromedial thigh flap and vascularized iliac bone graft can be easily obtained as an extended combined osteocutaneous flap. (8) Other neighboring skin flaps, such as a groin flap, a paraumbilical perforator-based flap, or a medial thigh flap, can be combined with this chimeric flap because several major muscle branches to be anastomosed derive from the lateral circumflex femoral system. Chimeric composite flaps using the lateral circumflex femoral system are considered suitable for the repair of massive composite defects of the head and neck. PMID:8341739
["Separation delay" on random flap: an experimental and clinical practice on delayed flap].
Zhao, S Q
A new technique of delayed flap, that is called "Separation delay" by the authors, has succeeded in animal experiment and clinical practice. In the years of 1985-1989, 11 cases of random skin flaps on the patients had been performed with the new method. All the flaps look like table tennis rackets. It's pedicle is very narrow, simultaneously, the flap itself is very large. So it is quite suitable for repairing a neighbouring wound surface. It can be rotated 180 degrees. "The Separation delay" is a handy way without microsurgical technique. It is also an useful and reliable technique for resurfacing wound on plastic and reconstructive surgery. PMID:2086104
Assessing safety of negative-pressure wound therapy over pedicled muscle flaps: A retrospective review of gastrocnemius muscle flap.
Lance, Samuel; Harrison, Lindsey; Orbay, Hakan; Boudreault, David; Pereira, Gavin; Sahar, David
The use of negative-pressure wound therapy (NPWT) for management of open wounds and immobilization of split-thickness skin grafts (STSGs) over wounds has been well described. However, there is a concern for potential compromise of flap viability when NPWT is used for skin grafts over pedicled muscle flaps. We have used NPWT to immobilize STSGs in eight patients who underwent a pedicled gastrocnemius muscle flap operation in our department. We applied a negative pressure of -75 mmHg on the muscle flaps for 5 days postoperatively. All wounds healed successfully, with a 97.5 ± 5.5% mean STSG uptake. No flap necrosis was observed. In our series, the use of NPWT for fixation of STSGs over pedicled gastrocnemius muscle flap was effective and had no negative impact on flap viability. PMID:26732293
Thumb Reconstruction Using Foucher's Flap
Kola, Nardi
BACKGROUND: Extensive pulp defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. AIM: This paper is focused in Foucher's neuro vascular flap. First DMCA or Foucher's pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance. MATERIAL AND METHODS: The first dorsal metacarpal artery (FDMCA) arises from the radial artery in the first intermetacarpal space, just distal to the tendon of the extensor pollicis longus. Pulp area of the thumb is the area where Foucher's flap is more utilizable. This technique has other applications such as first web reconstruction, thumb lengthening, and following resection of tumors on the dorsum of the hand. RESULTS: We have in study 7 cases with work related trauma in two years period of time, between 2012 and 2014. We had only one partial flap survival and all the other flaps survived entirely. We have also taken in consideration subjective satisfaction with a range score from 4 to 10, cold intolerance, flap area and donor site sensibility with a range score from low to medium to normal. CONCLUSION: Careful pedicle discovery, secured elevation, pedicle strangulation prevention are very important for flap survival.
Versatility of reverse sural fasciocutaneous flap for reconstruction of distal lower limb soft tissue defects.
Pan, Hai-tao; Zheng, Qi-xin; Yang, Shu-hua; Wu, Bin; Liu, Jian-xiang
In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years (14-83 years) and with a medium follow-up period of 18 months (12-24 months). Of all the cases of acute trauma, there were 10 cases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes (2 cases), advanced age (>65 years, 3 cases) and cigarette smoking (6 cases). The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the
Development and validation of a predictive model for survival and growth of Salmonella on chicken skin stored at 4 to 12 deg C
Technology Transfer Automated Retrieval System (TEKTRAN)
The minimum growth temperature for Salmonella is in the range of 6 to 8'C, which is within temperatures encountered during cold storage of poultry. The objective of this study was to investigate and model survival and growth of Salmonella on chicken skin during cold storage. Chicken skin was inocu...
The Bmi-1 polycomb protein antagonizes the (-)-epigallocatechin-3-gallate-dependent suppression of skin cancer cell survival.
Balasubramanian, Sivaprakasam; Adhikary, Gautam; Eckert, Richard L
The polycomb group (PcG) proteins are epigenetic regulators of gene expression that enhance cell survival. This regulation is achieved via action of two multiprotein PcG complexes--PRC2 (EED) and PRC1 [B-cell-specific Moloney murine leukemia virus integration site 1 (Bmi-1)]. These complexes modulate gene expression by increasing histone methylation and reducing acetylation--leading to a closed chromatin conformation. Activity of these proteins is associated with increased cell proliferation and survival. We show increased expression of key PcG proteins in immortalized keratinocytes and skin cancer cell lines. We examine the role of two key PcG proteins, Bmi-1 and enhancer of zeste homolog 2 (Ezh2), and the impact of the active agent in green tea, (-)-epigallocatechin-3-gallate (EGCG), on the function of these regulators. EGCG treatment of SCC-13 cells reduces Bmi-1 and Ezh2 level and this is associated with reduced cell survival. The reduction in survival is associated with a global reduction in histone H3 lysine 27 trimethylation, a hallmark of PRC2 complex action. This change in PcG protein expression is associated with reduced expression of key proteins that enhance progression through the cell cycle [cyclin-dependent kinase (cdk)1, cdk2, cdk4, cyclin D1, cyclin E, cyclin A and cyclin B1] and increased expression of proteins that inhibit cell cycle progression (p21 and p27). Apoptosis is also enhanced, as evidenced by increased caspase 9, 8 and 3 cleavage and increased poly(adenosine diphosphate ribose) polymerase cleavage. EGCG treatment also increases Bax and suppresses Bcl-xL expression. Vector-mediated enhanced Bmi-1 expression reverses these EGCG-dependent changes. These findings suggest that green tea polyphenols reduce skin tumor cell survival by influencing PcG-mediated epigenetic regulatory mechanisms. PMID:20015867
Dose-survival relationship for epithelial cells of human skin after multifraction irradiation: evaluation by a quantitative method in vivo
Arcangeli, G.; Mauro, F.; Nervi, C.; Withers, H.R.
The dose-survival relationship for normal epithelial cells after single and fractionated radiation exposures has been established by Withers for the mouse, but it is not available for humans according to a strict criterion for survival of single cell reproductive integrity. In an attempt to obtain such a quantitative estimation, 2 patients requiring radical radiation therapy to the chest wall were treated according to particular Multiple Daily Fractionation (MDF) protocols: i) 250 + 150 + 150 rad/day, 4 hr interval, 5 days/week; and ii) 150 + 150 + 150 + 150 rad/day, 3.5 hr interval, 5 days/week. In both cases, different strips of skin received different total doses: 6300, 6850, and 7150 rad, and 6300, 6750, and 7200 rad, respectively. In case (i), moist desquamation appeared and thereafter repopulating colonies of epithelium could be recognized and counted. Using these counts a survival curve having a D/sub o/ value of 490 +- 150 rad was estimated according to the formula proposed by Withers. In case (ii), no moist desquamation was reached at the doses delivered. The difference observed may imply that the initial region of the survival curve deviates appreciably from exponential between doses of 150 and 250 rad. If such is the case, a /sub 1/D/sub o/ value of 490 rad may represent an underestimate. These results are discussed from the point of view of both the shape of the survival curve and the effectiveness of nonconventional fractionation courses.
Skew flap for staged below-knee amputation in sepsis.
Matthews, Christopher O; Williams, Ian M; Lewis, Peter; McLain, A David; Twine, Christopher P
Skew flap amputation was first described in the 1980s but was never as popular as the long posterior flap amputation. This report describes a staged below-knee amputation in sepsis, with pus throughout the leg and a lack of skin coverage. One benefit of skew flaps never previously published is the fact that the suture line is not directly over the tibia. Therefore, an open wound or incomplete skin coverage is not as important as in long posterior flaps where it often leads to bone exposure and revision amputation. These benefits were utilized in this case leading to stump healing. PMID:26002782
Validation of a predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin for extrapolation to a previous history of frozen storage
Technology Transfer Automated Retrieval System (TEKTRAN)
A predictive model for survival and growth of Salmonella Typhimurium DT104 on chicken skin was evaluated for its ability to predict survival and growth of the same organism after frozen storage for 6 days at -20 C. Experimental methods used to collect data for model development were the same as tho...
Fasciocutaneous flap for vaginal and perineal reconstruction
Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.
A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.
Facial artery flaps in facial oncoplastic reconstruction.
Fabrizio, Tommaso
The face is one of the common sites for cutaneous cancer localization. It is well known that the face is the localization of more than 50% of skin cancers. Nowadays, the principles of modern "oncoplasty" recommend the complete excision of the cancer and the reconstruction with respect to cosmetic features of the face in terms of good color, good softness, and good texture of the flaps, utilized in cancer repair. The oncological and cosmetic results of facial reconstruction are strictly linked and the modern plastic and reconstructive surgeon must respect both oncological and cosmetic aspects. For that reason the best solution in facial cancer repair is the utilization of locoregional flaps based on the tributary vessels of the facial artery. In consideration of the dimension of recipient area to repair, the retroangular flap (RAF) or the submental flap could be used. This article is voted to illustrate a very large and long-term casuistry dedicated to these flaps. PMID:24037925
Efficacy of sunscreens containing pre-tocopheryl in a surviving human skin model submitted to UVA and B radiation.
Boisnic, S; Branchet-Gumila, M-C; Merial-Kieny, C; Nocera, T
The aim of the present study was to evaluate by means of histological and biochemical tools the additive efficacy of pre-tocopheryl during photoprotection using a sunscreen containing mineral sunblock agents 50B-10A (TiO(2), ZnO) and pre-tocopheryl in comparison to a cream containing only mineral sunblock agents 50B-10A. For this purpose, an ex vivo technique and an acetone-impaired human skin model were used in order to approximate in vivo metabolic conditions. Creams were topically applied to the surface of the epidermis and submitted to UV radiations. Then, human skin explants were maintained alive in organ culture for 3 days. Free radical modulation was analysed by hydroperoxide assay. Epidermal (involucrin, cell proliferation, stratum corneum lipids) and dermal changes (elastic fibres and collagen) were studied. Analysis of ex vivo surviving skin samples impaired by UV irradiations and treated with the mineral sunscreen 50B-10A showed a significant decrease in hydroperoxide production and an improvement in the elastic fibre and collagen network in the dermis. Adding pre-tocopheryl to this formula induced an increase in involucrin and epidermal lipids such as squalenes and ceramides. Altogether, these results confirm the efficacy of the combination of a mineral sunscreen and pre-tocopheryl in photoprotection and free radical protection. PMID:15908761
Survival of Skin Graft between Transgenic Cloned Dogs and Non-Transgenic Cloned Dogs
Kim, Geon A; Oh, Hyun Ju; Kim, Min Jung; Jo, Young Kwang; Choi, Jin; Park, Jung Eun; Park, Eun Jung; Lim, Sang Hyun; Yoon, Byung Il; Kang, Sung Keun; Jang, Goo; Lee, Byeong Chun
Whereas it has been assumed that genetically modified tissues or cells derived from somatic cell nuclear transfer (SCNT) should be accepted by a host of the same species, their immune compatibility has not been extensively explored. To identify acceptance of SCNT-derived cells or tissues, skin grafts were performed between cloned dogs that were identical except for their mitochondrial DNA (mtDNA) haplotypes and foreign gene. We showed here that differences in mtDNA haplotypes and genetic modification did not elicit immune responses in these dogs: 1) skin tissues from genetically-modified cloned dogs were successfully transplanted into genetically-modified cloned dogs with different mtDNA haplotype under three successive grafts over 63 days; and 2) non-transgenic cloned tissues were accepted into transgenic cloned syngeneic recipients with different mtDNA haplotypes and vice versa under two successive grafts over 63 days. In addition, expression of the inserted gene was maintained, being functional without eliciting graft rejection. In conclusion, these results show that transplanting genetically-modified tissues into normal, syngeneic or genetically-modified recipient dogs with different mtDNA haplotypes do not elicit skin graft rejection or affect expression of the inserted gene. Therefore, therapeutically valuable tissue derived from SCNT with genetic modification might be used safely in clinical applications for patients with diseased tissues. PMID:25372489
The split radial forearm flap for lower leg defects.
van Kampen, Robert J; Corten, Eveline M L; Schellekens, Pascal P A
The conventional free radial forearm flap is a very reliable, long-pedicled flap with thin, pliable skin. These properties make it an excellent choice for high-risk reconstructions or defects requiring only a thin cover. The split radial forearm flap allows primary closure of the donor site and has a large variability in shape and size. In this report, the cutaneous perforators of the radial artery were investigated in fresh cadavers and we present our clinical experience with the split radial artery flap in 9 patients with lower leg defects. Sufficient perforators exist to safely divide the flap proximally and distally into segments. In all clinical cases, the donor site could be closed primarily. All flaps remained viable and 8 of 9 patients obtained an esthetically pleasing result. The split radial forearm free flap is an elegant option for reconstruction of small- to moderate-sized soft tissue defects in the lower extremity. PMID:23657049
Characteristics of Adult T-Cell Leukemia/Lymphoma Patients with Long Survival: Prognostic Significance of Skin Lesions and Possible Beneficial Role of Valproic Acid.
Yves, Plumelle; Stephane, Michel; Rishika, Banydeen; Christine, Delaunay; Gérard, Panelatti
We describe the clinical and biological features of ten patients with a survival superior to ten years (long survival), out of 175 patients diagnosed with Adult T-cell Leukemia/Lymphoma (ATL) in Martinique (1983-2013). There were 5 lymphoma and 5 chronic subtypes. Five of them (3 chronic, 2 lymphoma) had been treated with valproic acid (VA) for neurological disorders developed before or after ATL diagnosis, suggesting a beneficial role for VA as a histone deacetylase inhibitor (HDI) in ATL treatment. Total duration of uninterrupted VA treatment ranged from 8 to 37 years. Overall, the 175 incident ATL cases presented with a median survival of 5.43 months. The five VA-treated (VA(+)) patients presented with longer survival compared to VA treatment-free patients (VA(-)). For chronic subtypes, survival periods were of 213 months for 3 VA(+) patients and of 33 months for 11 VA(-) patients (p = 0.023). For lymphoma subtypes, survival periods were of 144 months for 2 VA(+) patients versus 6 months for 49 VA(-) patients (p = 0.0046). ATL cases with skin lesions, particularly lymphoma subtypes, had a longer survival (13.96 months) compared to those without skin lesions (6.06 months, p = 0.002). Eight out of the 10 patients presenting with long survival had skin lesions. PMID:26199759
Characteristics of Adult T-Cell Leukemia/Lymphoma Patients with Long Survival: Prognostic Significance of Skin Lesions and Possible Beneficial Role of Valproic Acid
Yves, Plumelle; Stephane, Michel; Rishika, Banydeen; Christine, Delaunay; Gérard, Panelatti
We describe the clinical and biological features of ten patients with a survival superior to ten years (long survival), out of 175 patients diagnosed with Adult T-cell Leukemia/Lymphoma (ATL) in Martinique (1983–2013). There were 5 lymphoma and 5 chronic subtypes. Five of them (3 chronic, 2 lymphoma) had been treated with valproic acid (VA) for neurological disorders developed before or after ATL diagnosis, suggesting a beneficial role for VA as a histone deacetylase inhibitor (HDI) in ATL treatment. Total duration of uninterrupted VA treatment ranged from 8 to 37 years. Overall, the 175 incident ATL cases presented with a median survival of 5.43 months. The five VA-treated (VA+) patients presented with longer survival compared to VA treatment-free patients (VA−). For chronic subtypes, survival periods were of 213 months for 3 VA+ patients and of 33 months for 11 VA− patients (p = 0.023). For lymphoma subtypes, survival periods were of 144 months for 2 VA+ patients versus 6 months for 49 VA− patients (p = 0.0046). ATL cases with skin lesions, particularly lymphoma subtypes, had a longer survival (13.96 months) compared to those without skin lesions (6.06 months, p = 0.002). Eight out of the 10 patients presenting with long survival had skin lesions. PMID:26199759
Design and fabrication of an aeroelastic flap element for a Short TakeOff and Landing (STOL) aircraft model
NASA Technical Reports Server (NTRS)
Belleman, G. W.; June, R. R.
A flap element typifying a third element in the flap system of a short takeoff and landing aircraft was designed, fabricated, and instrumented. It was delivered to NASA for flight-simulated testing. The flap element was aluminum skin-stringer-rib construction with adhesive laminated skins. The tests conducted were as follows: (1) sonic check, (2) thermal expansion, (3) end fitting stiffness, (4) material properties, (5) maximum bending stress in the skin, and (6) effective skin width and stringer spacing.
NASA Technical Reports Server (NTRS)
Rao, D. M.
Segmented vortex flaps were suggested as a means of delaying the vortex spill-over causing thrust loss over the outboard region of single-panel flaps. Also proposed was hinge-line setback for exploiting leading-edge suction in conjunction with vortex flaps to improve the overall thrust per unit flap area. These two concepts in combination were tested on a 60-deg cropped delta wing model. Significant improvement in flap efficiency was indicated by a reduction of the flap/wing area from 11.4% of single-panel flap to 6.3% of a two segment delta flap design, with no lift/drag penalty at lift coefficients between 0.5 and 0.7. The more efficient vortex flap arrangement of this study should benefit the performance attainable with flaps of given area on wings of moderate leading-edge sweep.
The posterior calf fascial free flap.
Walton, R L; Matory, W E; Petry, J J
Six posterior calf fascial free flaps were employed to reconstruct defects of the upper and lower extremities. One flap failed due to a constricting dressing. Two flaps sustained partial loss secondary to bleeding and hematoma formation. One flap dehisced at the distal suture line due to mobility of an underlying fracture. All surviving flaps eventually healed and resulted in stable, thin coverage. Donor-site morbidity has been minimal. Shortcomings of this flap model have been defined in the peculiarities of its thinness, diffuse vascular oozing, the extent of the vascular territory, and in postoperative monitoring. These problems are analyzed and recommendations for their resolution are presented. Fascia represents a unique tissue which offers an exciting new dimension in the reconstruction of certain defects--particularly those in which thinness is a desirable option. In the posterior calf model, the inclusion of fat represents an alternative modification that allows the surgeon to tailor the design to a variety of problems where fascia alone is too thin and a cutaneous flap is too thick. This concept may find its greatest application in wounds involving the hand or foot. We believe that this and other fascial flap prototypes may offer an ideal solution for reconstruction of major wounds of the extremities. PMID:3906718
Use of a bilobed gracilis myocutaneous flap in perineal and genital reconstruction.
Vyas, Raj M; Pomahac, Bohdan
The gracilis myocutaneous flap has limited functional donor site morbidity and effectively contours genitoperineal reconstructions. When harvested using a traditional vertical skin paddle, distal-tip necrosis (secondary to inconsistent perforator anatomy) is a well-documented complication. Orienting the skin paddle transversely provides a reliable alternative with a shorter rotational arc but results in a more conspicuous deformity and smaller skin paddle when primary closure is desired. On the basis of recent anatomic studies, we designed a pedicled gracilis myocutaneous flap with a bilobed cutaneous paddle to maximally incorporate both the transverse and longitudinal dimensions of the flap's nearly circular angiosome. The bilobed design allows harvest of a larger transverse skin flap (with a shorter arc of rotation) while a shorter, more dependable vertical skin flap is inset into the transverse flap donor site (rather than inside the critical wound bed). Herein, we detail our surgical technique and provide 2 illustrative case examples. PMID:20606582
Deep circumflex iliac artery (DCIA) free flap without DCIA: report of a unique case.
Jairath, David; Hage, J Joris
The iliac crest free flap is a reliable source of cancellous bone, muscle, and skin. The vascularization of this flap arises from the deep circumflex iliac artery (DCIA) which allegedly is always present. The authors report a unique case of successful microvascular transplantation of an iliac crest osteomyocutaneous free flap in a patient in whom the DCIA and DCIV were absent. PMID:15534778
Histochemical and biochemical modifications induced by experimental irradiation of human skin maintained in survival conditions and modulation by application of an emulsion containing trolamine.
Boisnic, S; Branchet-Gumila, M C; Nizri, D; Ben Slama, L
Radiotherapy continues to cause skin disorders. In this article, with the aid of our human skin model maintained in ex vivo survival conditions for 15 days, we describe the modifications caused by irradiation and their modulation by a trolamine-containing emulsion (Biafine). Normal human skin fragments were maintained in organ culture. One ionizing radiation session with 5 Gy was applied. Skin parameters were evaluated 24 h after the radiation session and were compared with a nonirradiated skin fragment: vascular modifications (histology), edema, epithelial proliferation, interleukin (IL)-1alpha and IL-6. Another series of skin fragments was maintained in survival conditions for 15 days after the radiation session to evaluate collagen neosynthesis by fibroblasts and any vascular changes (CD34). After irradiation the basal cell proliferation was reduced by approximately 50%. Extensive vasodilation occurred with altered capillary permeability accompanied by decreased CD34 transmembrane protein expression. Collagen synthesis and IL-1 secretion were increased. Biafine significantly reduced capillary alterations, restored CD34 expression as well as epithelial cell proliferation and significantly decreased collagen synthesis and IL-1 expression. With this ex vivo human skin model we confirmed the main modifications induced by radiotherapy as previously described in animal models: decreased basal cell proliferation and endothelial cell alterations and increased collagen synthesis by fibroblasts, probably under the influence of IL-1. The effect of Biafine emulsion on these histological and biochemical parameters may support its clinical efficacy. PMID:12854882
Superthin Abdominal Wall Glove-Like Flap Combined With Vacuum-Assisted Closure Therapy for Soft Tissue Reconstruction in Severely Burned Hands or With Infection.
Wang, Fei; Liu, Sheng; Qiu, Le; Ma, Ben; Wang, Jian; Wang, Yong-Jie; Peszel, April; Chen, Xu-Lin
Severe burn and infection to hands always involves the deep structures, such as tendons, joints, and bones. These wounds cannot be closed immediately and therefore creates a high risk for complication. We presented 9 cases with deep dermal burns to the dorsal of the hand (6 electrical burns and 3 thermal crush injuries) with wound infections in 2 cases. The vacuum-assisted closure system was used continuously until the flap reconstruction was performed. A random pattern and superthin abdominal wall skin flap-like glove was designed. The flap was transferred to the defected portion of the dorsum of the hand and resected from the abdominal wall about 3 weeks later. The flaps in 8 of the patients treated by this technique survived completely and partial necrosis of the distal flap occurred in 1 patient. The defect resolved after operative treatment and the function of the hands and fingers were successfully salvaged. All patients resulted in having a satisfactory aesthetic outcome with no or minor discomfort at the abdominal donor area. Integration of the vacuum-assisted closure system and the superthin abdominal wall glove-like flap reconstruction appeared to be successful and should be considered in patients with severely burned hands. PMID:26418768
Immediate nipple reconstruction with thoracodorsal artery perforator flap in breast reconstruction by latissimus dorsi myocutaneous flap in patients with Poland's syndrome.
He, Jinguang; Xu, Hua; Wang, Tao; Qiao, Yufei; Zhang, Yi; Dong, Jiasheng
Loss of long-term projection is the major disadvantage of nipple reconstruction using local flaps. We report a technique of immediate perforator flap nipple reconstruction in breast reconstruction by latissimus dorsi (LD) myocutaneous flap in patients with Poland's syndrome. From March 2007 to July 2012, 12 female patients (age range, 15-21 years) underwent breast reconstructions and immediate nipple reconstructions. A thoracodorsal artery perforator (TAP) flap was simultaneously raised on the LD muscle flap and folded by itself to form the nipple. Both the LD flap and TAP flaps survived postoperatively. The nipple projection was measured by a caliper, and the average loss was 29% by the 1-year follow-up. Eleven patients considered the aesthetic appearance of reconstructed breast and nipple to be very good or good. The immediate nipple reconstruction with TAP flap could be safely performed and results in considerable satisfaction in breast reconstruction by LD myocutaneous flap in patients with Poland's syndrome. PMID:25752505
NASA Technical Reports Server (NTRS)
Andrews, D. G. (Inventor)
Variable camber actuator assemblies broaden the range of speeds at which lift to drag performance is maximized for slotted flap wings. Lift is improved over a broader range of cruising speeds by varying wing camber with rotational flap movements that do not introduce wing slots and induced drag. Forward flaps are secured to forward flange links which extended from, and are a part of forward flap linkage assemblies. The forward flaps rotate about flap pivots with their rotational displacement controlled by variable camber actuator assemblies located between the forward flaps and the forward flange links. Rear flaps are held relative to the forward flaps by rear flap linkage assemblies which may act independently from the forward flap linkage assemblies and the variable camber actuator assemblies. Wing camber is varied by rotating the flaps with the variable camber actuator assemblies while the flaps are in a deployed or tucked position. Rotating the flaps in a tucked position does not introduce significant wing surface discontinuities, and reduces aircraft fuel consumption on most flight profiles.
The Effect of Epigallocatechin Gallate on Flap Viability of Rat Perforator Abdominal Flaps.
Aksakal, İbrahim Alper; Küçüker, İsmail; Önger, Mehmet Emin; Engin, Murat Sinan; Keleş, Musa Kemal; Demir, Ahmet
Background Epigallocatechin gallate (EGCG) is a substance abundant in green tea. In this study, the effects of EGCG on perforator flap viability were investigated. Methods A total of 40 rats were assigned to four groups of 10 each. In each subject, a 4 × 6 cm abdominal skin flap was raised and adapted back onto its place. In the control group, no further procedures were taken. In the flap group, 40 mg/kg/d EGCG was injected into the flap. In the gavage group, 100 mg/kg/d EGCG was given through a feeding tube. In the intraperitoneal group, 50 mg/kg/d EGCG was injected intraperitoneally. On the 7th postoperative day, flaps were photographed and the viable areas were measured and compared via a one-way analysis of variance. Results The ratios of viable and contracted flap area were 9.15/12.01, 4.59/16.46, 11.56/11.20, and 11.65/10.77 cm(2) for the control, flap group, gavage group, and intraperitoneal group, respectively. While the flap group yielded the worst results in the sense of flap contraction and viability (p < 0.001), the gavage and intraperitoneal groups were significantly better than those of the control group (p = 0.03). Histologically, epidermal, papillary dermal, and capillary tissue volumes were evaluated. In comparison to the control group, the flap group yielded significantly increased epidermal and dermal volumes (p = 0.03), however, these values were significantly decreased (p = 0.04) in the gavage and intraperitoneal groups. Capillary volumes were significantly decreased in EGCG treatment groups (p < 0.01). Conclusion Our experiment has shown that oral and intraperitoneal administration of EGCG increases the perforator flap viability when compared with controls, while direct injection decreases the viability. PMID:26919381
Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report.
Scaglioni, Mario F; Chen, Yen-Chou; Yang, Johnson Chia-Shen
Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction. PMID:26314393
Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients
If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6–53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and
Propeller thoracodorsal artery perforator flap for breast reconstruction
Angrigiani, Claudio; Escudero, Ezequiel; Artero, Guillermo; Gercovich, Gustavo; Deza, Ernesto Gil
Background The thoracodorsal artery perforator (TDAP) flap has been described for breast reconstruction. This flap requires intramuscular dissection of the pedicle. A modification of the conventional TDAP surgical technique for breast reconstruction is described, utilizing instead a propeller TDAP flap. The authors present their clinical experience with the propeller TDAP flap in breast reconstruction alone or in combination with expanders or permanent implants. Methods From January 2009 to February 2013, sixteen patients had breast reconstruction utilizing a propeller TDAP flap. Retrospective analysis of patient characteristics, clinical indications, procedure and outcomes were performed. The follow-up period ranged from 4 to 48 months. Results Sixteen patients had breast reconstruction using a TDAP flap with or without simultaneous insertion of an expander or implant. All flaps survived, while two cases required minimal resection due to distal flap necrosis, healing by second intention. There were not donor-site seromas, while minimal wound dehiscence was detected in two cases. Conclusions The propeller TDAP flap appears to be safe and effective for breast reconstruction, resulting in minimal donor site morbidity. The use of this propeller flap emerges as a true alternative to the traditional TDAP flap. PMID:25207210
Preservation of Hand Function Using Muscle Perforator Flaps
Adequate soft tissue coverage is imperative after any interventions performed to maximize or preserve hand function. Although this can most simply be achieved by primary closure or a skin graft if possible, often a vascularized flap will be preferable, especially if a later secondary procedure is planned. Even moderately sized skin deficits of the upper extremity, and especially if involving the hand itself, can be better covered using a free tissue transfer. Many reasonable options in this regard are available. Muscle perforator flaps, as a relatively new variant of a fasciocutaneous flap, have unique attributes, including availability, diversity, accessibility, large size, and lengthy vascular pedicle, and since no muscle need be included, donor site function is preserved. As is shown here in a series of nine muscle perforator flaps in eight patients, these represent yet another alternative that should be considered if selection of a free flap is indicated to maintain hand function. PMID:18780005
Skin and Neourethral Necrosis in Staged Hypospadias Repair
Mahdavi, Alireza; Sarafi, Mehdi
Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage with scrotal flaps. PMID:27398320
Skin and Neourethral Necrosis in Staged Hypospadias Repair.
Mirshemirani, Alireza; Mahdavi, Alireza; Sarafi, Mehdi
Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage with scrotal flaps. PMID:27398320
Versatility of V-Y Flap in Gluteal Area
El-Sabbagh, Ahmed
BACKGROUND Lesions in perineal area are common. The usual treatment is coverage by skin graft and flaps which may be local, pedicled or free types. In this paper V-Y flaps were used to cover the defects. METHODS V-Y flaps were used in the gluteal area in 15 patients. Lesions were due to different causes. RESULTS Of 15 patients, 11 were males and 4 were females. Their ages ranged from 3 weeks to 52 years old. Two cases were due to myelomeningocele, necrotizing fasciitis (2 cases) and the rest were due to bed sores (11 cases). The flaps were located over the trochanter (3 cases), ischial (6 cases) and sacral (6 cases). Good healing and durable coverage were obtained in all cases except one case. CONCLUSION V-Y flap as a working horse flap is recommended in the gluteal area. PMID:27579271
Upper lip reconstruction with a radial forearm free flap.
Mandrekas, A D; Page, R; O'Neill, T J
Although there are several methods available for lip reconstruction, the challenge for plastic surgeons is young children, in whom there is no laxity of skin. Free-tissue transfer is the method of choice in young children to avoid large unsightly scars and severe distortion of facial appearance. The radial forearm free flap is an ideal flap for lip reconstruction because it is thin and can be folded to restore both the skin and the inner lining. We present reconstruction of half the upper lip in a young girl, in whom the radial forearm free flap was folded to replace the full-thickness defect. PMID:7918852
High-fat diet exacerbates inflammation and cell survival signals in the skin of ultraviolet B-irradiated C57BL/6 mice
Meeran, Syed M.; Singh, Tripti; Nagy, Tim R.; Katiyar, Santosh K.
Inflammation induced by chronic exposure to ultraviolet (UV) radiation has been implicated in various skin diseases. We formulated the hypothesis that a high-fat diet may influence the UV-induced inflammatory responses in the skin. C57BL/6 mice were fed a high-fat diet or control diet and exposed to UVB radiation (120 mJ/cm{sup 2}) three times/week for 10 weeks. The mice were then sacrificed and skin and plasma samples collected for analysis of biomarkers of inflammatory responses using immunohistochemistry, western blotting, ELISA and real-time PCR. We found that the levels of inflammatory biomarkers were increased in the UVB-exposed skin of the mice fed the high-fat diet than the UVB-exposed skin of the mice fed the control diet. The levels of inflammatory biomarkers of early responses to UVB exposure (e.g., myeloperoxidase, cyclooxygenase-2, prostaglandin-E{sub 2}), proinflammatory cytokines (i.e., tumor necrosis factor-alpha, interleukin-1beta, interleukin-6), and proliferating cell nuclear antigen and cell survival signals (phosphatidylinositol-3-kinase and p-Akt-Ser{sup 473}) were higher in high-fat-diet-fed mouse skin than control-diet-fed mouse skin. The plasma levels of insulin growth factor-1 were greater in the UVB-irradiated mice fed the high-fat diet than the UVB-irradiated mice fed the control diet, whereas the levels of plasma adiponectin were significantly lower. This pronounced exacerbation of the UVB-induced inflammatory responses in the skin of mice fed a high-fat diet suggests that high-fat diet may increase susceptibility to inflammation-associated skin diseases, including the risk of skin cancer.
Rotational and Axial Pattern Flaps in a Cat for Wound Reconstruction Secondary to Urethral Rupture.
Watrous, Gwyneth K; Martin, Dawn M; Plesman, Rhea L; Ringwood, Brendon
A 3 yr old intact male domestic shorthair cat was presented with urine extravasation from urethral rupture. Extensive skin necrosis developed in the perineal region and left hind limb that necessitated delayed primary wound closure with a caudal superficial epigastric axial pattern flap, scrotal and preputial rotational skin flaps, and perineal urethrostomy. PMID:26606210
What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.
Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan
Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas. PMID:25785382
Combining flaps. Medical canthal/lateral nasal root reconstruction utilizing glabellar "fan" and cheek rotation flaps--an O-to-Z variation.
Field, L M; Dachow-Siwiec, E; Szymanczyk, J
An increased use of multiple flaps applied to single reconstructive problems is encouraged. Removal of a basal cell carcinoma involving the medial canthus and adjacent lateral nasal root skin resulted in significant defect. When a glabellar "fan" flap failed to provide adequate tissue for canthal reconstruction without undue distortion, a preplanned medial cheek rotation flap followed sequentially in the repair process. The basic principles of an O-to-Z flap reconstruction were therefore fulfilled by conjoining two different flap design applications. PMID:8151035
Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps
Muto, Mayu; Ogawa, Marina; Shibuya, Mai; Yasumura, Kazunori; Kobayashi, Shinji; Ishikawa, Takashi; Maegawa, Jiro
Background: For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity. Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon. Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps). Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative. PMID:25878925
Clinical reliability of radial forearm free flap in repair of buccal defects
Background The ideal method for buccal defects should provide good outcome of both function and appearance; our goal is to highlight the reliability of radial forearm flap in buccal reconstruction. Methods A retrospective study was conducted. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects. We analyzed the superiority and reliability of the flap; in addition, we reviewed some related literature and made a comparison between radial forearm flap and platysma flap. Results All radial forearm flaps totally survived, but two flaps suffered venous obstruction, hematoma, respectively. Radial forearm flap preserved the original interincisal distance well. In our follow-up, all patients had sufficient mouth-opening width (mean: 4.3 cm). Conclusion Radial forearm flap is a reliable method for buccal defect reconstruction. PMID:23363472
Comparison of the effects of different vasoactive and antiplatelet drugs on perforator flap viability. An experimental study.
Demir, Bülent; Engin, Murat Sinan; Keleş, Musa Kemal; Küçüker, İsmail; Yosma, Engin
Perforator flaps are very popular in the reconstruction of soft tissue defects. As these flaps generally depend on a single perforator, drugs that increase the perfusion of the flap and/or prevent vascular complications may increase flap survival. In this study, we compared the effects of systemically administered hydralazine (arterial vasodilator via potassium channels), nifedipine (arterial vasodilator via calcium channels), piracetam (antiplatelet and regulator of microcirculation) and alprostadil (vasodilator, antiplatelet, rheological and cytoprotective) on flap survival in a rat epigastric artery perforator flap model. The percentage of necrosis was measured on each flap and evaluated using one-way analysis of variance (Anova). Histopathological analyses were also performed. Mean flap survival area was 3.85 cm(2) in the control group. Mean flap survival area was 4.88 cm(2) in the nifedipine group, 4.69 cm(2) in the hydralazine group, 10.55 cm(2) in the piracetam group and 11.3 cm(2) in the alprostadil group. When compared with the control group, all drugs except hydralazine improved flap survival; piracetam and alprostadil yielded significantly better results than nifedipine. Only the alprostadil group showed signs of improved vascularity in the histological analysis. As far as perforator flap survival is concerned, drugs that regulate the microcirculation by a combination of different antiaggregation mechanisms appear more beneficial than single action vasodilators. Alprostadil, a synthetic PGE-1 analogue, has combined antiplatelet and vasoactive effects that further increase flap survival. PMID:27117026
Development of a Mouse Model of Abdominal Cutaneous Flaps for Breast Reconstruction
Womac, Daniel John; Palanisamy, Arun Prathap; Eslick, Rene; Schimpf, Dennis Kenneth; Chavin, Kenneth David
Autologous tissue transfer, in addition to replacing tissue that was lost during injury or surgery, offers women an excellent option to improve cosmetic appearance and self-confidence following mastectomy due to breast cancer. However, flap necrosis is a complication in obese patients undergoing this procedure. We created a mouse model to study the flap-related complications that leads to decreased flap survival in autologous breast reconstruction. Methods Left superficial inferior epigastric (SIE) pedicle abdominal-cutaneous flaps were elevated in 8 week-old, obese ob/ob male mice and their lean littermates. Flaps were followed by serial photography. Area of flap necrosis was measured at 7 days. Statistical analysis was performed. Results Necrosis was observed at the distal margin of the flaps, in both lean and obese groups. Lean left SIE flaps (n = 8) had a total area flap necrosis of 9.1% at 7 days whereas obese left SIE flaps (n = 8) had a total area flap necrosis of 45.5% at 7 days. Obese flaps had a statistically significant increase in necrosis compared to the lean flaps, p = 0.001. Conclusions There was a significant difference between flap survival in lean and obese SIE pedicle flaps in our mouse model. We have developed the first flap model of obesity utilizing the superficial epigastric pedicle in the mouse. This model is optimal for future studies to dissect out mechanisms that lead to the complications related to flap survival for breast reconstruction, especially in obese subjects. PMID:23308122
The trapezius osteomusculocutaneous flap in dogs.
Philibert, D; Fowler, J D
A pedicled osteomusculocutaneous flap, composed of the cervical part of the trapezius muscle with its overlying skin and the central spine and body of the scapula, was elevated on the prescapular branch of the superficial cervical vascular pedicle in four dogs. The flap was replaced in an orthotopic location. Bone viability was evaluated using histology, fluorescence bone labeling, and angiography. Bone from the scapular spines had a high percentage of viable osteocytes, positive fluorescence, and vessels were outlined in the angiographic study. Bone from the body of the scapula was not viable based on similar criteria. PMID:8116199
Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study
Pennington, David G.
Background: The maximum weight of tissue that a single perforator can perfuse remains an important question in reconstructive microsurgery. An empirically based equation, known as the flap viability index (FVI), has been established to determine what weight of tissue will survive on one or more perforators. The equation is FVI = Sum d(n)^4/W, where d is the internal diameter of each perforator and W is the final weight of the flap. It has been shown that if FVI exceeds 10, total flap survival is likely, but if under 10, partial flap necrosis is probable. The aim of this study was to measure absolute flow rates in deep inferior epigastric perforator (DIEP) flap pedicles and assess correlation with the determinants of the FVI, perforator diameter and flap weight. Methods: Color Doppler ultrasound was used to quantify arterial flow in 10 consecutive DIEP flap pedicles 24 hours after anastomosis. Results: In single-perforator DIEP flaps, flow rate was highly correlated with perforator diameter (r = 0.82, P = 0.01). Mean arterial flow rate was significantly reduced in DIEP flaps with 2 or more perforators (6 vs 38 cm3/min; P < 0.05). Conclusions: This study confirms that perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival. PMID:25426345
Free Flap Reconstruction for Complex Scalp and Forehead Defects with Associated Full-Thickness Calvarial Bone Resections
Larrañaga, Juan; Rios, Alfredo; Franciosi, Edgardo; Mazzaro, Eduardo; Figari, Marcelo
Extensive defects of the scalp and forehead associated with calvarial bone resections demand complex reconstructions. Free flaps offer vascularized tissue of excellent quality and quantity. We report six patients with extensive scalp and forehead defects associated with calvarial bone resections reconstructed with free flaps. Five patients also required a cranioplasty. The flaps used were two anterolateral thigh flaps, one vastus lateralis flap, one myocutaneous latissimus dorsi flap, one latissimus dorsi flap, and one radial forearm flap. All flaps survived with no partial necrosis. There were no donor site complications. One patient presented an exposure of the alloplastic material used for cranioplasty. We strongly recommend the use of free flaps for this kind of reconstruction. PMID:24294403
Versatility of Pedicled Tensor Fascia Lata Flap: A Useful and Reliable Technique for Reconstruction of Different Anatomical Districts
Akhtar, Md. Sohaib; Khurram, Mohd Fahud; Khan, Arshad Hafeez
Aims and Objectives. The aim of this study was to evaluate the versatility of pedicled tensor fascia lata flap for reconstruction of various anatomical regions. Materials and Methods. In this retrospective study a total of 34 patients with defects over various anatomical regions were included. The defects were located over the trochanter (n = 12), groin (n = 8), perineum (n = 6), lower anterior abdomen (n = 6), gluteal region (n = 1), and ischial region (n = 1). The etiology of defects included trauma (n = 12), infection (n = 8), pressure sores (n = 8), and malignancy (n = 6). Reconstruction was performed using pedicled tensor fascia lata flaps. Patients were evaluated in terms of viability of the flap and donor site morbidity. The technical details of the operative procedure have also been outlined. Results. All the flaps survived well except 5 patients in which minor complications were noted and 1 who experienced complete flap loss. Of those with minor complications, 1 patient developed distal marginal necrosis and 1 developed infection which subsided within three days by dressings and antibiotics and in 2 patients partial loss of the skin graft occurred at the donor site out of which 1 required regrafting and another one healed completely with dressing and antibiotics. All the patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming procedure for the coverage of defects around trochanter, groin, lower anterior abdomen, perineum, and ischial region. PMID:25485149
Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction.
Rozen, Warren Matthew; Patel, Nakul Gamanlal; Ramakrishnan, Venkat V
For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791
Pharmacologic manipulation of the microcirculation in cutaneous and myocutaneous flaps in pigs
Pang, C.Y.; Neligan, P.C.; Nakatsuka, T.; Sasaki, G.H.
The vascular effects of isoxsuprine, diazoxide, and isoproterenol were studied in arterial buttock flaps and latissimus dorsi myocutaneous flaps in pigs. Capillary blood flow to the skin and muscles of these flaps was measured by the radioactive microsphere (15-mu diameter) technique 6 hours postoperatively under pentobarbital anesthesia. It was observed that isoproterenol, a beta-adrenergic receptor agonist, was not effective in augmentation of skin blood flow in the arterial buttock flaps. However, isoproterenol significantly increased capillary blood flow to the arterialized portion of latissimus dorsi myocutaneous flaps compared with controls. Isoxsuprine and diazoxide (vascular smooth muscle relaxants) significantly (p less than 0.05) increased total capillary blood flow to the skin of arterial buttock flaps and to the skin and muscles of the latissimus dorsi myocutaneous flaps. However, the increase in capillary blood flow occurred mainly in the arterialized portion of these flaps. The capillary blood flow, which was supplied by the small arteries in the distal portion of the arterial buttock and latissimus dorsi flaps, was not increased by treatment with isoxsuprine or diazoxide. Therefore, there was also no increase in the maximum distance of capillary blood flow from the pedicle to the distal end of the flaps. These observations led the authors to hypothesize that different sizes (diameters) of arteries in the skin and muscle have different reactivity (or sensitivity) to vasodilatory drugs. In the present experiment, the large dominant artery of the arterial buttock and latissimus dorsi flaps responded to isoxsuprine or diazoxide (vascular smooth-muscle relaxants), resulting in an increase in blood supply to the capillaries in the proximal portion of the flaps.
Leptin deficiency-induced obesity exacerbates ultraviolet B radiation-induced cyclooxygenase-2 expression and cell survival signals in ultraviolet B-irradiated mouse skin
Sharma, Som D.; Katiyar, Santosh K.
Obesity has been implicated in several inflammatory diseases and in different types of cancer. Chronic inflammation induced by exposure to ultraviolet (UV) radiation has been implicated in various skin diseases, including melanoma and nonmelanoma skin cancers. As the relationship between obesity and susceptibility to UV radiation-caused inflammation is not clearly understood, we assessed the role of obesity on UVB-induced inflammation, and mediators of this inflammatory response, using the genetically obese (leptin-deficient) mouse model. Leptin-deficient obese (ob/ob) mice and wild-type counterparts (C57/BL6 mice) were exposed to UVB radiation (120 mJ/cm{sup 2}) on alternate days for 1 month. The mice were then euthanized and skin samples collected for analysis of biomarkers of inflammatory responses using immunohistochemistry, western blotting, ELISA and real-time PCR. Here, we report that the levels of inflammatory responses were higher in the UVB-exposed skin of the ob/ob obese mice than those in the UVB-exposed skin of the wild-type non-obese mice. The levels of UVB-induced cyclooxygenase-2 expression, prostaglandin-E{sub 2} production, proinflammatory cytokines (i.e., tumor necrosis factor-alpha, interleukin-1beta, interleukin-6), and proliferating cell nuclear antigen and cell survival signals (phosphatidylinositol-3-kinase and p-Akt-Ser{sup 473}) were higher in the skin of the ob/ob obese mice than the those in skin of their wild-type non-obese counterparts. Compared with the wild-type non-obese mice, the leptin-deficient obese mice also exhibited greater activation of NF-kappaB/p65 and fewer apoptotic cells in the UVB-irradiated skin. Our study suggests for the first time that obesity in mice is associated with greater susceptibility to UVB-induced inflammatory responses and, therefore, obesity may increase susceptibility to UVB-induced inflammation-associated skin diseases, including the risk of skin cancer.
Prolongation of skin allograft survival in rats by the transplantation of microencapsulated xenogeneic neonatal porcine Sertoli cells.
Bistoni, Giovanni; Calvitti, Mario; Mancuso, Francesca; Arato, Iva; Falabella, Giulia; Cucchia, Rosa; Fallarino, Francesca; Becchetti, Alessio; Baroni, Tiziano; Mazzitelli, Stefania; Nastruzzi, Claudio; Bodo, Maria; Becchetti, Ennio; Cameron, Don F; Luca, Giovanni; Calafiore, Riccardo
Skin rejection remains a major hurdle in skin reconstructive transplantation surgery. In fact, 85% of the grafted patients experience at least one episode of acute skin rejection in the first year. It has been observed that Sertoli cells (SC), when co-transplanted with allo- or xenogeneic cell/tissues, can induce graft acceptance in the absence of systemic immunosuppression. A method aimed at significantly prolonging skin allografts in rats transplanted with barium alginate-based microencapsulated xenogeneic porcine SC (SC-MCs) is described. Results demonstrated that intraperitoneal (IP) transplantation of SC-MCs with high cellular viability and function can significantly prolong allogeneic skin grafts when compared to transplantation controls receiving only empty alginate capsules (E-MCs). Lymphocytic infiltration at the skin graft site was not observed in 80% of the SC-MCs transplanted rats and these recipient animals showed a significant increased expression of T regulatory (Tregs) cells when compared to E-MCs transplantation controls. The findings of this report further substantiate the positive therapeutic effects of SC on transplantation technology mediated by Sertoli cell-induced alterations of the host's immune system and indicate new perspectives and new strategies for successful skin tissue allografts. PMID:22560198
Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle
Liu, Lifeng; Cao, Xuexin; Zou, Lin; Li, Zongyu; Cao, Xuecheng; Cai, Jinfang
The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps. PMID:24376731
Osteoradionecrosis of the olecranon: treatment by radial forearm flap
Thornton, J.W.; Stevenson, T.R.; VanderKolk, C.A.
Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.
Low levels of glutathione are sufficient for survival of keratinocytes after UV irradiation and for healing of mouse skin wounds.
Telorack, Michèle; Abplanalp, Jeannette; Werner, Sabine
Reduced levels of the cellular antioxidant glutathione are associated with premature skin aging, cancer and impaired wound healing, but the in vivo functions of glutathione in the skin remain largely unknown. Therefore, we analyzed mice lacking the modifier subunit of the glutamate cysteine ligase (Gclm), the enzyme that catalyzes the rate-limiting step of glutathione biosynthesis. Glutathione levels in the skin of these mice were reduced by 70 %. However, neither skin development and homeostasis, nor UVA- or UVB-induced apoptosis in the epidermis were affected. Histomorphometric analysis of excisional wounds did not reveal wound healing abnormalities in young Gclm-deficient mice, while the area of hyperproliferative epithelium as well as keratinocyte proliferation were affected in aged mice. These findings suggest that low levels of glutathione are sufficient for wound repair in young mice, but become rate-limiting upon aging. PMID:27262586
Modified free latissimus dorsi musculocutaneous flap in the reconstruction of extensive postoncologic defects in the head and neck region.
Zhu, Guiquan; Li, Chunhua; Chen, Jin; Cai, Yongcong; Li, Ling; Wang, Zhaohui
Oncological resection of advanced carcinoma in the head and neck region results in vast defects. The free latissimus dorsi musculocutaneous flap (FLDMF) is one of the most commonly used flaps for the repair of complex head and neck defects. We tried to modify FLDMF to multiple segments or combine it with acellular dermis to fit through-and-through defects in the oral-facial region during the last decade. A retrospective review of patients with FLDMF reconstruction between 2004 and 2012 was undertaken. Demographics, histology, surgical management, disease control and overall survival, complications, radiotherapy, aesthetic outcome, as well as economic results were analyzed. The majority of the patients (66.7%) had recurrent tumors, and the rest of the patients had primary tumor with stage IV. Fourteen patients (38.9%) had a history of prior radiation therapy, whereas 27.8% of the patients had postoperative radiation therapy. The areas of the defects vary from 52 cm to 180 cm (mean, 86.4 cm). The flap failed in 1 of the 37 patients. The complications at the recipient site include hematoma (n = 6, 16.7%), venous insufficiency (n = 4, 11.1%), infection (n = 3, 8.3), and partial flap necrosis (n = 2, 5.5%). The donor-site complications include delayed healing, necrosis of skin graft, and limited shoulder function. The 5-year overall survival rate was 39.1%, and the 5-year disease-free survival rate was 22.1%. In conclusion, the FLDMF could be modified to fit vast defects where voluminous tissue is needed to be transferred in the head and neck region. PMID:25723665
Dynamic properties of blood flow and leukocyte mobilization in infected flaps
Feng, L.J.; Price, D.C.; Mathes, S.J.; Hohn, D. )
Two aspects of the inflammatory response to infection--blood flow alteration and leukocyte mobilization--are investigated in the canine model. The elevation of paired musculocutaneous (MC) and random pattern (RP) flaps allowed comparison of healing flaps with significant differences in blood flow (lower in random pattern flaps) and resistance to infection (greater in musculocutaneous flaps). Blood flow changes as determined by radioactive xenon washout were compared in normal skin and distal flap skin both after elevation and following bacterial inoculation. Simultaneous use of In-111 labeled leukocytes allowed determination of leukocyte mobilization and subsequent localization in response to flap infection. Blood flow significantly improved in the musculocutaneous flap in response to infection. Although total leukocyte mobilization in the random pattern flap was greater, the leukocytes in the musculocutaneous flap were localized around the site of bacterial inoculation within the dermis. Differences in the dynamic blood flow and leukocyte mobilization may, in part, explain the greater reliability of musculocutaneous flaps when transposed in the presence of infection.
Arsenic transformation predisposes human skin keratinocytes to UV-induced DNA damage yet enhances their survival apparently by diminishing oxidant response
Sun Yang; Kojima, Chikara; Chignell, Colin; Mason, Ronald; Waalkes, Michael P.
Inorganic arsenic and UV, both human skin carcinogens, may act together as skin co-carcinogens. We find human skin keratinocytes (HaCaT cells) are malignantly transformed by low-level arsenite (100 nM, 30 weeks; termed As-TM cells) and with transformation concurrently undergo full adaptation to arsenic toxicity involving reduced apoptosis and oxidative stress response to high arsenite concentrations. Oxidative DNA damage (ODD) is a possible mechanism in arsenic carcinogenesis and a hallmark of UV-induced skin cancer. In the current work, inorganic arsenite exposure (100 nM) did not induce ODD during the 30 weeks required for malignant transformation. Although acute UV-treatment (UVA, 25 J/cm{sup 2}) increased ODD in passage-matched control cells, once transformed by arsenic to As-TM cells, acute UV actually further increased ODD (> 50%). Despite enhanced ODD, As-TM cells were resistant to UV-induced apoptosis. The response of apoptotic factors and oxidative stress genes was strongly mitigated in As-TM cells after UV exposure including increased Bcl2/Bax ratio and reduced Caspase-3, Nrf2, and Keap1 expression. Several Nrf2-related genes (HO-1, GCLs, SOD) showed diminished responses in As-TM cells after UV exposure consistent with reduced oxidant stress response. UV-exposed As-TM cells showed increased expression of cyclin D1 (proliferation gene) and decreased p16 (tumor suppressor). UV exposure enhanced the malignant phenotype of As-TM cells. Thus, the co-carcinogenicity between UV and arsenic in skin cancer might involve adaptation to chronic arsenic exposure generally mitigating the oxidative stress response, allowing apoptotic by-pass after UV and enhanced cell survival even in the face of increased UV-induced oxidative stress and increased ODD. - Highlights: > Arsenic transformation adapted to UV-induced apoptosis. > Arsenic transformation diminished oxidant response. > Arsenic transformation enhanced UV-induced DNA damage.
Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection.
Nakatsuka, Takashi; Harii, Kiyonori; Asato, Hirotaka; Takushima, Akihiko; Ebihara, Satoshi; Kimata, Yoshihiro; Yamada, Atsushi; Ueda, Kazuki; Ichioka, Shigeru
Microvascular free tissue transfer has gained world-wide acceptance as a means of reconstructing post-oncologic surgical defects in the head and neck region. Since 1977, the authors have introduced this reconstructive procedure to head and neck reconstruction after cancer ablation, and a total of 2372 free flaps were transferred in 2301 patients during a period of over 23 years. The most frequently used flap was the rectus abdominis flap (784 flaps: 33.1 percent), followed by the jejunum (644 flaps: 27.2 percent) and the forearm flap (384 flaps: 16.2 percent). In the reported series, total and partial flap necrosis accounted for 4.2 percent and 2.5 percent of cases, respectively. There was a significant statistical difference ( p < 0.05) in complete flap survival rate between immediate and secondary reconstruction cases. The authors believe that the above-mentioned three flaps have been a major part of the armamentarium for head and neck reconstruction because of a lower rate of flap necrosis, compared to other flaps. PMID:14515225
PRFM enhance wound healing process in skin graft.
Reksodiputro, Mirta; Widodo, Dini; Bashiruddin, Jenny; Siregar, Nurjati; Malik, Safarina
Facial plastic and reconstructive surgery often used skin graft on defects that cannot be covered primarily by a local flap. However, wound healing using skin graft is slow, most of the time the graft is contractured and the take of graft is not optimal. Platelet rich fibrin matrix (PRFM) is a new generation of concentrated platelets that produce natural fibrin and reported to speed up the healing process. Application of PRFM in the skin graft implants is expected to increase the survival of the graft. We used porcine as animal models to elucidate the effect of autologous PRFM on wound healing in full-thickness (FTSG) and split-thickness (STSG) skin grafts. Survival level of the skin graft was determined by using ImageJ software based on the formation of collagen type 1 and graft take. We observed that the use of PRFM in FTSG and STSG increased type 1 collagen formation. We also found that PRFM addition in STSG gave the best skin graft take. PMID:25536135
Subcutaneous Nasolabial Flap for Eliminating Depressed Nasal Floor in Adult Cleft Rhinoplasty: Technical Note.
Rahpeyma, Amin; Khajehahmadi, Saeedeh; Torabizadeh Siraji, Arman
Depressed nasal floor extension into the nostril in cleft patients is difficult to solve. Suggested ways for solving this problem need skin incisions other than routine open rhinoplasty incisions. Nasolabia subcutaneous flap makes the infrastructure in depressed nasal floor in cleft patients. Alar advancement and medial nasal floor triangular flap cover it. PMID:26180711
Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome
Changchien, Chih-Hsuan; Chen, Wei-Chen; Su, Yu-Min
Abstract We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate. PMID:27583272
Utility of the quadrilobe flap for repairing defects of the nasal tip.
Ong, Suyin; Mortimer, Neil J; Salmon, Paul Jm
The quadrilobe flap allows the mobilisation of the skin of the upper nose and nasofacial sulcus to the distal nose while avoiding unfavourable tension vectors that would distort the free margin of the ala. We report our experience over the past 3 years in the first case series of quadrilobe flaps for repair of surgical defects on the nose. PMID:27029409
Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome.
Changchien, Chih-Hsuan; Chen, Wei-Chen; Su, Yu-Min
We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate. PMID:27583272
The Modified 3-square Flap Method for Reconstruction of Toe Syndactyly
Watanabe, Ayako
Bandoh reported the 3-square-flap method as a procedure for interdigital space reconstruction in patients with minor syndactyly. We recently modified this flap design so that it could be used in the treatment of toe syndactyly involving fusion of the areas distal to the proximal interphalangeal joint. With our method, the reconstructed interdigital space consists of 4 oblong flaps (A through D). Flaps A and D are designed on the dorsal side, flap B is designed on the frontal plane of the interdigital space, and flap C is designed on the plantar side. Flaps A, B, and C are raised immediately below the dermis in a manner that allowed slight fat tissue to adhere to each flap. Flap D is freed to a degree minimally needed for dislocation, while leaving a thick subcutaneous pedicle. Flaps A, B, and C are each folded in 90 degrees; flap D is dislocated to the proximal plane of the reconstructed digit, followed by skin suturing. In this process, suturing is avoided between flaps A and C, between flaps A and D, and between flaps B and D. During the period of 2011 to 2015, we treated 8 patients of toe syndactyly involving fusion distal to the proximal interphalangeal joint. Cases of congenital syndactyly received surgery between the ages of 8 and 11 months. Using this technique, flap ischemia/necrosis was not observed. During the postoperative follow-up period, the interdigital space retained sufficient depth without developing any scar contracture. No case required additional surgery. PMID:27536472
The Modified 3-square Flap Method for Reconstruction of Toe Syndactyly.
Iida, Naoshige; Watanabe, Ayako
Bandoh reported the 3-square-flap method as a procedure for interdigital space reconstruction in patients with minor syndactyly. We recently modified this flap design so that it could be used in the treatment of toe syndactyly involving fusion of the areas distal to the proximal interphalangeal joint. With our method, the reconstructed interdigital space consists of 4 oblong flaps (A through D). Flaps A and D are designed on the dorsal side, flap B is designed on the frontal plane of the interdigital space, and flap C is designed on the plantar side. Flaps A, B, and C are raised immediately below the dermis in a manner that allowed slight fat tissue to adhere to each flap. Flap D is freed to a degree minimally needed for dislocation, while leaving a thick subcutaneous pedicle. Flaps A, B, and C are each folded in 90 degrees; flap D is dislocated to the proximal plane of the reconstructed digit, followed by skin suturing. In this process, suturing is avoided between flaps A and C, between flaps A and D, and between flaps B and D. During the period of 2011 to 2015, we treated 8 patients of toe syndactyly involving fusion distal to the proximal interphalangeal joint. Cases of congenital syndactyly received surgery between the ages of 8 and 11 months. Using this technique, flap ischemia/necrosis was not observed. During the postoperative follow-up period, the interdigital space retained sufficient depth without developing any scar contracture. No case required additional surgery. PMID:27536472
Effective delivery of stem cells using an extracellular matrix patch results in increased cell survival and proliferation and reduced scarring in skin wound healing.
Lam, Mai T; Nauta, Allison; Meyer, Nathaniel P; Wu, Joseph C; Longaker, Michael T
Wound healing is one of the most complex biological processes and occurs in all tissues and organs of the body. In humans, fibrotic tissue, or scar, hinders function and is aesthetically unappealing. Stem cell therapy offers a promising new technique for aiding in wound healing; however, current findings show that stem cells typically die and/or migrate from the wound site, greatly decreasing efficacy of the treatment. Here, we demonstrate effectiveness of a stem cell therapy for improving wound healing in the skin and reducing scarring by introducing stem cells using a natural patch material. Adipose-derived stromal cells were introduced to excisional wounds created in mice using a nonimmunogenic extracellular matrix (ECM) patch material derived from porcine small-intestine submucosa (SIS). The SIS served as an attractive delivery vehicle because of its natural ECM components, including its collagen fiber network, providing the stem cells with a familiar structure. Experimental groups consisted of wounds with stem cell-seeded patches removed at different time points after wounding to determine an optimal treatment protocol. Stem cells delivered alone to skin wounds did not survive post-transplantation as evidenced by bioluminescence in vivo imaging. In contrast, delivery with the patch enabled a significant increase in stem cell proliferation and survival. Wound healing rates were moderately improved by treatment with stem cells on the patch; however, areas of fibrosis, indicating scarring, were significantly reduced in wounds treated with the stem cells on the patch compared to untreated wounds. PMID:23072446
Hemato - Immunological and biochemical parameters, skin antibacterial activity, and survival in rainbow trout (Oncorhynchus mykiss) following the diet supplemented with Mentha piperita against Yersinia ruckeri.
Adel, Milad; Pourgholam, Reza; Zorriehzahra, Jalil; Ghiasi, Maryam
This study was aimed to assess the potential effects of Mentha piperita on the hemato - immunological and biochemical parameters, skin antibacterial activity and protection against Yersinia ruckeri infection in rainbow trout Oncorhynchus mykiss. Fish were divided into 4 groups before being fed diets supplemented with 0, 1, 2 and 3% of Mentha piperita (MP) plant extract for 8 weeks. Dose-dependent increases immune (both in skin mucus and blood serum) and hematological parameters (number of red and white cells, hematocrit and hemoglobin contents), as well as in respiratory burst activity, total protein, albumin, and neutrophil levels in fish fed supplemented diets compared to the control fish. Furthermore, dietary MP plant extract supplements have no significant effect on blood biochemical parameters and enzymatic activities of liver determined in serum of rainbow trout. After 8 weeks the cessation of feeding with MP plant extract, survival rates of 54.4%, 63.6% and 75.2% were recorded in groups which received 1, 2 and 3% of MP plant extract of feed, respectively, compared to 34.6% survivals in the control. This study underlying several positive effects of dietary administration of MP plant extract to farmed fish. PMID:27245867
Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction
Patel, Nakul Gamanlal; Ramakrishnan, Venkat V.
For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791
NASA Astrophysics Data System (ADS)
Huang, Yangyang; Kanso, Eva
Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. Yet the effects of muscle stiffness on the performance of insect wings remain unclear. Here, we construct an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring and submerged in an oscillatory flow. The wing system is free to rotate and flap. We first explore the extent to which the flyer can withstand roll perturbations, then study its flapping behavior and performance as a function of spring stiffness. We find an optimal range of spring stiffness that results in large flapping amplitudes, high force generation and good storage of elastic energy. We conclude by conjecturing that insects may select and adjust the muscle spring stiffness to achieve desired movement. These findings may have significant implications on the design principles of wings in micro air-vehicles.
[Flap-reconstruction in mouth and oropharynx. A clinical comparison of methods (author's transl)].
Eitschberger, E; Weidenbecher, M
The possible methods for plastic reconstruction after resection of malignant tumors in the mouth and oropharynx are reported. A total of 165 patients, operated upon between 1973 and 1980, has been reviewed. The tumor was located 26 times in the tongue, 4 times within the base of the tongue, 27 times in the floor of the mouth, 10 times in the floor of the mouth and in the tongue and 80 times in the tonsils. For reconstruction 8 times the deltopectoral flap, 51 times the forehead flap, 42 times the tongue flap, 7 times the myocutaneous sternocleido-mastoideus island flap were used. 8 times other methods were applied, like for instance skin grafts, and in 41 cases a primary closure of the defect was possible. Complete necrosis of the flap were rare, more frequent in contrast were partial dehiscences with or without a fistula. Thus in the forehead flap 5 times a necrosis occurred whereas in 15 cases a dehiscence was seen. Even better results were achieved for the deltopectoral- and tongue flap. In contrast, the skin island of the myocutaneous sternocleidomastoideus flaps all became necrotic, but only once a temporary fistula developed. Of the pectoralis myocutaneous island flaps the first two became necrotic, probably due to lack of surgical experience. Taking into account the surgical expenditure, the functional as well as cosmetical results, the methods may be scaled according to clinical value as follows: The pectoralis major myocutaneous island flap and the tongue flap equally range on the first place, followed by the myocutaneous sternocleidomastoideus island flap, and on the 3. and 4. place by the deltopectoral and forehead flap. PMID:7287523
Noninvasive Free Flap Monitoring Using Eulerian Video Magnification
Liu, Yuan Fang; Vuong, Christopher; Walker, Paul Charles; Peterson, Nathaniel Ray; Inman, Jared Christian; Filho, Pedro Alcantara Andrade; Lee, Steve Choon-Sung
Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free. PMID:27092284
Oral reconstruction with submental flap
Rahpeyma, Amin; Khajehahmadi, Saeedeh
Background: Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Hair bearing nature of this flap in men makes it less appropriate. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap. Recently, application of this flap has been introduced in maxillofacial trauma patients. Materials and Methods: Deepithelialized orthograde submental flap is used for the reconstruction of oral cavity mucosal defects. Results: Four cases including two trauma patients and two squamous cell carcinomas (SCCs) of oral cavity were treated using deepithelialized orthograde submental flap. There were no complications in all four patients and secondary epithelialization occurred in raw surface of the flap which was exposed to oral cavity. Conclusion: Deepithelialized orthograde submental flap is very effective in reconstruction of oral cavity in men. The problem of hair is readily solved using this technique without jeopardizing flap blood supply. PMID:24205473
Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap
Mathes, S.J.; Stevenson, T.R.
The vertical trapezius musculocutaneous flap has been successfully utilized for reconstruction in 13 patients with complex posterior skull and neck defects. This flap based on its vascular pedicle, the descending branch of the transverse cervical artery, provides well-vascularized tissue for coverage of defects related to chronic osteomyelitis, tumor extirpation, osteoradionecrosis, and dehisced cervical laminectomy wounds. Emphasis on flap design, including the location of the skin island, allows adequate wound coverage, direct donor site closure, and muscle function preservation. With its large size and wide arc of rotation, the vertical trapezius musculocutaneous flap provides reliable coverage for posterior trunk, cervical, and skull defects.
NASA Technical Reports Server (NTRS)
Greenblatt, David
A wind tunnel investigation was carried out on a semi-span wing model to assess the feasibility of controlling vortices emanating from outboard flaps and tip-flaps by actively varying the degree of boundary layer separation. Separation was varied by means of perturbations produced from segmented zero-efflux oscillatory blowing slots, while estimates of span loadings and vortex sheet strengths were obtained by integrating wing surface pressures. These estimates were used as input to inviscid rollup relations as a means of predicting changes to the vortex characteristics resulting from the perturbations. Surveys of flow in the wake of the outboard and tip-flaps were made using a seven-hole probe, from which the vortex characteristics were directly deduced. Varying the degree of separation had a marked effect on vortex location, strength, tangential velocity, axial velocity and size for both outboard and tip-flaps. Qualitative changes in vortex characteristics were well predicted by the inviscid rollup relations, while the failure to account for viscosity was presumed to be the main reason for observed discrepancies. Introducing perturbations near the outboard flap-edges or on the tip-flap exerted significant control over vortices while producing negligible lift excursions.
Intravascular heparin protects muscle flaps from ischemia/reperfusion injury.
Li, X; Cooley, B C; Fowler, J D; Gould, J S
Heparin has been found to decrease ischemia/reperfusion injury in skeletal muscle and other tissue/organ systems. The timing of heparin administration to the muscle vasculature has not been explored. We investigated the use of heparinized blood as a washout solution during ischemia to reduce ischemia/reperfusion injury. A rat cutaneous maximus muscle free flap was subjected to a 10-hr period of room temperature ischemia, then was heterotopically transplanted to the groin via microsurgical revascularization to the femoral vessels. In three experimental groups, flaps were subjected to brief ex vivo perfusion with autologous heparinized blood, at 2, 5, or 8 hr into the 10-hr ischemic interval. In the two other groups, the flaps were not perfused, and the animals were systemically heparinized either before ischemia or before transplantation, respectively. A control group underwent no flap perfusion or systemic heparinization. After transplantation, flaps were given a 48-hr period of in vivo reperfusion, then were harvested for evaluation. Flaps undergoing ex vivo perfusion or preischemic heparinization had no significant differences in weight gain (edema) compared with flaps receiving posttransplant heparinization or no heparinization (controls). The dehydrogenase staining of muscle biopsies was significantly faster (indicative of viable tissue) for perfused flaps and the flaps for which the animals received preischemic heparinization, when compared with flaps for which the animals received posttransplant heparinization or no heparinization. From these results, we conclude that heparin offers protection from ischemia/reperfusion injury when it can be introduced into the vascular network either prior to or during the ischemia period. These findings suggest the possibility of using heparinized washout solutions to enhance survival in amputated extremities. PMID:7783611
Combined Use of the Latissimus Dorsi Musculocutaneous Flap and the Anterolateral Thigh Flap to Reconstruct an Extensive Shoulder Defect in an NF-1 Patient
Fujiki, Masahide; Sakisaka, Masanobu; Kawai, Akira
Summary: Soft tissue coverage after the resection of a large malignant peripheral neural sheath tumor (MPNST) is a challenge. We report the successful reconstruction of an extensive shoulder defect after MPNST resection in a patient with a type 1 neurofibromatosis with a novel combination of flaps. A 70-year-old man with type 1 neurofibromatosis presented with a recurrent MPNST on his right shoulder. He underwent a wide excision of the tumor, which resulted in a huge soft tissue defect around the shoulder joint. The resultant defect was reconstructed with a pedicled latissimus dorsi musculocutaneous flap and a free anterolateral thigh flap. The flaps survived, and the wounds healed uneventfully. His affected arm was useful. The combination of a pedicled latissimus dorsi musculocutaneous flap and a free anterolateral thigh flap is a versatile option for the reconstruction of an extensive shoulder defect. PMID:27200231
Anterolateral thigh adipofascial flap for the restoration of facial contour deformities.
Jin, Xiaolei; Teng, Li; Xu, Jiajie; Lu, Jianjian; Zhang, Chao; Zhang, Bo; Zhao, Zhenmin
From January 2000 to May 2008, 50 patients with facial contour deformities underwent soft tissue augmentation with 51 anterolateral thigh (ALT) adipofascial flaps. Fifty flaps survived with no complications; partial fat necrosis occurred in one flap. Mean follow-up was 16 months. Flaps ranged from 10 x 6 cm to 20 x 12 cm. Perforators were found in 50 flaps, 43 musculocutaneous perforators (84.3%) and 7 septocutaneous perforators (13.7%), with a mean of 2.5 perforators per flap. In one flap (2.0%), no perforator was found. In this case, we used an anteromedial thigh adipofascial flap using the medial branch of the descending branch of lateral circumflex femoral artery as the vascular pedicle. Relatively symmetric facial contour was achieved in 20 cases. In 30 cases, adjunctive procedures including flap debulking, fat injection, and resuspension were necessary, and 23 patients achieved satisfactory outcomes. We conclude that the ALT adipofascial flap can be successfully elevated and transplanted for the correction of soft tissue facial defects. This flap can provide tissue to fill large defects, and posses the qualities of pliability, an excellent blood supply, ease of suspension and fixation, and minimal morbidity at the donor site. PMID:20049917
The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage
Mishra, Sharad; Sharma, Ramesh Kumar
Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region. This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose. PMID:20368851
Blowing Flap Experiment: PIV Measurements
NASA Technical Reports Server (NTRS)
Hutcheson, Florence V.; Stead, Daniel J.; Bremmer, David M.
PIV measurements of the flow in the region of a flap side edge are presented for several flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the flap vortex system. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.
[Harvesting technique of chimeric multiple paddles fibular flap for wide oromandibular defects].
Foy, J-P; Qassemyar, Q; Assouly, N; Temam, S; Kolb, F
Carcinological head and neck reconstruction still remains a challenge due to the volume and varied tissues needed. Large and wide oromandibular defects require, not just the bone but also soft tissues for the pelvilingual reconstruction and therefore, a second free flap may become necessary in addition to a fibular flap. The option of an unique chimeric flap based on the fibular artery and its branches is less known whereas it offers the advantage of a unique flap with bone, muscle and multiple skin paddles, independent of each other. The aim of this technical note is to present step by step the surgical procedure of this chimeric flap and share this method that avoids a second free flap. PMID:26497269
Masseter flap for reconstruction of defects after excision of buccal mucosa cancers with intact mandible.
Chaturvedi, Pankaj; Lerra, Sandeep; Ustad, Farheen; Pai, Prathamesh S; Chaukar, Devendra A; D'Cruz, Anil K
Among the reconstructive options available for buccal mucosa defects with an intact mandible, free flap with microvascular anastomosis is the best option. However, in the developing world, with poor resources, limited infrastructure, and high patient load, this cannot be offered to all patients. We report on the success of the masseter flap for reconstruction of such defects in carefully selected patients. Despite some known limitations, this flap is easy to learn and carries acceptable complications. The results of this flap may not be comparable to those of microvascular reconstructions, but they are better than those from other options such as skin graft, nasolabial flap, submental flap, etc., in terms of surgical time required, no donor site morbidity, and minimal aesthetic deformity. PMID:26535825
Bilateral Pedicled Superficial Inferior Epigastric Artery Flap in the Treatment of Hidradenitis Suppurativa
Hoang, Don; Saber, Sepideh; Patel, Ketan; Carey, Joseph
Summary: The authors present a new technique in surgically treating hidradenitis suppurativa (HS), a debilitating skin condition. In HS, surgical treatment is often the best option because of the high recurrence rates despite extensive medical treatment. A commonly successful surgical method is using skin flaps after excision of the affected area. A superficial inferior epigastric artery flap is demonstrated here as a new alternative approach to treating a case of extensive HS of the groin. By using the pedicled superficial inferior epigastric artery flap for groin reconstruction, inguinal HS can be widely excised and reconstructed with minimal donor-site morbidity and a good aesthetic outcome.
Chimeric Superficial Circumflex Iliac Perforator Flap Including External Oblique Fascia: A Refinement of Conventional Harvesting
Fernandez Garrido, Manuel; Vega Garcia, Carmen; Pons Playa, Gemma; Masiá Ayala, Jaume
Summary: The superficial circumflex iliac perforator (SCIP) flap is one of the most suitable flaps to cover distal extremity defects due to its lack of bulkiness and donor site concealment. However, it is less popular than other perforator flaps due to its anatomical variations, short pedicle length, and small caliber vessels. We describe a novel design for the SCIP flap, consisting of a chimeric flap with a piece of the external oblique muscle fascia. The purpose of this design is to cover and protect the vascular anastomosis in distal lower limb defects where recipient vessels are superficial and skin coverage is poor. In addition, lengthening the pedicle with this design makes the flap more versatile. The addition of a cuff of fascia in harvesting of the SCIP flap lengthens the pedicle, allowing easier insetting of the skin paddle and providing complete protection and coverage of the vessels. This procedure allows greater versatility in inset of the skin paddle and is particularly suitable in cases where recipient vessels are superficial or when skin coverage is poor. PMID:27482505
A Rapid, Simple, Effective, and Inexpensive Reconstructed Nipple Flap Guard.
Khan, Khurrum; Chevray, Pierre M
Nipple reconstruction is a commonly performed component of breast reconstruction. A nipple reconstructed using local skin flaps requires protection from trauma. Here we describe a novel, effective, simple, rapid, inexpensive, and convenient method to protect a reconstructed nipple in the early postoperative period. PMID:26579352
A Rapid, Simple, Effective, and Inexpensive Reconstructed Nipple Flap Guard
Khan, Khurrum
Summary: Nipple reconstruction is a commonly performed component of breast reconstruction. A nipple reconstructed using local skin flaps requires protection from trauma. Here we describe a novel, effective, simple, rapid, inexpensive, and convenient method to protect a reconstructed nipple in the early postoperative period. PMID:26579352
The median forehead flap reviewed: a histologic study on vascular anatomy.
Skaria, A M
Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose. PMID:24756613
Extending the use of the gracilis muscle flap in perineal reconstruction surgery.
Goldie, Stephen J; Almasharqah, Riyadh; Fogg, Quentin A; Anderson, William
Reconstruction of the perineum is required following oncological resections. Plastic surgical techniques can be used to restore the aesthetics and function of the perineum. The gracilis myocutaneous flap provides a substantial skin paddle, with minimal donor site morbidity. The flap is pedicled on a perforator from the medial circumflex femoral artery, giving it limited reach across the perineum. Tunnelling the flap under the adductor longus muscle may free up more of the arterial pedicle, increasing its reach. On three female cadavers, bilateral gracilis flaps were raised in the standard surgical manner, giving six flaps in total. With the flaps pedicled across the perineum, the distance from the tip of each flap was measured to the anterior superior iliac spine (ASIS). The flaps were then tunnelled under the adductor longus muscle. The distances to the ASIS were measured again. The average pedicle length was greater than 7 cm. Tunnelling the flap under the adductor longus muscle increased the reach by more than 4 cm on average. Cadaveric dissection has shown that tunnelling of the flap in a novel way increase its reach across the perineum. This additional flexibility improves its use clinically and is of benefit to plastic surgeons operating in perineal reconstruction. PMID:27221783
Externally blown flap impingement noise
NASA Technical Reports Server (NTRS)
Lasagna, P. L.; Putnam, T. W.
Tests of the noise produced by the impingement of the jet exhaust on the wing and flap for an externally blown flap system were conducted with a CF700 turbofan engine and an F-111B wing panel. The noise produced with a daisy nozzle installed on the engine was greater than that produced by a conical nozzle at the same thrust. The presence of the wing next to the test nozzles increased the noise, as did increasing the flap deflection angle. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested. Tests showed that the single-slotted flap deflected 60 deg, produced less noise than the double-slotted flaps. Also, maintaining the maximum distance between the exit nozzle and flap system resulted in a minor reduction in noise.
A standardized model for predicting flap failure using indocyanine green dye
NASA Astrophysics Data System (ADS)
Zimmermann, Terence M.; Moore, Lindsay S.; Warram, Jason M.; Greene, Benjamin J.; Nakhmani, Arie; Korb, Melissa L.; Rosenthal, Eben L.
Techniques that provide a non-invasive method for evaluation of intraoperative skin flap perfusion are currently available but underutilized. We hypothesize that intraoperative vascular imaging can be used to reliably assess skin flap perfusion and elucidate areas of future necrosis by means of a standardized critical perfusion threshold. Five animal groups (negative controls, n=4; positive controls, n=5; chemotherapy group, n=5; radiation group, n=5; chemoradiation group, n=5) underwent pre-flap treatments two weeks prior to undergoing random pattern dorsal fasciocutaneous flaps with a length to width ratio of 2:1 (3 x 1.5 cm). Flap perfusion was assessed via laser-assisted indocyanine green dye angiography and compared to standard clinical assessment for predictive accuracy of flap necrosis. For estimating flap-failure, clinical prediction achieved a sensitivity of 79.3% and a specificity of 90.5%. When average flap perfusion was more than three standard deviations below the average flap perfusion for the negative control group at the time of the flap procedure (144.3+/-17.05 absolute perfusion units), laser-assisted indocyanine green dye angiography achieved a sensitivity of 81.1% and a specificity of 97.3%. When absolute perfusion units were seven standard deviations below the average flap perfusion for the negative control group, specificity of necrosis prediction was 100%. Quantitative absolute perfusion units can improve specificity for intraoperative prediction of viable tissue. Using this strategy, a positive predictive threshold of flap failure can be standardized for clinical use.
Recent advances for FLAP inhibitors.
Pettersen, Daniel; Davidsson, Öjvind; Whatling, Carl
A number of FLAP inhibitors have been progressed to clinical trials for respiratory and other inflammatory indications but so far no drug has reached the market. With this Digest we assess the opportunity to develop FLAP inhibitors for indications beyond respiratory disease, and in particular for atherosclerotic cardiovascular disease. We also show how recently disclosed FLAP inhibitors have structurally evolved from the first generation FLAP inhibitors paving the way for new compound classes. PMID:26004579
Free posterior tibial flap reconstruction for hypopharyngeal squamous cell carcinoma
Objectives The aim of this article was to determine outcomes in patients with squamous cell carcinoma of the hypopharynx (SCCHP) in whom the free posterior tibial flap was used for primary reconstruction of hypopharynx defects after cancer resection. Subjects and methods Between August 2009 and February 2012, 10 patients with SCCHP underwent posterior tibial flap reconstruction for hypopharynx defects. The corresponding clinical data were retrospectively collected and analyzed. Results Despite the multistep and time-consuming procedure, the posterior tibial flap survival rate was 100%. Operation-induced complications did not occur in four patients. Six patients developed postoperative hypoproteinemia, four patients developed postoperative pulmonary infections, and four patients developed pharyngeal fistula. The pharyngeal and laryngeal functions of all patients were preserved. Conclusion Our experience demonstrates that the posterior tibial flap is a safe and reliable choice for the reconstruction of hypopharynx defects. PMID:24884631
Graft-infiltrating cells expressing a CD200 transgene prolong allogeneic skin graft survival in association with local increases in Foxp3(+)Treg and mast cells.
Gorczynski, Reginald M; Chen, Zhiqi; Khatri, Ismat; Yu, Kai
Expression of the molecule CD200 has been reported to increase allograft survival by suppression of inflammation and acquired immunity. In previous studies we have shown that increased skin and cardiac allograft survival in transgenic mice over-expressing CD200 (CD200(tg)) occurs in association with increased intra-graft expression of mRNAs for genes associated with altered T cell subset differentiation. We investigated changes in graft-infiltrating cells, Treg and mast cells in skin grafts post transplantation into control or CD200(tg) mice, using focused gene array and real-time PCR to assess altered gene expression, and FACS, immunohistology and MLC to determine numbers/function of those cells. Graft-infiltrating cells isolated from CD200(tg) recipients suppressed induction of CTL from control lymph node cells in vitro, and contained increased numbers of infiltrating, non-degranulating, mast cells and Foxp3(+)Treg. Mast cells were also evident in graft tissue of control animals, but there these cells showed evidence for degranulation, and fewer Foxp3(+)Treg were present than was the case of CD200(tg) mice. The infusion of a competitive inhibitor of CD200:CD200R interactions, CD200(tr), at high concentrations (50μg/mouse iv) caused rapid rejection of grafts in CD200(tg) mice, mast cell degranulation within graft tissue, and a decrease in Treg infiltrates. These effects were attenuated by simultaneous infusion of the mast cell stabilizer, sodium cromoglycate. We conclude that CD200 expression contributes to graft prolongation through local suppression of mast cell degranulation, attraction/expansion of Treg, and attenuation of T cell effector activation. PMID:21801836
IL-25 promotes the function of CD4+CD25+ T regulatory cells and prolongs skin-graft survival in murine models.
Tang, Jiayou; Zhou, Xiaohui; Liu, Jie; Meng, Qingshu; Han, Yang; Wang, Zhulin; Fan, Huimin; Liu, Zhongmin
Interleukin (IL)-25, also known as IL-17E, belongs to the IL-17 family of cytokines. Unlike other IL-17 family members, IL-25 promotes Th2-type immune responses, stimulating IL-4, IL-5, and IL-13 production. Here, we employed murine models of skin graft to explore the role of IL-25 in suppression of graft rejection. We found that IL-25 expression is increased during allograft rejection, and allograft rejection was enhanced in IL-25 KO mice. IL-25 KO was associated with down-regulation of Foxp3 expression in CD4+ T cells. Further, while adoptive transfer of WT regulatory T cells (Tregs) protected against allograft rejection, adoptive transfer of IL-25 deficient Tregs failed to protect against allograft rejection. Exogenous IL-25 restored Foxp3 expression and Treg function in vitro. Moreover, IL-25 promoted phosphorylation of NFAT2. Thus, IL-25 may enhance Treg function by up-regulating NFAT2 phosphorylation. Our findings suggest that IL-25 can sustain Foxp3 expression, enhance the suppressive function of Tregs, and prolong skin-graft survival. PMID:25864622
Treatment of defects and instable skin scars on heavily exposed parts of the leg.
Kletenský, J; Tvrdek, M; Pros, Z; Nejedlý, A; Svoboda, S
The authors report a series of 41 patients subjected to a transfer of the sensitive fasciocutaneous flap to a defect or to instable skin scars on the leg. Described are immediate as well as longterm surgical results in relation to the sensitivity of the transferred flap and the condition of the donnor site of the flap. PMID:9018863
Sanchez-Conejo-Mir, J.; Bueno Montes, J.; Moreno Gimenez, J.C.; Camacho-Martinez, F.
The bilobed flap is a simple reconstructive technique principally used to correct substantial defects in the facial region. The authors present their experience with this local flap in the difficult plantar area, with excellent short-term functional results. They describe the special characteristics of the bilobed flap in this zone, and comment on its indications and possible complications.
Parker, Daniel C.; Morey, Allen F.
Perineal urethrostomy (PU) has been performed with success for the treatment of refractory and advanced urethral stricture disease for at least the past six decades. Here, we review the indications and outcomes of PU for indications such as complex hypospadias repair and urethral stricture disease resulting from trauma, infection, and failure of prior urethroplasty. We also describe the role of 7-flap PU, a novel alternative to the conventional approach that offers the surgeon added flexibility in tailoring urethrostomy creation based on intraoperative findings. The authors' updated experience with 7-flap PU demonstrates a comparable 95% success rate in patients with a wide variety of stricture etiology. PU through either a conventional approach or a 7-flap technique is a valuable option for improving the quality of life in patients with debilitating urethral stricture disease. PMID:26816809
Hyza, P; Lombardo, G A G; Kubek, T; Jelinkova, Z; Vesely, J; Perrotta, R
The deep inferior epigastric artery perforator (DIEAp) flap is becoming a widely used method of autologous breast reconstruction. Despite the huge use of the DIEAp flap in reconstructive field, an evidenced based approach in perforator selection has not yet been developed. Unfortunately there is no clear evidence about the relation between the number and dimension of the perforator vessel and the prediction of flap survival in a living model. An old technique like the vascular delay could be extremely useful as a lifeboat procedure when the vascularization of the flap after the dissection is inadequate. PMID:26650110
Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap
Jaiswal, Dushyant; Yadav, Prabha; Shankhdhar, Vinay Kant; Gujjalanavar, Rajendra Suresh; Puranik, Prashant
Introduction: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula. Materials and Methods: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. Results: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. Conclusion: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula. PMID:26933281
Rotation flaps for coverage after total knee arthroplasty
Pozzobon, Leonardo Rafael; Helito, Camilo Partezani; Guimarães, Tales Mollica; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis
OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series. PMID:24453672
The Effects of 405-nm Visible Light on the Survival of Campylobacter on Chicken Skin and Stainless Steel.
Gunther, Nereus W; Phillips, John G; Sommers, Christopher
Campylobacter spp. are foodborne pathogens responsible for a significant portion of human cases of bacterial-mediated gastrointestinal disease. A primary method for the introduction of Campylobacter into the food supply is through poultry products. Reducing the number of Campylobacter on poultry products may reduce the incidence of human disease. Research has been conducted on the use of light to inactivate Campylobacter on poultry products and processing environments. More recently, the use of high intensity visible 405-nm light has been proposed for the elimination of pathogenic bacteria. This study investigated the ability of 405-nm light to reduce Campylobacter jejuni and Campylobacter coli in poultry products. Campylobacter in chicken exudate were placed onto chicken skin or food-grade stainless steel before treatment with 405-nm light. A range of 405-nm light doses were applied to cocktails of six C. jejuni or six C. coli strains in exudate at 10°C to minimize thermal effects. Little difference was observed between inactivation of C. jejuni and C. coli on poultry skin with only minor average reductions of 1.7 logs and 2.1 logs, respectively, at the maximal dose of 184-186 J/cm(2). More noticeable differences were observed when the samples were placed on stainless steel and treated with a dose of 89 J/cm(2), producing an average reduction of 3.0 logs for C. coli but only 1.1 logs for C. jejuni. The maximal dose (181-183 J/cm(2)) applied to Campylobacter on stainless steel produced significant (p ≤ 0.05) reductions for C. jejuni and C. coli of 4.9 logs and 5.1 logs, respectively. However, significant 405-nm-mediated reductions in Campylobacter numbers required exposure times to achieve necessary dose levels that might be impractical under processing conditions. In addition, the most potent exposure times likely produced secondary thermal effects by raising sample surface temperatures above 48°C. PMID:26938455
Systematic Review and Operative Technique of Recalcitrant Pressure Ulcers Using a Fillet Flap Technique
Rao, Venkat K.
Background: The purpose of this article is to describe the indications, operative technique, outcomes, and systematic review of the literature on the reconstruction of patients with end-stage pressure ulcers using a fillet flap technique. In this technique, the femur, tibia, and fibula are removed from the thigh and leg, and the soft tissue is used as a pedicled, or free, myocutaneous flap for reconstruction. Long-term outcomes, salient surgical technique of flap elevation, and design are detailed for patients who had a fillet of leg flap for reconstruction of extensive pressure ulcers. Methods: The indications, surgical technique, and postoperative outcomes of 5 patients who had pedicled fillet flaps are reviewed including patient age, sex, underlying comorbidities, duration of paraplegia, operative technique, and complications. A systematic review of the literature was performed searching PubMed, Cochrane Database, and Medline with the following MeSH terms: pressure ulcer, pressure sore, decubitus ulcer, fillet flap, and fillet flap. Inclusion criteria were use of a fillet technique, article data on the number of reconstructions before fillet flap, complications, and English language. Results: Most of our patients were male 75% (n = 3) with an average age of 47.5 years, had been paralyzed for an average of 16 years, and had few medical comorbidities. Two patients (3 flaps) required hip disarticulation, 1 patient had a bilateral fillet flaps, and 3 patients had resection of tibia/fibula. After following patients for an average of 1.4 years (4 mo to 2 yr), complications were limited to 1 patient who had partial-thickness flap loss at the distal skin flap that healed by secondary intention and 1 patient who had ulcer recurrence because of noncompliance. Four articles met inclusion criteria for systematic review and 3 were excluded. Conclusions: The fillet of leg flap remains a useful and reliable method of reconstructing end-stage pressure ulcers. PMID:27622082
A triceps musculocutaneous flap for chest-wall defects
Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. )
A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.
Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair
Shim, Jung-Hwan; Hwang, Na-Hyun; Yoon, Eul-Sik; Dhong, Eun-Sang; Kim, Sang-Dae
Background The global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures. PMID:26848442
Externally blown flap impingement noise.
NASA Technical Reports Server (NTRS)
Putnam, T. W.; Lasagna, P. L.
An investigation of externally blown flap impingement noise was conducted using a full-scale turbofan engine and aircraft wing. The noise produced with a daisy nozzle installed on the engine exhaust system was greater than that produced by a conical nozzle at the same thrust. The daisy nozzle caused the jet velocity to decay about 35 percent at the flap. The presence of the wing next to the conical nozzle increased the noise, as did increasing the flap deflection. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested.
Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction.
Hekner, D D; Roeling, T A P; Van Cann, E M
The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were injected with epoxy resin (Araldite) and the perforating arteries were dissected. The number of clinically relevant perforators from the radial and ulnar arteries was not significantly different in the distal forearm. Most perforators were located in the proximal half of the distal one third, making this part probably the safest location for flap harvest. Close to the wrist, i.e. most distally, there were more perforators on the ulnar side than on the radial side. The ulnar artery stained 77% of the skin surface area of the forearm, showing the ulnar forearm free flap to be more suitable than the radial forearm free flap for the restoration of large defects. PMID:27012603
Random Pattern Vertically Oriented, Partial Thickness Buccinator Myomucosal Flap for Intraoral Reconstruction:A Report of Two Cases
Rahpeyma, Amin; khajehahmadi, Saeedeh
Introduction: Reconstruction of the oral cavity with a flap design containing the buccal mucosa and buccinator muscle but excluding the facial artery and vein is the topic of these case reports. Case Reports: This article uses random pattern vertically oriented partial thickness buccinator myomucosal flap for intraoral reconstruction in two cases. The first was for lining the mandibular anterior vestibule in a trauma patient. The second was for oral side coverage of bone graft in special cleft patient. In both patients, this flap survived and good bone coverage with non-keratinized mucosa was obtained. Conclusion: Thin long buccal myomucosal flap not including facial artery and vein can survive. PMID:27429953
Noise Reduction of Aircraft Flap
NASA Technical Reports Server (NTRS)
Hutcheson, Florence V. (Inventor); Brooks, Thomas F. (Inventor)
A reduction in noise radiating from a side of a deployed aircraft flap is achieved by locating a slot adjacent the side of the flap, and then forcing air out through the slot with a suitable mechanism. One, two or even three or more slots are possible, where the slot is located at one;or more locations selected from a group of locations comprising a top surface of the flap, a bottom surface of the flap, an intersection of the top and side surface of the flap, an intersection of the bottom and side surfaces of the flap, and a side surface of the flap. In at least one embodiment the slot is substantially rectangular. A device for adjusting a rate of the air forced out through the slot can also be provided.
A case report of total breast reconstruction using an inframammary adipofascial flap with an implant
Ogawa, Tomoko; Yamakawa, Tomomi
Introduction Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap. Presentation of case The patient was a 27-year-old female with moderate ptotic breasts, who had ductal carcinoma in situ in the lower outer quadrant of her left breast. After NSM through the inframammary fold (IMF) incision, the subcutaneous fat of the intended inframammary area was undermined, and the tongue shaped adipofascial flap was pulled up in the intended area. After inserting a tissue expander under the major pectoral muscle, this adipofascial flap was reflected back to the inferior portion of the breast area. After modeling the breast mound with this flap, the inframammary skin incision was sutured. Eleven months later, the patient underwent surgery to replace the expander with a permanent implant. Eight months after the replacement with an implant, the cosmetic result is good. Discussion This procedure can be performed through the same skin incision on the IMF as NSM. Total breast reconstruction using the inframammary adipofascial flap with an implant can be an alternative approach to achieving symmetry in some patients. Conclusion This method is useful for breast reconstruction after NSM for young patients with moderate-ptotic breasts. PMID:27107500
Technical refinements of composite thoracodorsal system free flaps for 1-stage lower extremity reconstruction resulting in reduced donor-site morbidity.
Bannasch, Holger; Strohm, Peter C; Al Awadi, Khalid; Stark, G Björn; Momeni, Arash
A multitude of local flaps has been suggested for lower extremity reconstruction. However, the gold standard for defect coverage remains free tissue transfer. In this regard, the scapular vascular axis is a well-established source of expendable skin, fascia, muscle, and bone for use in free flap reconstruction of defects requiring bone and soft tissue in complex 3-dimensional relationships. Composite bone and soft-tissue flaps derived from the subscapular vascular axis include the osteocutaneous scapular flap, the "latissimus/bone flap," and the thoracodorsal artery perforator-scapular osteocutaneous flap.Patient outcome following reconstruction of lower extremity defects with composite free flaps from the thoracodorsal system were analyzed. Here, we demonstrate the execution of technical refinements on free composite flap transfers based on the thoracodorsal vascular axis, thus resulting in a stepwise reduction of donor-site morbidity. PMID:18362565
Low-concentration methylene blue maintains energy production and strongly improves survival of Leigh syndrome French Canadian skin fibroblasts.
Legault, Jean; Larouche, Pierre-Luc; Côté, Isabelle; Bouchard, Line; Pichette, André; Robinson, Brian H; Morin, Charles
Leigh syndrome French Canadian (LSFC) is a recessive disease caused by mutations in the LRPPRC gene (leucine-rich pentatricopeptide repeat containing protein). These mutations induce a cytochrome c oxidase (COX) deficiency resulting in episodes of acute acidotic crisis that will often lead to death. There is no effective treatment. Methylene blue (MB) is a redox dye that increases COX content and activity in vitro and in vivo suggesting that MB could prevent and treat LSFC. In this study, the protective effect of low-concentration MB was tested on two LSFC cell lines, including LSFC-F1, homozygous for the mutation A354V, and LSFC-F2 a compound heterozygous for the mutations A354V and C12775STOP. MB effect on metabolic activity was assessed on both LSFC cells in stable and acidotic conditions. For LSFC-F1, results showed that metabolic activity drastically decline after 96 hours in both conditions but not LSFC-F2 and normal cells. MB completely prevents the decrease of metabolic activity in LSFC-F1. Intracellular ATP content was also measured in both culture media. After 96 hours in acidotic medium, ATP content was almost completely depleted for both LSFC cells. Interestingly, MB completely restores ATP content in LSFC-F1 and LSFC-F2 cells. Finally, MB strongly improves the survival of both LSFC cells. PMID:22202226
Cosmetic Tattooing of Free Flaps following Head and Neck Reconstruction
Batstone, Martin D.; Fox, Carly M.; Dingley, Mary E.; Cornelius, C. Peter
Free flap reconstruction of the head and neck is a widespread procedure. The aesthetic outcome is frequently compromised by color mismatch between the donor site skin and the complex pigmentation of the face. Various surgical procedures have been described to improve the appearance of external skin paddles. Medical tattooing is commonly used for nipple pigmentation in breast reconstruction and cosmetic procedures such as permanent makeup. This article describes the technique and its application to head and neck reconstruction. Medical tattooing can be used to improve the cosmetic appearance of head and neck free flaps. There is no donor site morbidity and subtle changes in color can be replicated. The article describes the technique of medical tattooing with the use of illustrative cases. Medical tattooing is a viable alternative for improving the appearance of cutaneous skin paddles following head and neck reconstruction with free flaps. Its advantages include no donor site morbidity, availability of an infinite range of colors, no requirement for general anesthesia, and the ability to use multiple colors in the one flap for complex pigmentation requirements. Its disadvantages include the need for specialized skills and equipment and the fading of color over time. PMID:24436738
General regression neural network and Monte Carlo simulation model for survival and growth of Salmonella on raw chicken skin as a function of serotype, temperature and time for use in risk assessment
Technology Transfer Automated Retrieval System (TEKTRAN)
A general regression neural network and Monte Carlo simulation model for predicting survival and growth of Salmonella on raw chicken skin as a function of serotype (Typhimurium, Kentucky, Hadar), temperature (5 to 50C) and time (0 to 8 h) was developed. Poultry isolates of Salmonella with natural r...
Skin Injuries Reduce Survival and Modulate Corticosterone, C-Reactive Protein, Complement Component 3, IgM, and Prostaglandin E2 after Whole-Body Reactor-Produced Mixed Field (n + γ-Photons) Irradiation
Kiang, Juliann G.; Ledney, G. David
Skin injuries such as wounds or burns following whole-body γ-irradiation (radiation combined injury (RCI)) increase mortality more than whole-body γ-irradiation alone. Wound-induced decreases in survival after irradiation are triggered by sustained activation of inducible nitric oxide synthase pathways, persistent alteration of cytokine homeostasis, and increased susceptibility to systemic bacterial infection. Among these factors, radiation-induced increases in interleukin-6 (IL-6) concentrations in serum were amplified by skin wound trauma. Herein, the IL-6-induced stress proteins including C-reactive protein (CRP), complement 3 (C3), immunoglobulin M (IgM), and prostaglandin E2 (PGE2) were evaluated after skin injuries given following a mixed radiation environment that might be found after a nuclear incident. In this report, mice received 3 Gy of reactor-produced mixed field (n + γ-photons) radiations at 0.38 Gy/min followed by nonlethal skin wounding or burning. Both wounds and burns reduced survival and increased CRP, C3, and PGE2 in serum after radiation. Decreased IgM production along with an early rise in corticosterone followed by a subsequent decrease was noted for each RCI situation. These results suggest that RCI-induced alterations of corticosterone, CRP, C3, IgM, and PGE2 cause homeostatic imbalance and may contribute to reduced survival. Agents inhibiting these responses may prove to be therapeutic for RCI and improve related survival. PMID:24175013
Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap.
Tomita, K; Inoue, K
We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID:9718154
Pedicled TRAM Flap in Presence of Desmoid Tumor of the Rectus Sheath; a Case Report.
Khater, Ashraf
Creating TRAM flap in obese patient is a challenging issue with a hazard of flap ischemia and breast envelope loss or sepsis. In this case we show our experience in doing an interval TRAM flap in markedly obese patient (BMI index 39) in the presence of Desmoid tumor of the anterior abdominal wall on top of previous mesh hernioplasty in the contralateral side of the tumor. Interval TRAM was decided with achieving of a complete vascular delay in the same sitting with skin sparing mastectomy. On doing abdominal ultrasonography for perforator mapping a desmoid tumor was encountered in the contralateral side. The decision was to elevate the flap together with excision of the desmoid tumor with the flap to be sutured in situ at the end of operation and after 5 days to transfer the flap to the mastectomy site. There was no major complications apart from mild wound sepsis of the breast pocket that was controlled medically. According to our proposed aesthetical score, our patient expressed the outcome as good (8/10 points). Pedicled TRAM flap creation in markedly obese patients is hazardous and we recommend this new concept of interval TRAM for this situation. Moreover the presence of desmoid tumor in the rectus sheath is not a contraindication to this flap elevation. The presence of abdominal desmoid tumor is not a contraindication for TRAM flap provided that it can be resected with sparing of perforators on one side of the rectus sheath. PMID:27065672
Uncommon Flaps for Chest Wall Reconstruction
Matros, Evan; Disa, Joseph J.
The omentum, external oblique musculocutaneous, and thoracoepigastric flaps are uncommonly used for chest wall reconstruction. Nevertheless, awareness and knowledge of these flaps is essential for reconstructive surgeons because they fill specific niche indications or serve as lifeboats when workhorse flaps are unavailable. The current report describes the anatomic basis, technical aspects of flap elevation, and indications for these unusual flaps. PMID:22294943
Orandi flap for penile urethral stricture: Polishing the gold standard
Goel, Apul; Kumar, Manoj; Singh, Manmeet
Introduction: We describe the combined use of the Orandi flap and the scrotal skin advancement flap to reduce complications for pendulous urethral stricture in men >40 years old. Methods: Over the last 40 months, 10 men underwent urethroplasty for pendulous stricture by the modified Orandi urethroplasty. In this, additionally, a midline hairless scrotal skin flap of the size of the ventral skin defect on the pendulous portion was raised based on the dartos fascia. This flap was mobilized so that it reached the pendulous portion without tension and covered the penile defect. The catheter was removed after 4 weeks. Patients were followed every 3 months using uroflowmetry and the American Urological Association (AUA) symptom score. Results: The mean age was 55.5. Of the 10 patients, the etiology was post-catheterization in 5 and idiopathic in the remaining 5. Three men also had stricture extending into the bulbous urethra (repaired using buccal graft). The mean additional time needed for the flap coverage was 36.2 minutes (range: 30–45). The median follow-up was 12 months (range: 3–40). The mean postoperative symptom score was 5.2 and the mean flow rate was 20.1 mL/sec. In 2 men, the meatus got retracted to the distal penile part (probably due to downward traction by scrotal skin). No patient complained of disfigurement. Two men reported recurrence (1 each in bulbous and penile urethra). The limitations are small number of patients and the observational nature of this study. Conclusions: The intermediate-term results show that the modified Orandi urethroplasty is an acceptable treatment option with acceptable cosmetic results. PMID:26085873
Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap
Watanabe, Hidekata; Masumoto, Kazuyuki; Kikuchi, Mamoru; Satake, Yoshiyasu; Yanai, Tetsu; Harada, Yoshimi; Ishihara, Yasuhiro; Yasuta, Masato
Background: The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. Methods: Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. Results: The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. Conclusion: Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity. PMID:27200258
Surgical correction of cryptotia combined with intraoperative distention using isotonic saline injection and rotation flap method.
Uemura, Tetsuji; Matsumoto, Naozumi; Tanabe, Tsuyoshi; Saitoh, Tomoichi; Matsushita, Shigeto; Mitsukawa, Nobuyuki
The following report describes the combination of surgical correction with intraoperative distention using isotonic saline injection and the rotation flap method for correction of cryptotia. This technique provided extensive skin coverage of the upper portion of the auricle and was an easy and quick method of dissecting the cartilage of the posterior auricle. The main advantages of this technique include achievement of skin expansion without the need for expander material, simple design of the skin incision, and easy dissection of the cartilage. Although one patient experienced partial congestion in the upper tip of the rotation flap, no other complications occurred. Further, cryptotia did not recur. PMID:15915119
The flap by flap dissection in terminal ballistic applied to less lethal weapons.
de Freminville, Humbert; Rongieras, Fréderic; Prat, Nicolas; Voiglio, Eric J
Medical examiners often have to solve questions such as firing distance and bullet trajectory for lethal weapons. Knowledge in the field of terminal ballistics has increased during the last 30 years and layer by layer dissection reveals superficial wounds that can be linked with the permanent cavity. At the end of the 1990s, terminal ballistics also focused on less lethal weapons and their wounds. Here, 2 different less lethal weapons with single bullets were tested on nonembalmed and undressed cadavers (N = 26) at different ranges and speeds. We have developed a technique for dissection which we call flap by flap dissection that reveals the advantage of the bullet-skin-bone entity, the absence of wounds linking its components and range of less lethal weapons. PMID:20110799
Towards an advanced vortex flap system: The cavity flap
NASA Technical Reports Server (NTRS)
Rao, D. M.
An extension of the vortex flap concept was explored with the aim of providing high-alpha flight control capability coupled with maneuver drag reduction for highly swept wing configurations. A retractable lower surface flap mounted on a translating hinge is proposed, allowing chordwise extension as well as deflection, the two movements being independently controlled. The frontal cavity formed by the partially extended and deflected flap captures a vortex above a certain angle of attack. The cavity vortex downwash alleviates the effective incidence of the wing leading edge, thus modulating vortex lift; at the same time, the induced suction in the cavity generates thrust. These postulated aerodynamic features of the cavity flap were validated through low speed tunnel pressure and visualization tests on a 65 deg swept oblique wing model, which also provided initial trends of the leading edge vortex alleviation and cavity suction with respect to flap extension, deflection and angle of attack. Force tests on a 60 deg delta model further showed the cavity flap L/D performance to compare favorably with the conventional vortex flap. A two segment flap arrangement with independently control led segments was envisaged for exploiting the vortex modulation capability of the cavity flap for pitch, roll and yaw control, in addition to drag reduction at high angles of attack.
Indications and long-term assessment of 10 cases of cross-leg free DCIA flaps.
Townsend, P L
Compound fractures of the lower limb with skin and bone loss are difficult repair problems, especially in multiple level injuries. With bone loss between 6 and 12 cms, the deep circumflex iliac artery (DCIA) flap is usually the flap of choice in reconstruction; the aim is to carry out microvascular anastomosis of the flap vessels to vessels on the damaged leg. However, this may be difficult or even impossible. Experience of 10 cross-leg DCIA flaps is outlined, with indications and surgical technique. The long-term bone healing is compared with 13 cases with anastomosis based on the same leg. There appears to be no difference in callus formation and remodelling of bone, indicating that despite subsequently dividing the original main vascular supply the bone in the DCIA flap remains vascularized and behaves as such. PMID:3310809
Externally blown flap noise research
NASA Technical Reports Server (NTRS)
Dorsch, R. G.
The Lewis Research Center cold-flow model externally blown flap (EBF) noise research test program is summarized. Both engine under-the-wing and over-the-wing EBF wing section configurations were studied. Ten large scale and nineteen small scale EBF models were tested. A limited number of forward airspeed effect and flap noise suppression tests were also run. The key results and conclusions drawn from the flap noise tests are summarized and discussed.
NASA Astrophysics Data System (ADS)
Buerge, Brandon T.
The Vortex Flap is a new type of mechanically driven high-lift device consisting of a rotating cylinder placed underneath and near the trailing edge of an airfoil. Wind tunnel tests were designed and conducted in the Washington University Low-Speed Wind Tunnel. Wind tunnel tests indicate that the Vortex Flap produces notable lift coefficient increments and increases maximum lift coefficients, particularly for the low Reynolds number range tested. The best configurations of the configurations investigated (not necessarily optimal) produce lift increments of 300-900% at low-to-moderate angles of attack, and increase the maximum lift coefficient on the order of 200%. The large lift increments found, particularly at low angles of attack, underscore the ability to drive the airfoil to high lift coefficients even at low angles of attack, a potentially useful characteristic for certain flight maneuvers. Regions of fairly high L/D (on the order of 10) as well as low L/D performance were identified. The nondimensional cylinder rotation speed was found to be the most important experimental parameter. Methods for correcting wind tunnel data were developed and outlined, and a Response Surface Method was applied to the corrected data for ease of interpretation. Performance comparisons between the Vortex Flap and other trailing-edge high-lift devices are included. To demonstrate the potential of the device, a Navy mission specification for a VTOL ship-borne UAV, currently filled by a rotary-wing aircraft, is analyzed using a hypothetical fixed wing aircraft and the Vortex Flap. It is demonstrated that, under certain reasonable wind-over-deck conditions, such an aircraft could hypothetically fill a VTOL mission.
Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction.
Choi, Dong Hoon; Goh, Terence; Cho, Jae Young; Hong, Joon Pio
Distant free flaps have become a routine option for reconstruction of large, complicated facial soft tissue defects. The challenge is to find a flap that is pliable to provide good contour and function. The purpose of this paper was to evaluate the use of superficial circumflex iliac artery perforator (SCIP) flaps for facial defects. From November 2010 to June 2013, facial reconstruction was performed on 6 patients (age range, 15-79 years). The harvesting technique was modified to elevate above the deep fat, and the pedicles were taken above or just below the deep fascia. The mean size of the flap was 75.6 cm2, with a thickness of 7 mm; the mean pedicle length was 4.9 cm; and the mean artery caliber was 0.7 mm. The supermicrosurgery technique was used successfully in all 6 cases. Donor sites were all closed primarily. The mean follow-up was 16.7 months. All flaps survived without flap loss, and the donor sites healed without complications including lymphorrhea. The patients were satisfied with contour and function after reconstruction. The result of these 6 cases suggested that the SCIP flap can be a reliable flap for moderate-sized to large defects in the face. The use of new instrumentation and supermicrosurgical techniques allows use of the SCIP flap reliably while providing patients with a good contour, function, and minimal donor site morbidity. PMID:25329846
The use of fabricated chimeric flap for reconstruction of extensive foot defects.
Song, Baoqiang; Chen, Jianwu; Han, Yan; Hu, Yalan; Su, Yingjun; Li, Yang; Zhang, Juan; Guo, Shuzhong
Repair of extensive foot defects requires both adequate tissues for wound coverage and special tissues for functional reconstruction. To maximize its function reconstruction, fabricated chimeric flaps consisting of multiple separate flaps were designed to reconstruct such defects. Five patients suffered extensive foot defects with sizes ranging from 23 × 12 cm to 38 × 14 cm(2) in multiple regions including heel, forefoot, dorsum, ankle, anterior leg, and even toes. Causes included crushing injuries, avulsion injuries, and scar excision. Most areas of the defects except heel were first covered by latissimus dorsi muscle flap or anterolateral thigh flap and their pedicles were anastomosed with recipient vessels. Then free medial plantar flaps were transferred for heel reconstruction and their pedicles were further attached to either side branches of the main source vessel or to its distal continuation. All chimeric flaps survived uneventfully and all patients were able to walk in normal footwear during the 1.5- to 4-years follow-up. None of the flaps developed ulcer and flap breakdown. The assessment by Maryland Foot Score showed that four of the five patients gained a "good" recovery and one patient showed moderate improvement of foot functions. Appearances of reconstructed heels were near-normal. The results indicate that fabricated chimeric flap has good design flexibility and may provide an option for functional reconstruction of extensive foot defects. © 2015 Wiley Periodicals, Inc. Microsurgery 36:303-309, 2016. PMID:25752811
Dorsal Intercostal Artery Perforator Propeller Flaps: A Reliable Option in Reconstruction of Large Meningomyelocele Defects.
Basterzi, Yavuz; Tenekeci, Goktekin
Several options have been reported for the reconstruction of myelomeningocele defects. In this article, we present our experience on soft tissue reconstruction of myelomeningocele defects by using island propeller dorsal intercostal artery perforator (DIAP) flaps. Between January 2008 and February 2014, all newborns with large myelomeningocele defects (13 newborns) were reconstructed with island propeller DIAP flaps. All flaps survived completely. In 8 patients out of 13, venous insufficiency was observed which then resolved spontaneously. Flap donor sites were closed primarily. Myelomeningocele defects with a diameter larger than 5 cm require reconstruction with flaps. To mobilize a well-vascularized tissue over the defect without tension in which the suture lines will not overlap over the midline where the dura is repaired and over the meninges is one of the goals of reconstruction for such defects. Perforator propeller flaps enable us to reach those goals. Use of perforator flaps provides 2 important advantages, namely, more predictability and also more freedom in mobilizing flaps toward the defect. This study proves the reliability of DIAP propeller flaps in the reconstruction of myelomeningocele defects. PMID:26010351
The Versatile Modiolus Perforator Flap
Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo
Background: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap successfully for several indications, and it is our first choice for perioral reconstruction. PMID:27257591
NASA Astrophysics Data System (ADS)
Alben, Silas; Shoele, Kourosh; Mittal, Rajat; Jha, Sourabh; Glezer, Ari
We study the flapping of a flag in an inviscid channel flow. We focus especially on how quantities vary with channel spacing. As the channel walls move inwards towards the flag, heavier flags become more unstable, while light flags' stability is less affected. We use a vortex sheet model to compute large-amplitude flapping, and find that the flag undergoes a series of jumps to higher flapping modes as the channel walls are moved towards the flag. Meanwhile, the drag on the flag and the energy lost to the wake first rise as the walls become closer, then drop sharply as the flag moves to a higher flapping mode.
Doughy skin; Poor skin turgor; Good skin turgor; Decreased skin turgor ... Call your health care provider if: Poor skin turgor occurs with vomiting, diarrhea, or fever. The skin is very slow to return to normal, or the skin "tents" up ...
Reconstruction of Large Cheek Defect With/Without Sideburn Using Malar-Posterior Auricular-Cervico Flap.
Hayashi, Toshihiko; Yamamoto, Yuhei; Oyama, Akihiko; Funayama, Emi; Shichinohe, Ryuji; Murao, Naoki; Furukawa, Hiroshi
The cheek region is the most common site for malignant tumor occurrence and the treatment of malignant skin tumor requires extensive local excision. Many previous reports have covered methods of reconstruction using local flaps for skin defects in the cheek region.In this article, we describe our experience with a surgical reconstruction using a new flap method for 8 patients with missing tissue in the cheek region. This flap is based on the concept of separately designing the flap with the 3 areas comprising the malar, posterior auricular, and cervical regions. We named the flap containing these 3 regions the malar-posterior auricular-cervico flap. Esthetically satisfactory outcomes were achieved in all cases.In conclusion, we recommend our malar-posterior auricular-cervico flap to reconstruct the tissue defects of approximately 20 to 40 cm after tumor excision in the cheek region. If preauricular skin is included in the design of this flap, the sideburn can be reconstructed using a part of the nape region with hair. PMID:26559648
The role of flaps in the management of contracted eye sockets.
Guyuron, B
Based on the pathology of the eye socket and periorbital deficiencies, three distinct classes of patients can be recognized: I. Those who solely have eye socket deficiency with normal orbital and periorbital tissue. The suggested surgical treatment for this class of patient would be a skin or mucosa graft. II. Patients who have inadequate lining, as well as orbital volume deficiency. The preferred reconstructive approach includes cartilage (rib or ear) with or without fat graft, and skin or mucosa grafts for eye socket expansion. III. For failed reconstructions of classes I and II or for patients with severe orbital and periorbital deficiencies, the choice is one of three flaps: If the superficial temporal vessels and the postauricular skin is intact, the ideal flap is postauricular fasciocutaneous. If the postauricular skin has previously been used yet the superficial vasculature is intact, a secondary flap is the better choice. In cases where both postauricular skin and superficial temporal vessels have been sacrificed the recommended flap is a free flap with microvascular anastomosis. PMID:1457057
Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle.
Ehtesham-ul-Haq; Aslam, Ayesha; Hameed, Shahid; Ahmad, Rao Saood; Majid, Abdul; Waqas, Muhammad
The anterolateral thigh flap (ALTF) has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle. PMID:21798144
Sebaceous Gland Carcinoma of the Lower Eyelid Reconstructed with a Composite Flap: A Case Report
Durairaj, Alagar Raja; Kothandaraman, Kanmani; Rajamanohar, Vimal Chander; Prabakaran, Aarthi
Sebaceous gland carcinomas are skin adnexal tumours occurring in the periocular region of elderly females. It is an uncommon malignancy usually involving the upper eyelid and has an indolent course. Mainstay of treatment is surgical excision. Here we present a case of a sebaceous gland carcinoma of the lower eyelid for which wide local excision was done and the lower eyelid reconstructed using a composite flap of nasal chondromucosal graft with a nasolabial flap. PMID:27504351
Medial and Lateral Canthal Reconstruction with an Orbicularis Oculi Myocutaneous Island Flap
Han, Jihyeon; Kwon, Sung Tack; Kim, Suk Wha
Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity. PMID:25606488
Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.
Wolff, Klaus-Dietrich; Fichter, Andreas; Braun, Christian; Bauer, Florian; Humbs, Martin
Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons. PMID:24938642
Novel biogeometric designs of first dorsal metacarpal artery flap in hand reconstruction.
Doğan, Fatih; Çoruh, Atilla
Reconstruction of the soft tissue defects of the first web space and proximal dorsal thumb is still one of the most challenging problems in reconstructive surgery. Depending on the defect size, various reconstructive methods have been described, including local, regional, distant and free flaps. The authors described new biogeometric designs of first dorsal metacarpal artery flap for the reconstruction of the soft tissue defects of the first web space and the proximal dorsal thumb. These modifications are bilobed and V-Y advancement first dorsal metacarpal artery flaps. Three patients had burn wound adduction contractures of the first web space and three had acute wounds resulting from electrical burns, the defects of which were located on the first web space and on the dorsum of the thumb. The defect sizes ranged from 2.5 × 2 cm to 3.5 × 4 cm, and were reconstructed with the bilobed and V-Y advancement first dorsal metacarpal artery flaps. None of these flap modifications had any problems related to the perfusion of the flap, such as arterial insufficiency or venous congestion. The mean follow-up period was 16 months and all the patients were satisfied with the functional result and the donor site scars appearance. The bilobed and V-Y advancement first dorsal metacarpal artery flaps described by the authors for the hand reconstruction are safe, easily performed, and are versatile without skin grafts at the donor site because of inherent excellent elasticity and mobility of the dorsal hand skin. PMID:25100542
The multiple osteotomized free iliac osteocutaneous flap for reconstructions of complex maxillofacial and oromandibular defects.
Karaaltin, Mehmet Veli; Canter, Halil Ibrahim; Batioğlu-Karaaltin, Ayşegül; Yoğun, Fatma Nilay; Güneren, Ethem; Sönmez, Tolga Taha
The vascularized iliac osteocutaneous flap has been used successfully for jaw reconstruction. To obtain a better contour of the reconstructed area in large upper and lower jaw resections, the transferred bone actually needs to be osteotomized. Single closing-wedge osteotomy of the iliac flap for mandibular reconstruction has been previously described. In this article, the modified multiple osteotomized perforator-based versatile free iliac osteocutaneous flap is described. Eleven cases were enrolled. Seven patients had wide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1 patient had complicated orbitomaxillary defect due to blast injury. Skin paddle was based on the perforators. In 8 patients, the bony segment was divided into 3 segments by 2 osteotomies, whereas in 2 patients the bony segment was divided into 4 segments by 3 osteotomies. In 10 cases, the flap was used for anterior mandibular defects, whereas in 1 case the flap was customized to fit an L-shaped defect at the naso-orbito-maxillary region. The overall flap success rate was 100%. No resorption or morbidity related to the osteotomy of the bony segments was observed. The size of perforator skin paddle was 6 to 8 × 15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneous iliac flap can provide a safe and versatile bony segment to be arranged and adapted to reconstruct complex mandibular and maxillofacial defects. PMID:24036732
[Secondary reconstruction, after maxillectomy, using an osteocutaneous flap from the fibula. Report of a case].
Ferrari, S; Raffaini, M; Caradonna, L; Sesenna, E
Surgical functional reconstruction after partial maxillectomy with fibula free flap. A bilateral upper alveolar bone, gingival and palatal defect after tumor resection, has various problems originating from reconstruction with prosthesis or temporalis muscle flap. We report a secondary reconstructive procedure using the fibula osteocutaneous free flap. The combined bone segments created the upper alveolar arch, and the skin paddle closed the palatal defect. This procedure restored the patient to masticatory function of the upper jaw, intelligible speech and natural facial appearance. As a result quality of life of patient was extremely improved. PMID:9432561
Extended V-Y Advancement Flap Reconstruction of a Large Posterior Upper Midline Trunk Defect
Fukudome, Eugene Y.; Bharadia, Deepak R.; Helm, Douglas L.
Summary: Large posterior upper trunk defects can be challenging to reconstruct. Trapezius or latissimus dorsi myocutaneous flaps are principally utilized for reconstruction; however, some defects may not be amenable to this standard approach. Here, we describe a patient with a full-thickness skin and subcutaneous tissue loss of the upper back and inferior cervical region after dermatofibrosarcoma protuberans resection. A large, extended V-Y flap was used for closure of this wound secondary to its location, size, and orientation. This approach preserves shoulder function, allows for readvancement of the flap as needed, and is a reconstructive option for patients with large upper back defects.
Scrotal reconstruction using a superficial circumflex iliac artery perforator flap following Fournier's gangrene.
Han, Hyun H; Lee, Jung H; Kim, Sue M; Jun, Young J; Kim, Young J
Fournier's gangrene is a type of necrotising fasciitis around the scrotum and perineum. Because of its aggressive nature, patients should be treated with broad-spectrum antibiotics and emergency, radical debridement during the acute phase. After recovering from the acute phase, reconstruction of the scrotal and perineal soft tissue defects is needed and is often challenging. Traditionally, various reconstruction methods have been used, including skin grafts, fasciocutaneous flaps and musculocutaneous flaps, each with its pros and cons. We successfully covered a wide scrotal defect using a superficial circumflex iliac artery perforator flap, which has not been previously reported for this indication. The design and operative technique are introduced in this study. PMID:25091799
Extended V-Y Advancement Flap Reconstruction of a Large Posterior Upper Midline Trunk Defect.
Fukudome, Eugene Y; Bharadia, Deepak R; Helm, Douglas L; Sinha, Indranil
Large posterior upper trunk defects can be challenging to reconstruct. Trapezius or latissimus dorsi myocutaneous flaps are principally utilized for reconstruction; however, some defects may not be amenable to this standard approach. Here, we describe a patient with a full-thickness skin and subcutaneous tissue loss of the upper back and inferior cervical region after dermatofibrosarcoma protuberans resection. A large, extended V-Y flap was used for closure of this wound secondary to its location, size, and orientation. This approach preserves shoulder function, allows for readvancement of the flap as needed, and is a reconstructive option for patients with large upper back defects. PMID:27579237
Gelatin Facial Skin Simulator for Cutaneous Reconstruction.
Taylor, Steven R; Chang, C W David
Reconstruction of facial defects can be an intimidating endeavor, especially to resident physicians. When local flap reconstruction is preferred, design of the optimal flap can be a difficult choice. Poor selection can lead to unsightly scarring as well as increased morbidity. A low-cost, easy-to-fabricate gelatin prosthetic facial skin simulator is presented to offer training experience in wound closure, local tissue rearrangement, and facial defect reconstruction for resident instruction. In conjunction with a didactic lecture, 10 participants were asked to perform a Z-plasty, bilobed, rhomboid, and paramedian forehead flap, followed by an 18-question survey. While initial impressions are favorable, further validation studies are warranted. PMID:26645528
Reduction of Flap Side Edge Noise - the Blowing Flap
NASA Technical Reports Server (NTRS)
Hutcheson, Florence V.; Brooks, THomas F.
A technique to reduce the noise radiating from a wing-flap side edge is being developed. As an airplane wing with an extended flap is exposed to a subsonic airflow, air is blown outward through thin rectangular chord-wise slots at various locations along the side edges and side surface of the flap to weaken and push away the vortices that originate in that region of the flap and are responsible for important noise emissions. Air is blown through the slots at up to twice the local flow velocity. The blowing is done using one or multiple slots, where a slot is located along the top, bottom or side surface of the flap along the side edge, or also along the intersection of the bottom (or top) and side surfaces.
Reverse saphenous conduit flap in small animals: Clinical applications and outcomes.
Elliott, Ross C
Due to the lack of skin elasticity defects of the distal hind limb can be a challenge to close. This article assesses a well-described, but completely under-used technique for closure of wounds on the distal tarsus. The technique was used with good success in six cases presenting to the Bryanston Veterinary Hospital with a wide range of underlying pathology ranging from trauma to neoplastic disease of the tarsus. All six cases were treated with a reverse saphenous conduit flap and two of them underwent radiation therapy with no adverse side effects. All cases showed excellent results with a very low degree of flap necrosis that never exceeded 15% of the total flap area. This skin flap provides an excellent treatment method that is reliable in closure of defects of the distal tarsus with few adverse effects. To the author's knowledge there has been only one previously published report on the clinical use of this type of skin flap, even though the flap is well described in most texts. PMID:25685994
Reconstruction of low hairline microtia of Treacher Collins syndrome with a hinged mastoid fascial flap.
Maeda, T; Oyama, A; Funayama, E; Yamamoto, Y
Treacher Collins syndrome (TCS) is a rare genetic disorder leading to congenital craniofacial malformations. Although this syndrome presents with various symptoms, corrective surgery for bilateral microtia with low hairline is one of the most challenging operations given the complex contours of the external ear. In this technical note, a novel, simple procedure for dealing with the low hairline by using a hinged mastoid fascial flap simultaneously with costal cartilage grafting is described. Several techniques for the reconstruction of low hairline microtia have been reported previously, such as skin graft, skin flap, and tissue expander, but the high number of repeat operations and residual scars remain problematic. As a simultaneous procedure with framework grafting, the use of a temporoparietal flap with skin grafting is popular; however, its drawbacks include the operative scar, decreased hair growth, and hair thinning. Patients with TCS show anatomical variations of the superficial temporal vessels supplying the temporoparietal flap. In contrast, due to the high vascularity of the mastoid fascia, the mastoid fascial flap can be elevated safely and easily as an anteriorly, posteriorly, superiorly, or inferiorly based flap. PMID:26744099
Comparison of Long-Term Outcomes of Postmastectomy Radiotherapy between Breast Cancer Patients with and without Immediate Flap Reconstruction
Lee, Hsin-Hua; Hou, Ming-Feng; Wei, Shu-Yi; Lin, Sin-Daw; Luo, Kuei-Hau; Huang, Ming-Yii; Ou-Yang, Fu; Huang, Chih-Jen
Purpose To compare the long-term clinical outcomes of postmastectomy radiotherapy (PMRT) between breast cancer patients with and without immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Methods The study included 492 patients with stage II or III breast cancer who underwent modified radical mastectomy (MRM) and chemotherapy followed by PMRT between 1997 and 2011. Cox regression model and Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups. Results Among 492 patients, 213 patients had immediate TRAM flap reconstruction. The mean follow-up was 7.2 years (range, 11–191 months). The 5-year and 10-year disease free survival rates were 81% and 76% for the TRAM flap group and 78% and 73% for the non-flap group. The 5-year and 10-year overall survival rates were 89% and 73% for the TRAM flap group and 83% and 74% for the non-flap group. Conclusions There exists no statistically significant difference in the rates of local recurrence, distant metastasis, disease-free and overall survival when comparing immediate TRAM flap reconstruction with no reconstruction. Our results suggest that immediate TRAM flap reconstruction does not compromise long term clinical outcomes in breast cancer patients requiring PMRT. PMID:26863006
Turn over split fascial flap - a refinement for resurfacing shin defect
Bhattacharya, Visweswar; Agrawal, Neeraj K; Chaudhuri, Gaurab R; Barooah, Partha S; SK, Tripathi; Birendra, Rana; Bhattacharya, Siddhartha; Deka, Dhruva J
Moderate size defects of the shin of tibia are frequently encountered following trauma and infection. They may be associated with or without a fracture. Such defects require resurfacing by a flap. Many different types of flaps have been described but most of them proved to be more bulky than desired. Although these procedures cover the defects successfully the results they produce are not aesthetically appropriate. The flap looks bulkier because the native subcutaneous tissue is thin over the shin and distal leg. Hence a search for a vascularized tissue of minimal bulk for suitable resurfacing was initiated. A turnover fascial flap fulfilled the requirement. Such a flap can be made thinner by splitting its distal part into two layers while maintaining a common vascular fascial pedicle with both the layers of the fascia. This allowed a larger surface area to be covered. Such refinement is based on the following parameters (a) fresh cadaveric dissection, (b) demonstration of live microcirculation individually in the superficial and deep layers of the deep fascia and (c) intraoperative flourescein study of the split fascial flap. The technique has been used in 5 cases over the upper and middle third of the shin of tibia. The split fascial flap was turned over and inset in the defect and covered with a split skin graft. The donor site was primarily closed. The functional and aesthetic results were highly satisfactory. The follow up of 18 months proved the durability and usefulness of the flap. PMID:23071906
Computational Study of Porous Treatment for Altering Flap Side-Edge Flowfield
NASA Technical Reports Server (NTRS)
Choudhari, Meelan; Khorrami, Mehdi R.
Reynolds-averaged Navier-Stokes calculations are used to investigate porous side-edge treatment as a passive means for flap noise reduction. Steady-state simulations are used to infer effects of the treatment on acoustically relevant features of the mean flow near the flap side edge. Application of the porous treatment over a miniscule fraction of the wetted flap area (scaling with the flap thickness) results in significantly weaker side-edge vortex structures via modification of the vortex initiation and roll-up processes. At high flap deflections, the region of axial flow reversal associated with the breakdown of the side-edge vortex is also eliminated, indicating an absence of vortex bursting in the presence of the treatment. Potential ramifications of the mean-flow modifications for flap-noise reduction are examined in the light of lessons learned from recent studies on flap noise. Computations confirm that any noise reduction benefit via the porous treatment would be achieved without compromising the aerodynamic effectiveness of the flap. Results of the parameter study contribute additional insight into the measured data from the 7x10 wind tunnel at NASA Ames and provide preliminary guidance for specifying optimal treatment characteristics in terms of treatment location, spatial extent, and flow resistance of the porous skin.
Nasolabial pedicled compared with island flaps for intraoral reconstruction of oncological defects: complications, recovery of sensitivity, and assessment of quality of life.
Maria, Lazaridou; Konstantinos, Vaxtsevanos; Ioannis, Dimitrakopoulos; Nikolaos, Lazaridis; Konstantinos, Antoniades
Our aim was to compare pedicled and island nasolabial flaps used for reconstruction of oral defects in terms of postoperative complications, recovery of sensitivity, and quality of life. We organised a retrospective cohort study of 49 patients who had had intraoral reconstruction with nasolabial pedicled (n-=13) and island (n=36) flaps. Twenty- two patients filled in a validated quality-of-life (QoL) questionnaire and we did sensitivity tests (sharp discrimination with the aid of a Semmes-Weinstein™ aesthesiometer). Descriptive and bivariate statistics were computed and probabilities of 0.05 were accepted as significant. There were 11 flap-related complications (22%), and the flap was totally necrotic in three patients (6%), all of whom had island flaps. There was a significant association between flap-related complications and the use of reconstruction plate p=0.001, 95% CI 2.36 to 11.37) and advanced stage (T3 and T4 p=0.01, 95% CI 1.45 to 5.26). Skin sensitivity recovered in both island and pedicled flaps. Patients treated with island flaps had significantly more problems with prosthetic rehabilitation than those treated with pedicled flaps. The relatively low morbidity and adequate functional and aesthetic results make the pedicled nasolabial flap a viable technique. De-epithelialisation of the pedicle in island flaps permits coverage of defects with unilateral flaps in a one-stage reconstruction. However, the pedicle may be excessively stretched, leading to ischaemic complications. PMID:27182010
Deep circumflex iliac perforator flap.
Kimata, Yoshihiro
The increased freedom of the DCIP flap from the harvested iliac crest facilitates correct positioning. To ensure that the DCIP flap can be safely elevated, however, the presence of perforators (approximately 1 cm in diameter) must be confirmed preoperatively and intraoperatively. PMID:12916597
Anticoagulants and Statins As Pharmacological Agents in Free Flap Surgery: Current Rationale
Pršić, Adnan; Kiwanuka, Elizabeth; Caterson, Stephanie A.
Microvascular free flaps are key components of reconstructive surgery, but despite their common use and usual reliability, flap failures still occur. Many pharmacological agents have been utilized to minimize risk of flap failure caused by thrombosis. However, the challenge of most antithrombotic therapy lies in providing patients with optimal antithrombotic prophylaxis without adverse bleeding effects. There is a limited but growing body of evidence suggesting that the vasoprotective and anti-inflammatory actions of statins can be beneficial for free flap survival. By inhibiting mevalonic acid, the downstream effects of statins include reduction of inflammation, reduced thrombogenicity, and improved vasodilation. This review provides a summary of the pathophysiology of thrombus formation and the current evidence of anticoagulation practices with aspirin, heparin, and dextran. In addition, the potential benefits of statins in the perioperative management of free flaps are highlighted. PMID:26617953
Seromuscular Colonic Flap for Intrapelvic Soft-Tissue Coverage: A Reconstructive Option for Plastic Surgeons When Traditionally Used Flaps Are Not Available
Aho, Johnathon; Winocour, Sebastian; Hammoudeh, Ziyad S.; Nelson, Heidi; Rose, Peter; Tran, Nho V.
Background. Reconstruction of intrapelvic defects can be a challenging problem in patients with limited regional muscle flap options and previously resected omentum. In such situations, alternative methods of mobilizing vascularized tissue may be required. Methods. A case of a patient that underwent pelvic extirpation for recurrent rectal cancer who had limited donor sites for flap reconstruction is presented. The mucosa was removed from a blind loop of colon, and a pedicled seromuscular flap based on the colonic mesentery was placed into the pelvis for vascularized soft-tissue coverage and elimination of dead space. Results. The postoperative course was only complicated by a small subcutaneous fluid collection beneath the sacrectomy skin incision, which was drained with radiological assistance. The patient recovered without any major postoperative complications. Conclusion. Seromuscular colonic flap is a useful option for soft-tissue coverage after pelvic extirpation and should be considered by plastic surgeons when other reconstruction options are not available. PMID:26688771
NASA Technical Reports Server (NTRS)
Lippisch, Alexander
Before attempting to construct a human-powered aircraft, the aviator will first try to post himself theoretically on the possible method of operating the flapping wings. This report will present a graphic and mathematical method, which renders it possible to determine the power required, so far as it can be done on the basis of the wing dimensions. We will first consider the form of the flight path through the air. The simplest form is probably the curve of ordinary wave motion. After finding the flight curve, we must next determine the change in the angle of attack while passing through the different phases of the wave.
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Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft ... site. Most people who are having a skin graft have a split-thickness skin graft. This takes ...
The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction
Miteff, Kirstin G.
Background: The evolution of surgical breast cancer treatment has led to the oncologically safe preservation of greater amounts of native skin, yet we are still often using flaps with large skin paddles, thereby resulting in significant donor-site scars. This explains the increasing appeal of acellular dermal matrix reconstructions. Acellular dermal matrices can, however, have significant problems, particularly if there is any vascular compromise of the mastectomy skin flaps. We have developed a method of raising the latissimus dorsi flap through the anterior mastectomy incisions without requiring special instruments or repositioning. This can provide autologous vascularized cover of the prosthesis. Methods: A clear surgical description of the scarless latissimus dorsi flap harvest is provided, and our results of a retrospective cohort review of 20 consecutive patients with 27 traditional latissimus dorsi breast reconstructions were compared with those of 20 consecutive patients with 30 scarless latissimus dorsi breast reconstructions. Results: Operative time, length of stay, and complication rates were reduced in the scarless group. Patients Breast-Q scores were equivalent in each group. The aesthetic assessment was good/excellent in 77% of both groups; however, subscale assessment was better in the scarless group. This was statistically significant (P = 0.0). Conclusions: Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices. PMID:25289340
Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap.
Yeo, In Sung; Kim, Se-Hyuk; Park, Myong Chul; Lim, Hyoseob; Kim, Joo Hyoung; Lee, Il Jae
Skull base reconstruction presents a challenging therapeutic problem requiring a multispecialty surgical approach and close cooperation between the neurosurgeon, head and neck surgeon, as well as plastic and reconstructive surgeon during all stages of treatment. The principal goal of skull base reconstruction is to separate the intracranial space from the nasopharyngeal and oropharyngeal cavities, creating support for the brain and providing a water-tight barrier against cerebrospinal fluid leakage and ascending infection. We present a case involving a 58-year-old man with anterior skull base defects (2.5 cm × 3 cm) secondary to the removal of olfactory neuroblastoma. The patient received conventional radiation therapy at 6000 cGy in 30 fractions approximately a month before tumor removal. The patient had radiation therapy before surgery and was planned to have postoperative radiation therapy, which would lead to a higher complication rate of reconstruction. Artificial dura was used for the packing of the dural defect, which was also suspected to increase the complication rate of reconstruction. For these reasons, we chose to apply the dual flap technique, which uses both local pericranial flap and de-epithelized radial forearm free flap for anterior skull base defect to promote wound healing. During 28 months of follow-up after coverage of the anterior skull base defect, the dual flap survived completely, as confirmed through follow-up magnetic resonance imaging. The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and there was minimal donor-site morbidity of the radial forearm free flap. Reconstruction of anterior skull base defects using the dual flap technique is safe, reliable, and associated with low morbidity, and it is ideal for irradiated wounds and low-volume defects. PMID:24902109
Local Skin Warming Enhances Color Duplex Imaging of Cutaneous Perforators.
Li, Haizhou; Du, Zijing; Xie, Feng; Zan, Tao; Li, QingFeng
The perforator flap is one of the most useful techniques in reconstructive surgery. The operative procedure for these flaps will be greatly simplified if accurate localization of the course of the perforator can be preoperatively confirmed. However, small vessels with diameters less than 0.5 mm cannot be readily traced with conventional imaging techniques. Local skin warming temporarily increases cutaneous blood flow and vasodilation. In this study, we established a local skin warming procedure, and performed this before color duplex imaging to improve preoperative perforator mapping and enable precise flap design. PMID:23903089
A Novel Endoscopic-Assisted Harvesting of Pedicled Freestyle Fasciocutaneous Flaps
Huang, Jen-Wu; Lin, Yi-Ying; Wu, Nai-Yuan; Yen, David Hung-Tsang
Abstract The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects. From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects. All of the defects were caused by trauma with tendon or bone exposure. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months. The age of the 9 patients (8 men and 1 woman) ranged from 20 to 79 years (median 59 years). The defects ranged in size from 2 × 2 to 6 × 8 cm2. Two patients received anterolateral thigh transmuscular perforator flaps, 5 patients received fibular septocutaneous perforator flaps, and 2 patients received medial gastrocnemius transmuscular perforator flaps. The median incision length was 10 cm, and the median operative time was 120 minutes. None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL). At the end of the 3-month follow-up period, none of the patients had any complications on either recipient or donor site, including total or partial necrosis of the flaps, flap dehiscence, hematomas, seromas, wound infections, or any conditions that indicated additional unplanned operative procedures. All of the patients had surviving flaps. Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps. PMID:25715266
Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.
Costa, Dary J; Walen, Scott; Varvares, Mark; Walker, Ronald
Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure. PMID:26949586
Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants.
Nakayama, B; Matsuura, H; Ishihara, O; Hasegawa, H; Mataga, I; Torii, S
We have achieved functional reconstruction for a bilateral upper alveolar bone, gingival, and palatal defect that has various problems originating from instability of the prosthesis using the fibula osteocutaneous flap with osseointegrated implants. The flap had three bone segments and two skin paddles. The combined bone segments created the upper alveolar arch, and the skin paddles closed the palatal defect. Nine months later, prosthodontic treatment was performed successfully. Our procedure restored the patient to masticatory function of the upper jaw, intelligible speech, and natural facial appearance. As a result, quality of life of the patient was extremely improved. PMID:7568500
The Distally Based Dorsal Metatarsal Artery Perforator Flap: Vascular Study and Clinical Implications.
van Alphen, Nick A; Laungani, Alexis T; Christner, Jodie A; Lachman, Nirusha; Carlsen, Brian T; Saint-Cyr, Michel
Background Intrinsic flaps based on the dorsal metacarpal arteries are useful for coverage of dorsal hand, finger, and thumb defects. The purpose of this study was to explore the anatomy of the dorsal metatarsal arteries (DMtAs) in the foot to help define their clinical utility. We observed the size and numbers of distal perforators from the DMtAs and quantified the vascular perfusion pattern of the DMtA perforator across the skin. Methods Ten fresh cadaver feet were injected with latex and dissected to assess the size and number of distal perforators from the DMtAs. Five DMtA perforator flaps were injected with methylene blue to visualize and quantify the vascular territory of the skin flap to understand the clinical possibilities. In addition, a clinical case is described and shown. Results Ten fresh cadaver feet were dissected. The first DMtA was absent in two specimens and the second, third, or fourth DMtA was absent in one specimen each. The available DMtAs had between two and five cutaneous perforators supplying the skin (average, 3.7 perforators per DMtA). The largest perforators to the skin were always seen in the distal half of the DMtA and ranged from 0.4 to 0.8 mm (average, 0.5 mm). Methylene blue injections showed an average flap surface of 21.6 × 47.6 mm. Conclusion This cadaveric study demonstrates the usefulness of the DMtA perforator flap. The flap is a valuable addition to the arsenal of flaps to cover the dorsum of the toe, webspace, or defects exposing tendons on the distal dorsum of the foot. PMID:26165886
A Biodegradable Polyurethane Dermal Matrix in Reconstruction of Free Flap Donor Sites: A Pilot Study
Wagstaff, Marcus J.D.; Schmitt, Bradley J.; Coghlan, Patrick; Finkemeyer, James P.; Caplash, Yugesh
We have developed a biodegradable temporizing matrix (BTM) capable of supporting secondary split-skin graft-take in animal studies. We report its first long-term implantation and use as a dermal scaffold in humans. This preliminary study assesses its ability to integrate, its ease of delamination, its ability to sustain split-skin graft in complex wounds, the degree of wound contraction, and ultimately the quality of the scar at 1 year postimplantation. Ten patients were recruited, each requiring elective free flap reconstruction. Free flap donor sites created were anterolateral thigh flaps, fibular osseocutaneous flaps, or radial/ulnar forearm (RF/UF) flaps. The BTM was implanted when the flap was detached from its donor site. Dressing changes were performed twice weekly. The time elapsed between implantation and delamination depended on the type of flap and thus the wound bed left. Once integrated, the BTMs were delaminated in theatre, and the surface of the "neodermis" was refreshed by dermabrasion, prior to application of a split-skin graft. The BTM integration occurred in all patients (100% in 6 patients, with 90%, 84%, 76%, and 60% integration in the remainder). Integrated BTM sustained successful graft-take in all patients. Complete take was marred in 2 patients, over areas of BTM that had not integrated and graft application was performed too early. The BTM can be applied into wounds in humans and can integrate, persist in the presence of infection, and sustain split-skin overgrafting, despite the trial group presenting with significant comorbidities. PMID:25987938
A biodegradable polyurethane dermal matrix in reconstruction of free flap donor sites: a pilot study.
Wagstaff, Marcus J D; Schmitt, Bradley J; Coghlan, Patrick; Finkemeyer, James P; Caplash, Yugesh; Greenwood, John E
We have developed a biodegradable temporizing matrix (BTM) capable of supporting secondary split-skin graft-take in animal studies. We report its first long-term implantation and use as a dermal scaffold in humans. This preliminary study assesses its ability to integrate, its ease of delamination, its ability to sustain split-skin graft in complex wounds, the degree of wound contraction, and ultimately the quality of the scar at 1 year postimplantation. Ten patients were recruited, each requiring elective free flap reconstruction. Free flap donor sites created were anterolateral thigh flaps, fibular osseocutaneous flaps, or radial/ulnar forearm (RF/UF) flaps. The BTM was implanted when the flap was detached from its donor site. Dressing changes were performed twice weekly. The time elapsed between implantation and delamination depended on the type of flap and thus the wound bed left. Once integrated, the BTMs were delaminated in theatre, and the surface of the "neodermis" was refreshed by dermabrasion, prior to application of a split-skin graft. The BTM integration occurred in all patients (100% in 6 patients, with 90%, 84%, 76%, and 60% integration in the remainder). Integrated BTM sustained successful graft-take in all patients. Complete take was marred in 2 patients, over areas of BTM that had not integrated and graft application was performed too early. The BTM can be applied into wounds in humans and can integrate, persist in the presence of infection, and sustain split-skin overgrafting, despite the trial group presenting with significant comorbidities. PMID:25987938
Postoperative Controversies in the Management of Free Flap Surgery in the Head and Neck.
Cannady, Steven B; Hatten, Kyle; Wax, Mark K
Free tissue transfer is the gold standard for reconstructing head and neck defects. Free flap success approaches 95% in centers with experience, affording unparalleled ability to restore form and function in cancer, trauma, or other major composite tissue loss. It is critical to manage the perioperative variables that predict success; several areas of controversy have not yet reached consensus. This review focuses on postoperative anticoagulation, fluid management, and flap monitoring methods. These areas of controversy potentially influence flap survival. We review published practices considered within the standard of care, why controversy remains, and future directions to reach standardization. PMID:27400844
Flap Edge Noise Reduction Fins
NASA Technical Reports Server (NTRS)
Khorrami, Mehdi R. (Inventor); Choudhan, Meelan M. (Inventor)
A flap of the type that is movably connected to an aircraft wing to provide control of an aircraft in flight includes opposite ends, wherein at least a first opposite end includes a plurality of substantially rigid, laterally extending protrusions that are spaced apart to form a plurality of fluidly interconnected passageways. The passageways have openings adjacent to upper and lower sides of the flap, and the passageways include a plurality of bends such that high pressure fluid flows from a high pressure region to a low pressure region to provide a boundary condition that inhibits noise resulting from airflow around the end of the flap.
Dancing girl flap: a new flap suitable for web release.
Shinya, K
To create a deep web, a flap must be designed to have a high elongation effect in one direction along the mid-lateral line of the finger and also to have a shortening effect in the other direction, crossing at a right angle to the mid-lateral line. The dancing girl flap is a modification of a four-flap Z-plasty with two additional Z-plasties. It has a high elongation effect in one direction (>550%) and a shortening effect in the other direction at a right angle (<33%), creating a deep, U-shaped surface. This new flap can be used to release severe scar contracture with a web, and is most suitable for incomplete syndactyly with webs as high as the proximal interphalangeal joint. PMID:10597822
Keystone Flap: Versatile Flap for Reconstruction of Limb Defects
Janna, Rakesh K.
Background: There is always a constant search for a new solution to tackle defects in the limbs. The technique has to be simple, easily reproducible and performed within a short duration. The answer is keystone island flap keystone flap is a simple, less time consuming, durable and easily reproducible option to reconstruct most of the limb defects. Aim: The aim of this article is to study the usefulness of keystone flap in reconstruction of various upper and lower limb defects. Materials and Methods: This retrospective review involves study of 20 patients undergoing keystone flap reconstruction for various defects from 2012 to 2014. Patient demographic data, medical histories, comorbidities, surgical indications, defect characteristics and locations, hospitalization, complications and follow-up were evaluated and are presented as uncontrolled case series. Results: Ages of the patients were ranging from 18 to 65 y with an average of 38.75y. Among the defects, 10 were following trauma (50%), 5 were due to tumour resection (25%), 3 followed debridement of abscess (15%) and another 2 defects were due to surgical wound dehiscence (10%). The largest defect covered by this flap in our study measured 45 x 18 cm and the smallest defect was 8 x4 cm. The average intra-operative time was 45.5 min (range 20-90 min). Fourteen flaps were done to cover lower limb defects (70%), 4 for upper limb defects and 2 were for defects in the axilla. Partial flap necrosis was observed in one case. The average duration of hospital stay of patients was 3.45 d. All patients were followed until they achieved stable, healed wound.The overall success rate was 95%. Conclusion: Keystone flap can be safely used to cover various limb defects with minimal pain, a sensate cover and excellent cosmetic outcome, minimizing the need for microsurgical techniques or prolonged operative time. PMID:25954659
An Application of Keystone Perforator Island Flap for Closure of Lumbosacral Myelomeningocele Defects.
Park, Hye-Sung; Morrison, Edwin; Lo, Cheng; Leong, James
Myelomeningocele, also known as spina bifida, is the commonest form of neural tube defect in which both meninges and spinal cord herniate through a large vertebral defect. It may be located at any spinal level; however; lumbosacral involvement is most common. After birth, the closure of spinal lesion is preferably undertaken in the first 48 hours to minimize the risk of injury and central nervous system infection. Relatively small skin defects overlying the dural repair may be directly closed. However, larger defects require reconstructive closure. Numerous methods of reconstruction have been described, such as split skin graft, local flaps or lumbosacral fasciocutaneous flaps, muscle flaps using latissimus dorsi, gluteal or paraspinous muscles, and perforator flaps namely superior gluteal artery perforators, and dorsal intercostal artery perforator flaps. At Monash Health, Victoria, we have used the keystone perforator island flaps to reconstruct lumbosacral myelomeningocele defects on 5 newborns between January 2008 and January 2014. This article evaluates the short-term and long-term outcomes of these patients who were followed up for 10 to 66 months. PMID:26418773
Flap monitoring using infrared spectroscopy
NASA Astrophysics Data System (ADS)
Keller, Alex; Wright, Leigh P.; Elmandjra, Mohamed; Mao, Jian-min
We report results of clinical trials on flap monitoring in 65 plastic surgeries. Hemoglobin oxygen saturation of flap tissue (StO II) was monitored non-invasively by using ODISsey TM tissue oximeter, an infrared spectroscopic device. StO II measurements were conducted both intra-operatively and post-operatively. From the intra-operative measurements, we observed that StO II values dropped when the main blood vessels supplying the flap were clamped in surgery, and that StO II jumped after anastomosis to a value close to its pre-operative value. From post-operative monitoring measurements for the 65 flap cases, each lasted two days or so, we found that the StO II values approach to a level close to the baseline if the surgery was successful, and that the StO II value dropped to a value below 30% if there is a perfusion compromise, such as vascular thrombosis.
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Anterior-posterior dissociative slide facilitates the second stage of 3-stage forehead flap nasal reconstruction.
Weinfeld, Adam Bryce; DeLeon, Ashley Nicole
Pedicle-lining skin grafts contract between the first and second stage in a 3-stage forehead flap nasal reconstruction. The second stage involves an inherent reduction in vascularity due to the soft tissue thinning performed. The Anterior-Posterior Dissociative Slide restores first-stage pedicle length at the second stage. Incisions are made at the distal seam between the contracted graft and the pedicle tissue. The flap is then slid caudally relative to the fixed graft, thus relengthening the pedicle. This technique has been performed in 16 patients achieving an average length gain of 0.7 (+0.2) cm. The additional length created with the dissociative slide translates into reduced tension with flap reinset, thus increasing flap workability and overall artistry in the second stage. PMID:24051472
Full scale upper surface blown flap noise
NASA Technical Reports Server (NTRS)
Heidelberg, L. J.; Homyak, L.; Jones, W. L.
A highly noise suppressed TF 34 engine was used to investigate the noise of several powered lift configurations involving upper surface blown (USB) flaps. The configuration variables were nozzle type (i.e. slot and circular with deflector), flap chord length, and flap angle. The results of velocity surveys at both the nozzle exit and the flap trailing edge are also presented and used for correlation of the noise data. Configurations using a long flap design were 4 db quieter than a short flap typical of current trends in USB flap design. The lower noise for the long flap is attributed primarily to the greater velocity decay of the jet at the flap trailing edge. The full-scale data revealed substantially more quadrupole noise in the region near the deflected jet than observed in previous sub-scale tests.
Perforator Flaps in Head and Neck Reconstruction
Chana, Jagdeep S.; Odili, Joy
Free tissue transfer has revolutionized the management of complex head and neck defects. Perforator flaps represent the most recent advance in the development of free flap surgery. These flaps are based on perforating vessels and can be harvested without significant damage to associated muscles, thereby reducing the postoperative morbidity associated with muscle-based flaps. Elevation of perforator flaps requires meticulous technique and can be more challenging than raising muscle-based flaps. Use of a Doppler device enables reliable identification of the perforating vessels and aids in the design of free-style free flaps, where the flaps are designed purely according to the perforator located. The major advantage of free-style free flaps is that an unlimited number of flaps can potentially be designed on much shorter pedicles. The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction. Its use is described in detail, as is use of other less common perforator flaps. This article also describes head and neck reconstruction in a region-specific manner and gives a short-list of suitable flaps based on the location of the defect. PMID:22550446
Effects of Venous Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model
Zheng, Jun; Xi, Shanshan; Ding, Maochao; Li, Hong; Xu, Wei; Tang, Maolin; Chen, Shixin
Objective To comparatively assess the effects of venous superdrainage and arterial supercharging on dorsal perforator flap survival. Materials and Methods Sixty male Sprague-Dawley rats (450–550g) were randomly divided into three groups (n = 20), including control group (Control) and experimental groups A (venous superdrainage, Exp. A) and B (arterial supercharging, Exp. B). At postoperative day 7, survival areas of the flaps were evaluated and all animals underwent angiography. Laser Doppler was used to evaluate flap perfusion from 0h to 7days after surgery. Histology with hematoxylin and eosin staining was used to count microvessels. Tissue of "Choke vessels"was excised for quantification of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) by western blot assay at 6h and 7days after surgery. Results In the Exp. A group, almost all flaps survived (98.2±1.6%); in the Exp. B and control group, survival areas accounted for 78.8±8.5% and 60.3±7.8%, respectively (P <0.001). In addition, Exp. A animals showed improved anastomosis of choke vessels 2 compared with the Exp. B and Control groups. Furthermore, flap blood flow and partial pressure of oxygen in the Exp. A group were significantly higher compared with values obtained for the Exp. B and Control groups, from 6 hours to 7 days after surgery. More microvessels were found in the Exp. A group (11.65±1.33) than in Exp. B (9.25±0.34) and control (7.25±0.91) animals on POD 7. The relative expression level of HIF-1α and VEGF were significant at 6h and 7days after surgery. Conclusions Venous superdrainage in rat dorsal perforator flap is more effective than arterial supercharging in promoting flap survival, and could effectively alter hemodynamics in the microcirculation and stimulate blood vessel formation. PMID:27513520
Acellular Dermal Matrix Combined with Autologous Skin Grafts for Closure of Chronic Wounds after Reconstruction of Skull Defects with Titanium Mesh.
Luo, Xu; Lin, Cai; Wang, Xinling; Lin, Xiangwei; He, Sunyue; Liu, Yunfeng; Zhang, Yong; Yang, Ruijin; Zhu, Xinguo
Objective The closure of chronic wounds after skull defect reconstruction with titanium mesh is one of the most challenging problems for plastic and reconstructive surgeons. Current approaches are disappointing. Methods In 10 patients, we explored the role of acellular dermal matrix (ADM) in combination with autologous skin grafts (ASGs) for closure of chronic wounds after skull reconstruction with titanium. Results ADM and ASG survived in all patients. Grade A healing (healing well without defect) was achieved. The average operating time was 30 to 45 minutes, and the average blood loss 30 to 50 mL. After 3 months, the wound was still closed in all patients. Conclusion The combination of ADM plus ASG obtained a high wound closure rate. ADM plus ASG allows avoiding other procedures such as rotational flaps and free flaps that require more operating time, special equipment, and adequate training. PMID:27088591
Prevention of Recurrence in the Surgical Correction of Cryptotia Using Local Flaps With a Cartilage Wedge Graft
Oh, Jeong-Hoon; Park, Kyung Ho; Kim, Byung Guk
Abstract Cryptotia attributable to deficient posterior skin coverage frequently recurs. Because local flaps cover only the posterior aspects of the defective upper auricular cartilage and lack functional support to resist collapse of the helix, especially if severe helical cartilage anomalies are present, additional support is required to prevent the postoperative recurrence of this anomaly. The authors present cases of cryptotia treated using local flaps including a Z-plasty or formation of a trefoil flap with an additional cartilage wedge graft on the cephaloauricular sulcus to enhance projection of the helix. The combination of a graft with a local flap using a large Z-plasty or trefoil flap efficiently corrects the cryptotia, and is associated with minimal visible scarring and few complications, including recurrence. PMID:26967080
The Role of Muscle Flaps for Salvage of Failed Perforator Free Flaps
Background: Despite the most heroic efforts, sometimes free flaps fail. Perforator free flaps are not invincible and can suffer the same fate. The real challenge is how to decide what is the next best choice for achieving the desired outcome. Methods: Over the past decade, 298 free perforator flaps were used in our institution. Total failure occurred in 16 patients, and partial failure requiring a second free flap occurred in an additional 6 patients for a true success rate of 93%. All failures had some form of secondary vascularized tissue transfer, which included the use of muscle flaps in 9 (41%) different patients. Results: Initial flap salvage after a failed perforator free flap was attempted with 12 perforator and 5 muscle free flaps as well as 1 perforator and 2 muscle local flaps. These were not all successful, with loss of 3 muscle free flaps and 3 perforator flaps. Tertiary free flap coverage was successful in 3 cases using 2 muscle flaps and 1 perforator free flap. Local fasciocutaneous flaps or primary wound closure was used in the remaining individuals. Conclusions: Microsurgical tissue transfers can be the most rewarding and at the same time the most challenging reconstructive endeavor. Persistence in achieving the desired outcome can require multiple steps. Perforator flaps are an important asset to obtain this goal. However, muscle flaps can still be a useful alternative, and the message is that they should not be overlooked as sometimes a viable option. PMID:26893989
Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction.
Bendon, Charlotte L; Giele, Henk P
Traditionally, in free flap cover of lower limb injuries, every attempt is made to perform anastomoses proximal to the zone of injury. We report on the success of anastomoses within the zone of trauma, at the level of the fracture, avoiding further dissection and exposure. The records of free flap reconstructions for fractures of the lower extremity at a tertiary trauma centre between 2004 and 2010 were retrospectively reviewed. A total of 48 lower limb fractures required free flap reconstruction, performed at 28 days post injury (0-275 days). Anastomoses were proximal (21), distal (5) or within the zone of trauma (22). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between groups. Of the 22 performed within the zone of injury, five returned to theatre but only two for revision of anastomosis and 20 (91%) of these flaps survived. Of the 48 free flaps, arterial anastomoses were end to end in 34 (71%) and end to side in 14 (30%). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between the end-to-end and end-to-side groups. There was a tendency for arterial anastomoses to be performed end to end outside the zone of trauma (23/26) compared to within the zone of trauma (11/22). Our data suggest that free flap anastomoses can be performed safely in the zone of trauma in lower limb injuries. PMID:27108076
Anterior tibial artery perforator plus flaps for reconstruction of post-burn flexion contractures of the knee joint
Adhikari, S.; Bandyopadhyay, T.; Saha, J.K.
Summary Background. Post-burn flexion contractures of the knee may arise even with adequate treatment of the burn injury. After release of the contracture, most of these defects require flap coverage. Here we describe the application of the perforator plus flap concept in the management of these contractures. Method. Between December 2010 and December 2011 five female and two male patients with knee contractures were operated on using a perforator plus flap from the anterior tibia artery perforator. In one patient both sides were operated on and the rest had unilateral surgeries. All patients had mature scars and the aetiology was thermal burn injury. All these contractures were categorized as Category 4 and Level 3 by the ICIDH guidelines with an average contracture angle of 87.5 degrees. The flap was raised after release of the defect and a Doppler study located the perforator below the fibular head. The base of the flap was kept intact at all times. The flap was then transposed towards the defect and inset in a tensionless manner. Results. All flaps survived well with marginal necrosis in only one flap, providing stable coverage to the knee joint. The average residual contracture was around 10 degrees and the average range of flexion was 10-120 degrees. Conclusion. The perforator plus flap can be an excellent choice in defects over the posterior aspect of the knee where important neurovascular structures and tendons are exposed. Level of evidence: Level IV. PMID:23233827
A modified pectoralis major myocutaneous flap technique with improved vascular supply and an extended rotation arc for oral defects: A case report
The pedicled pectoralis major myocutaneous (PMMC) flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection. Although free-tissue transfer of a vascularized free flap is often preferred, the clinical benefits of the PMMC flap should not be overlooked. The conventional technique of harvesting a PMMC flap involves a single vascular supply from the pectoral branch of the thoracoacromial artery. However, this approach compromises the distal skin island of the flap, and requires an indirect blood supply via communicating vessels, which increases the potential risk of partial distal flap necrosis. When harvesting a PMMC flap for oral and maxillofacial reconstruction, preservation of the lateral thoracic artery and use of the subclavian route are alternatives that ensure sufficient blood supply and an increased rotation arc. Such an approach enables the harvesting of a PMMC flap that can reach the entire oral cavity, including the infraorbital region, palate, middle pterygopalatine fossa and nasopharynx, with no risk of vascular insufficiency to the distal skin island. In conclusion, the technique described in the present study was able to improve the blood supply of the distal PMMC flap and increase its rotation arc. PMID:26722234
Medial sural artery perforator free flap: legitimate use as a solution for the ipsilateral distal lower extremity defect.
Hallock, Geoffrey G
The medial sural artery perforator (MSAP) flap captures the cutaneous territory of the medial calf, and can potentially be advantageous as a thin free flap, even in the most obese individual, for coverage of most foot and/or ankle defects where bulk is a liability. The anatomy is fairly constant, as usually at least one reasonably large perforator can always be found emanating from the medial head of the gastrocnemius muscle. As a microsurgical tissue transfer, a long vascular pedicle of large caliber is routinely possible which facilitates any requisite microanastomoses.Over the past decade from our free flap registry, 14 patients with distal lower extremity wounds were covered specifically with a perforator flap based on the ipsilateral medial sural artery; out of which only 2 (14%) were females.In this series using a MSAP free flap, there was only one failure requiring salvage by a different free flap. All but one case was a sequel of trauma, and these involved all zones of the foot and ankle. A skin graft of the donor site was necessary in 5/14 (36%) patients. In no cases did the flap subsequently impede the use of shoes nor hinder ambulation.The study concluded the major disadvantage of the MSAP flap is the nonaesthetic scar left at the donor site which can be quite conspicuous, especially if a skin graft had to be used. Yet even this detriment can be acceptable for ipsilateral distal lower extremity defects where reconstruction of the defect itself may be cosmetically unappealing. This may be the best indication for the MSAP flap to be considered first as the free flap of choice. PMID:24114709
Upper cervicothoracic sympathetic block increases blood supply of unipedicled TRAM flap.
Tsoutsos, Dimosthenis; Kakagia, Despoina; Gravvanis, Andreas; Iconomou, Thomais; Tsagkarakis, Myron; Zogogiannis, Ioannis; Dimitriou, Vassilios
A prospective clinical study was conducted to evaluate the impact of upper cervicothoracic sympathetic block (CTGB) on blood supply of the unipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. The use of the technique is first reported herein, as a manipulation improving arterial blood flow within the flap in high-risk patients, thus reducing postoperative morbidity. From March 2003 to September 2006, 28 heavy smokers, who underwent delayed breast reconstruction with unipedicled TRAM flap, were included in the study. Intraoperative upper cervicothoracic block (ganglia C5,6,7 and T1,2) was performed in 16 patients (group A), while 12 patients, who did not consent to have the blockade (group B), were the control. Clinical evaluation and thermographic monitoring of skin temperature, using the Thermacam A40 (FLIR systems, Wilsonville, OR), was used in all patients and determined the blood flow within the flap. All patients were monitored for early and late complications. In all group A patients, CTGB resulted in TRAM flap temperature increase within 9.5 to 16 min. Flap temperature elevation was found to be significantly higher (P < 0.001) and hospital stay was significantly shorter (P = 0.004) in group A patients. No CTGB or TRAM flap complications were recorded in group A patients. However, in group B, major fat necrosis occurred in 2 patients and partial (1/3) flap necrosis in 1 patient. Upper cervicothoracic sympathetic block is a reliable, safe, and useful technique for increasing blood flow within TRAM flaps in high-risk patients, like heavy smokers, and it minimizes postoperative morbidity. PMID:18724121
The Flap Sandwich Technique for a Safe and Aesthetic Skull Base Reconstruction.
Yano, Tomoyuki; Okazaki, Mutsumi; Tanaka, Kentarou; Iida, Hideo
For safe and reliable skull base reconstruction combined with repair of cranial bone defects, we introduce the flap sandwich technique in this study. A titanium mesh is often used to repair structural cranial bone defects because it has less donor site morbidity and is easy to handle. However, titanium mesh has disadvantages of exposure and infection postoperatively. To improve surgical outcomes, we applied the flap sandwich technique to 3 cases of skull base reconstruction combined with cranial bone defect repair. Two anterior skull base defects and 1 middle skull base defect were included in this study. The subjects were all women, aged 30, 58, and 62 years. One patient had former multiple craniotomies and another patient had preoperative radiotherapy. The flap sandwich technique involves structural cranial bone reconstruction with a titanium mesh and soft tissue reconstruction with a chimeric anterolateral thigh free flap. First, the dead space between the repaired dura and the titanium mesh is filled with vastus lateralis muscle, and then structural reconstruction is performed with a titanium mesh. Finally, the titanium mesh is totally covered with the adiposal flap of the anterolateral thigh free flap. The muscle flap protects the dead space from infection, and the adiposal flap covers the titanium mesh to reduce mechanical stress on the covered skin and thus prevent the exposure of the titanium mesh through the scalp. By applying this technique, there was no intracranial infection or titanium mesh exposure in these 3 cases postoperatively, even though 2 patients had postoperative radiotherapy. Additionally, the adiposal flap could provide a soft and natural contour to the scalp and forehead region, and this gives patients a better facial appearance even though they have had skull base surgery. PMID:25954846
Stabilizing Morbidity and Predicting the Aesthetic Results of Radial Forearm Free Flap Donor Sites
Yun, Tae Kyoung; Ahn, Duck Sun; Park, Seung Ha; Lee, Byung Il; Kim, Hyon Surk; You, Hi Jin
Background The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. Methods In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. Results Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. Conclusions Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients. PMID:26618126
PIV Measurements on a Blowing Flap
NASA Technical Reports Server (NTRS)
Hutcheson, Florence V.; Stead, Daniel J.
PIV measurements of the flow in the region of a flap side edge are presented for several blowing flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main-element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the vortex system or accelerated the merging of the side vortex to the flap top surface. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.
The deep circumflex iliac artery perforator flap (DCIAP)--a reconstructive option for the large composite oro-mandibular cutaneous defect.
Bisase, Brian; Sloane, James; Coombes, Darryl M; Norris, Paul M
The deep circumflex iliac artery (DCIA) flap is often used for mandibular reconstruction but it is bulky and causes additional donor-site morbidity because of the inclusion of an "obligatory internal oblique muscle". Large composite segmental mandibular resections that consist of floor of mouth, subtotal tongue, and adjacent facial skin are a challenge in terms of reconstruction. They often require 2 free flaps or a free scapular flap and both have disadvantages. The deep circumflex iliac artery perforator (DCIAP) flap with a cutaneous component overcomes the disadvantages. We describe reconstructions with DCIAP flaps in 3 patients with large mandibular composite segmental defects. We report our experience of the flap and discuss some of the difficulties we encountered and the points we learned perioperatively. PMID:23891263
Experimental studies of flow separation and stalling on two-dimensional airfoils at low speeds. Phase 2: Studies with Fowler flap extended
NASA Technical Reports Server (NTRS)
Seetharam, H. C.; Wentz, W. H., Jr.
Results were given on experimental studies of flow separation and stalling on a two-dimensional GA(W)-1 17 percent thick airfoil with an extended Fowler flap. Experimental velocity profiles obtained from a five tube probe survey with optimum flap gap and overlap setting (flap at 40 deg) are shown at various stations above, below, and behind the airfoil/flap combination for various angles of attack. The typical zones of steady flow, intermittent turbulence, and large scale turbulence were obtained from a hot wire anemometer survey and are depicted graphically for an angle of attack of 12.5 deg. Local skin friction distributions were obtained and are given for various angles of attack. Computer plots of the boundary layer profiles are shown for the case of the flap at 40 deg. Static pressure contours are also given. A GA(W)-2 section model was fabricated with 30 percent Fowler flaps and with pressure tabs.
A Double-Lobe Flap Design Combined Nasolabial Advancement and Infraorbital Rotation for Reconstruction of Infraorbital Defect.
Guo, Xiao-Ke; Sun, Yan-Fang; Liu, Bing; Zhang, Wen-Feng; Xiong, Xue-Peng
Various adjacent flaps have been designed to close infraorbital defect, and each of them is trying to get an aesthetic outcome and meanwhile circumvent eyelid retraction, ectropion, and functional disability. Here, the authors report an adjacent double-lobe flap, which took advantage of nasolabial advancement and infraorbital rotation of the 2 lobes, combinatorially closed a pentagon infraorbital defect by removal of 2 small skin paddles as donor sites, and finally yielded an acceptable aesthetic and functional outcome. This flap may be a new option for closure of polygon infraorbital defects. PMID:27213736
Bradford, Porcia T
In general, skin cancer is uncommon in people of color when compared to Caucasians. When it does occur, it is often associated with increased morbidity and mortality. Differences in survival rates may be attributed to skin cancers being diagnosed at a more advanced stage, and socioeconomic factors such as lack of adequate insurance coverage and lack of transportation can function as barriers to timely diagnosis and early treatment. In addition to advanced stage at presentation, malignant skin lesions in skin of color often present in an atypical fashion. Because skin cancer prevention and screening practices historically have been lower among Hispanics, Blacks, and Asians, and given the changing demographics in the United States, interventions that are tailored to each of these groups will be needed. Public educational campaigns should be expanded to educate people of all skin types with emphasis on skin cancers occurring in areas not exposed to the sun (Byrd-Miles et al., 2007), since sunlight is not as important an etiologic factor in the pathogenesis of skin cancer in people of color. Dermatologists and primary care physicians should instruct their darker-skinned patients on how to perform routine skin self-examinations. Physicians should also encourage patients to ask their specialists such as their gynecologist, dentist, and ophthalmologist to look for abnormal pigmentation during routine exams. To reduce the burden of skin cancer, several prevention methods for all people have been strongly encouraged, including monthly self-examinations, daily use of SPF 30 or greater sunscreen, sunglasses with UV-absorbing lenses, and avoiding tanning booths (American Cancer Society, 2008) (see Table 7). In addition, recommendations for clinicians to promote the prevention of skin cancer in skin of color have also been made, including closely monitoring changing pigmented lesions on the palms and soles and hyperkeratotic or poorly healing ulcers in immunosuppressed patients
The anatomic basis for a trapezius muscle flap in dogs.
Philibert, D; Fowler, J D; Clapson, J B
The anatomy of the cervical part of the trapezius muscle and its dominant vascular supply, the prescapular branch of the superficial cervical artery, was studied by dissection and selective angiography of 16 canine cadavers. The prescapular branch of the superficial cervical artery supplies blood to the skin of the caudal half of the neck and the cervical part of the trapezius muscle and is a minor contributor to other muscles of the neck. In these dogs, the mean length of the vascular pedicles was 4.4 cm and the mean diameter was 1.0 mm. With this information, it is possible to design a broad musculocutaneous flap suitable for reconstructive microsurgery in dogs. The potential for successful incorporation of the scapular spine in such a flap remains uncertain. PMID:1455644
Experimental Study of Wake / Flap Interaction Noise and the Reduction of Flap Side Edge Noise
NASA Technical Reports Server (NTRS)
Hutcheson, Florence V.; Stead, Daniel J.; Plassman, Gerald E.
The effects of the interaction of a wake with a half-span flap on radiated noise are examined. The incident wake is generated by bars of various widths and lengths or by a simplified landing gear model. Single microphone and phased array measurements are used to isolate the effects of the wake interaction on the noise radiating from the flap side edge and flap cove regions. The effects on noise of the wake generator's geometry and relative placement with respect to the flap are assessed. Placement of the wake generators upstream of the flap side edge is shown to lead to the reduction of flap side edge noise by introducing a velocity deficit and likely altering the instabilities in the flap side edge vortex system. Significant reduction in flap side edge noise is achieved with a bar positioned directly upstream of the flap side edge. The noise reduction benefit is seen to improve with increased bar width, length and proximity to the flap edge. Positioning of the landing gear model upstream of the flap side edge also leads to decreased flap side edge noise. In addition, flap cove noise levels are significantly lower than when the landing gear is positioned upstream of the flap mid-span. The impact of the local flow velocity on the noise radiating directly from the landing gear is discussed. The effects of the landing gear side-braces on flap side edge, flap cove and landing gear noise are shown.
[Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].
Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M
Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap. PMID:9768175
Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects.
Onyekwelu, Obi; Kosutic, Damir
Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect. PMID:27583268
Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects
Onyekwelu, Obi; Kosutic, Damir
Abstract Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect. PMID:27583268
[Open window thoracostomy and muscle flap transposition for thoracic empyema].
Nakajima, Y
Open window thoracostomy for thoracic empyema: Open window thoracostomy is a simple, certain and final drainage procedure for thoracic empyema. It is most useful to drain purulent effusion from empyema space, especially for cases with broncho-pleural fistulas, and to clean up purulent necrotic debris on surface of empyema sac. For changing of packing gauzes in empyema space through a window once or twice every day after this procedure, thoracostomy will have to be made on the suitable position to empyema space. Usually skin incision will be layed along the costal bone just at the most expanded position of empyema. Following muscle splitting to thoracic wall, a costal bone just under the incision will be removed as 8-10 cm as long, and opened the empyema space through a costal bed. After the extension of empyema space will be preliminarily examined through a primary window by a finger or a long forceps, it will be decided costal bones must be removed how many (usually 2 or 3 totally) and how long (6-8 cm) to make a window up to 5 cm in diameter. Thickened empyema wall will be cut out just according to a window size, and finally skin edge and empyema wall will be sutured roughly along circular edge. Muscle flap transposition for empyema space: Pediclued muscle flap transposition is one of space-reducing operations for (chronic) empyema Usually this will be co-performed with other several procedures as curettages on empyema surface, closure of bronchopleural fistula and thoracoplasty. This is radically curable for primarily non fistulous empyema or secondarily empyema after open window thoracostomy done for fistula. Furthermore this is less invasive than other radical operations as like pleuro-pneumonectomy, decortication or air-plombage for empyema. There are 2 important points to do this technique. One is a volume of muscle flap and another is good blood flow in flap. The former suitable muscle volume is need to impact empyema space or to close fistula, and the
Shape-based 3D vascular tree extraction for perforator flaps
NASA Astrophysics Data System (ADS)
Wen, Quan; Gao, Jean
Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.
Modeling the survival of Salmonella on slice cooked ham as a function of apple skin polyphenols, acetic acid, oregano essential oil and carvacrol
Technology Transfer Automated Retrieval System (TEKTRAN)
Response surface methodology was applied to investigate the combined effect of apple skin polyphenols (ASP), acetic acid (AA), oregano essential oil (O) and carvacrol (C) on the inactivation of Salmonella on sliced cooked ham. A full factorial experimental design was employed with control variables ...
New model of flap-gliding flight.
Sachs, Gottfried
A new modelling approach is presented for describing flap-gliding flight in birds and the associated mechanical energy cost of travelling. The new approach is based on the difference in the drag characteristics between flapping and non-flapping due to the drag increase caused by flapping. Thus, the possibility of a gliding flight phase, as it exists in flap-gliding flight, yields a performance advantage resulting from the decrease in the drag when compared with continuous flapping flight. Introducing an appropriate non-dimensionalization for the mathematical relations describing flap-gliding flight, results and findings of generally valid nature are derived. It is shown that there is an energy saving of flap-gliding flight in the entire speed range compared to continuous flapping flight. The energy saving reaches the highest level in the lower speed region. The travelling speed of flap-gliding flight is composed of the weighted average of the differing speeds in the flapping and gliding phases. Furthermore, the maximum range performance achievable with flap-gliding flight and the associated optimal travelling speed are determined. PMID:25841702
14 CFR 23.701 - Flap interconnection.
Code of Federal Regulations, 2013 CFR
... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Flap interconnection. 23.701 Section 23.701... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a...
14 CFR 23.701 - Flap interconnection.
Code of Federal Regulations, 2014 CFR
... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flap interconnection. 23.701 Section 23.701... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a...
14 CFR 23.701 - Flap interconnection.
Code of Federal Regulations, 2011 CFR
... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flap interconnection. 23.701 Section 23.701... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a...
The bilobed flap for popliteal defect reconstruction
Kelahmetoglu, Osman; Yagmur, Caglayan; Aslan, Ozan; Firinciogullari, Remzi
Abstract Bilobed flaps were first introduced to close small nasal defects. We reconstructed a defect of the popliteal fossa using a random-pattern bilobed flap. We recommend the use of random-pattern bilobed flaps as a reliable technique for covering defects of the popliteal fossa.
Efficient flapping flight of pterosaurs
NASA Astrophysics Data System (ADS)
Strang, Karl Axel
In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for
Perforator pedicled sural neurocutaneous vascular flap: a modeling study in the rabbit
Wen, Gen; Zhong, Wanrun; Lu, Shengdi; Wang, Chunyang; Han, Pei; Chai, Yimin
Background: An animal model of a distal pedicled sural neurocutaneous flap for experimental research has not previously been established. The purpose of this study was to construct a sural neurocutaneous vascular flap model in the rabbit. Materials and methods: Thirty-five New England rabbits were divided into four groups. Five rabbits in Group A were used for an anatomical study. Red latex and gelatin-lead oxide were injected into posterior tibial arteries of five rabbits in Groups B and C, respectively. In Group D, 40 neurocutaneous flaps with a single perforator pedicle were raised bilaterally in twenty rabbits. In the right legs, 20 flaps were raised by the normal procedure. In the left legs, the perforator pedicles of 20 flaps were ligated as controls. Results: The sural nerve originated from the posterior tibial nerve. Its accompanying artery originated from the deep femoral artery and ran to the lateral malleolus following the sural nerve. A perforator of the posterior tibial artery at the superior calcaneus originated from the midpoint of the connecting line between the medial malleolus and calcaneus, and was 0.46 ± 0.03 mm in diameter at its origin. The survival rate of the flaps in the right leg 10 days after operation was 64.7 ± 8.7%. Flaps on the left side underwent total necrosis. Conclusion: The distal single perforator-based sural neurocutaneous vascular flap in the rabbit presents with anatomical stability, is easy to harvest, and has a reliable arterial supply. The developed method represents a useful animal model for the study of single perforator-based neurocutaneous vascular flaps. PMID:26131105
Free Antropyloric Valve Flap for End-Stage Fecal Incontinence as a Substitute to Permanent Colostomy.
Mishra, Brijesh; Chandra, Abhijeet; Gejje, Somashekar; Noushif, M; Upadhyay, Divya N; Mishra, Nalini
Background Surgical removal of the anal canal and sphincter for carcinoma results in end-stage fecal incontinence (ESFI) and requires a permanent colostomy resulting in significant impact on quality of life. Presently, there are limited options for EFSI. The successful use of pedicled antropyloric valve (APV) based on left gastroepiploic artery as an alternative to permanent colostomy has previously been described. It is based on a long omental pedicle which at times is risky and is difficult to perform. A free APV flap could be the only solution in such cases. We assessed the vascular anatomy for the technical feasibility of a free APV flap, and report the first ever clinical application of free APV flap. Methods Bench dissection of 10 pancreaticoduodenectomy specimens was done to delineate the vessels of APV flap. It showed the consistent presence of right gastroepiploic and infrapyloric vessels in all specimens with sufficient diameters. After the technical feasibility, a free APV Flap transposition to perineum was done in a patient, where pedicled transposition was not feasible. Results The free APV flap with vagus nerve branch was harvested without extensive dissection along the greater curvature of stomach. A tension free anastomosis was achieved between the epiploic and left colic vessels. The flap survived well and had a definite tone on digital examination. It was evaluated by radiological and manometric methods. Conclusions APV flap for EFSI can be done as a free flap with distinct advantages and it has the potential of becoming popular options for EFSI. PMID:26473796
Local Vascularized Flaps for Augmentation of Reinke's Space
Dailey, Seth H.; Gunderson, McLean; Chan, Roger; Torrealba, Jose; Kimura, Miwako; Welham, Nathan V.
Objectives/Hypothesis The purpose of this study is to describe and test a novel surgical strategy for augmentation of Reinke's space using vascularized flaps: a thyroid ala perichondrium flap (TAP) and a composite thyroid ala perichondrium flap (CTAP) from the anterior larynx. We hypothesized that these specially designed vascularized flaps would remain viable once inset into the lamina propria, and that they would not disrupt rheologic, biomechanical, and histologic properties of the native vocal fold. Study Design Experimental. In vivo canine model. Methods The length and volume of test flaps harvested in six adult human cadaveric larynges were analyzed to determine suitability for use in augmentation in the lamina propria. Also, 12 beagles randomly underwent unilateral placement of either TAP or CTAP, which were designed in accordance with the human adult cadaveric experiments. Flap perfusion was measured before and after harvest with laser Doppler. After 1 month, the beagles were humanely sacrificed and their larynges subjected to aerodynamic and acoustic evaluation using an excised larynx apparatus. The vocal fold lamina propria of four larynges—two TAP and two CTAP—underwent rheologic evaluation using a simple-shear rheometer. The remaining eight larynges underwent quantitative histologic and immunohistochemical evaluation. The survival and complication (swallowing, airway, local wound) rates of all dogs were noted. Results Initial studies with adult human cadaveric larynges established that TAP and CTAP possessed length and volume greater than native lamina propria. In the canine experiments, the perfusion change in the flaps was similar between flap groups. The damping ratio (ζ), dynamic viscosity (η′), elastic shear modulus (G′), and viscous shear modulus (G″) of treated and untreated native vocal folds were not statistically different. The glottic function measures of vocal efficiency, laryngeal resistance, jitter, shimmer, and harmonics
Effective Use of a Silicone-induced Capsular Flap in Secondary Asian Rhinoplasty
Oh, Sang-Ha; Suh, Man Koon; Kim, Chang Kyung; Kim, Kenneth K.
Summary: Performing secondary rhinoplasty in patients who underwent primary rhinoplasty using a silicone implant is difficult due to thinning of nasal skin and formation of a capsule. Excess capsule formation can cause capsular contracture, resulting in short nose deformity or implant deviation, migration, or implant demarcation. Revision rhinoplasty using a capsular flap, dorsal silicone implant, and tip plasty was performed in 95 Korean patients (91 women and 4 men; mean age, 27 years) who previously underwent primary augmentation rhinoplasty using silicone implants. The capsular flap was composed by creating a dual plane above the anterior capsule and below the posterior capsule. The existing silicone implant was removed, and a new silicone implant was placed under the posterior capsule. The patients were followed up for 6 months to 4 years (mean, 31.7 months). Of the 95 patients who underwent secondary augmentation rhinoplasty using a capsular flap, 88 patients (92.6%) showed satisfactory results. There was no hematoma or nasal skin vascular compromise. There was no visible or palpable capsule resorption or recurrent capsular contracture. Early implant malpositioning (within 30 days postoperatively) was observed in 4 patients, and tip shape dissatisfaction (within 60 days postoperatively) was reported by 3 patients. Four patients underwent revision surgery and had successful outcomes. Nasal augmentation using a silicone implant and capsular flap in secondary rhinoplasty avoids complications caused by removal of the capsule. Recurrent capsule formation or clinically noticeable resorption of the capsular flap was not observed in this study. PMID:25289365
Aesthetic reconstruction of the upper antihelix in external ear with banner pull-through flap
Ali, Ebrahimi; Nasrin, Nejadsarvari; Azin, Ebrahimi
Introduction: We can use pre auricular and post auricular skin as a pull through flap for upper antihelix defects reconstruction. Patients and Methods: This was a prospective case-series study, which was done in the Department of Plastic and Reconstructive Surgery Ward. In this study, 15 patients (3 women, 12 men), ranging from 45 to 72 years old (mean, 58 years) underwent operation with pull through banner flap for reconstruction of upper antihelix (7 cases) and triangular fossa with superior and inferior crura (5cases) caused by BCC or SCC excision. Reconstruction of upper antihelix defects up to 20 × 30 mm with post auricle pull through flap and reconstruction of triangular fossa up to 20 × 20 mm with pre auricle pull through flap were done. Results: Our study showed that pull through flap with superior pedicle from post auricular and preauricular area was an effective method for reconstruction of upper ear antihelix defects. Conclusion: We advocate that the pull through flap with superior pedicle from post auricle and pre auricle is an excellent choice for reconstruction of upper antihelix ear reconstruction in both crura and triangular fossa. PMID:26865786
Free neurovascular flap from the first web of the foot in hand reconstruction.
May, J W; Chait, L A; Cohen, B E; O'Brien, B M
To identify an anatomically reliable and functionally acceptable neurovascular free flap for use in hand reconstruction, 50 fresh cadaver feet were dissected under the operating microscope, with particular attention paid to the anatomy of the first web area. A distal communicating artery was seen in 100% of dissections, allowing either dorsal or plantar donor artery inflow to nourish the entire flap area. Because of the ease of dissection, the first dorsal metatarsal or dorsalis pedis is suggested as the donor artery, and a dorsal branch of the greater saphenous venous system is suggested as the donor vein. The deep peroneal nerve was seen to consistently innervate the first web and, along with the plantar digital nerves, is suggested as an anatomically identifiable donor nerve. Either part of the foot first web may be used alone or together as a free flap. When indicated further dorsal skin may be incorporated into the web flap to expand its application. Two-point discrimination studies of the lateral plantar surface of the great toe in 50 normal individuals showed an average of 11.2 mm. This was significantly better as a potential donor flap than the medial dorsum of the foot where the average was 32 mm. A single case demonstrating the application of this flap in hand reconstruction is presented. PMID:332757
Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores.
Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni
We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore. PMID:26495200
Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores
Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni
Summary: We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore. PMID:26495200
Reconstruction of fingertip defects with the neurovascular tranquilli-leali flap.
Loréa, P; Chahidi, N; Marchesi, S; Ezzedine, R; Marin Braun, F; Dury, M
For many years, bipedicled palmar advancement flaps were used rarely in fingers because they sacrificed the dorsal branches of the digital arteries, risking dorsal skin necrosis. In 1995, a short bipedicled neurovascular VY advancement flap raised distally to the PIP flexion crease, which spared the dorsal blood supply, was described by Elliot et al. (1995). This paper includes an anatomical study on 28 fresh cadaver fingers to evaluate the advancement potential of this flap. It also reviews 22 fingertip reconstructions in 22 patients using this flap. The mean advancement of the flap in the cadaver study was 14 (range 10-16) mm. This procedure gave good clinical results in respect of healing, sensibility, bone cover and appearance. Complications occurred in four fingers (18%), viz. two infections, one neuroma and one stiff proximal interphalangeal joint. Our study suggests that this flap can be used to treat fingertip defects of a size of approximately half of the pulp of the distal phalangeal segment of the finger. PMID:16403425
Achieving Symmetry in Unilateral DIEP Flap Breast Reconstruction: An Analysis of 126 Cases over 3 Years.
Wang, Tao; He, Jinguang; Xu, Hua; Ma, Sunxiang; Dong, Jiasheng
Many patients who prefer breast reconstruction by a deep inferior epigastric artery perforator (DIEP) flap often lack skin laxity at the lower abdomen. Recreating a symmetrical breast with various degrees of ptosis is one of the most difficult procedures. In this report, varied DIEP flap shapes were precisely designed on the basis of normal breast ptosis. The reconstructive outcomes were quantitatively evaluated for asymmetry of footprint, volume, breast projection, and nipple position by a 3-dimensional scanning system. One hundred twenty-six cases of unilateral DIEP flap breast reconstruction were successfully performed from January 2009 to July 2012. The maximal flap width ranged from 7.5 to 10.5 cm (mean, 9.0 cm), and the flap length ranged from 28 to 38 cm (mean, 32.5 cm). The discrepancy of the footprint and nipple position did not differ significantly between the reconstructed and normal breasts. However, the reconstructed side had significantly higher breast volume and projection. For patients with a relatively tight abdomen, the flap design and shaping approach we propose achieves a maximal symmetrical outcome and should be considered as a good and reliable option. PMID:25409622
In-flight surface-flow measurements on a subsonic transport high-lift flap system
NASA Technical Reports Server (NTRS)
Yip, Long P.; Vijgen, Paul M. H. W.; Hardin, Jay D.
As part of a multiphased program for subsonic transport high-lift flight research, flight tests were conducted on the Transport Systems Research Vehicle (B737-100 aircraft) at the NASA Langley Research Center, to obtain detailed flow characteristics of the high-lift flap system for correlation with computational and wind-tunnel investigations. Pressure distributions, skin friction, and flow-visualization measurements were made on a triple-slotted flap system for a range of flap deflections, chord Reynolds numbers (10 to 21 million), and Mach numbers (0.16 to 0.36). Experimental test results are given for representative flap settings indicating flow separation on the fore-flap element for the largest flap deflection. Comparisons of the in-flight flow measurements were made with predictions from available viscous multielement computational methods modified with simple-sweep theory. Computational results overpredicted the experimentally measured pressures, particularly in the case involving separation of the fore lap, indicating the need for better modeling of confluent boundary layers and three-dimensional sweep effects.
Outcome after pharyngeal reconstruction using pectoralis major and radial forearm flap after resection of pharyngeal and laryngeal squamous cell carcinomas.
Knopf, Andreas; Mansour, Naglaa; Hofauer, Benedikt; Bier, Henning; Scherer, Elias Q
The objective of this study is to assess the outcome after pharyngeal reconstruction using pectoralis major and radial forearm flaps in pharyngeal and laryngeal carcinomas. 90 patients who underwent flap surgery due to oro/-hypopharyngeal and laryngeal carcinomas were compared with 404 patients without pharyngeal reconstruction. Differences between the groups were analyzed using the Chi-square, Fisher exact, and the unpaired student's t test. Survival rates were calculated by Kaplan-Meier. Overall survival in oropharyngeal and hypopharyngeal/laryngeal cancer showed comparable results in patients with or without pharyngeal reconstruction (5-year: 53.4 vs. 64.2 %, p = 0.23; 5-year: 51.8 vs. 62.4 %, p = 0.94), while the survival time after flap surgery was significantly decreased (5-year: 44.8 vs. 62.4 %, p < 0.02; 5-year: 30.3 vs. 64.2 %, p = 0.07). Subgroup analysis attributed the worse survival after flap surgery to patients who underwent flap surgery due to functional deficits or recurrent disease (p = 0.002). In these patients, the median survival after flap surgery was 26 (hypopharyngeal/laryngeal cancer) or 13 months (oropharyngeal cancer) and associated with a significant increase in severe complications and hospitalization time (p < 0.0001). The hospitalization time correlated with the history of prior radiotherapy and the extent of surgery (r = 0.26; r = 0.3; p < 0.0001). Flap surgery in primary oropharyngeal and hypopharyngeal/laryngeal cancer showed an unaltered overall survival when compared with patients without reconstruction. Patients with recurrent disease or functional deficits demonstrated a significant decrease in survival combined with an increase of severe complications. PMID:26345240
General regression neural network and monte carlo simulation model for survival and growth of salmonella on raw chicken skin as a function of serotype, temperature, and time for use in risk assessment.
Oscar, Thomas P
A general regression neural network (GRNN) and Monte Carlo simulation model for predicting survival and growth of Salmonella on raw chicken skin as a function of serotype (Typhimurium, Kentucky, and Hadar), temperature (5 to 50 degrees C), and time (0 to 8 h) was developed. Poultry isolates of Salmonella with natural resistance to antibiotics were used to investigate and model survival and growth from a low initial dose (<1 log) on raw chicken skin. Computer spreadsheet and spreadsheet add-in programs were used to develop and simulate a GRNN model. Model performance was evaluated by determining the percentage of residuals in an acceptable prediction zone from -1 log (fail-safe) to 0.5 log (fail-dangerous). The GRNN model had an acceptable prediction rate of 92% for dependent data (n = 464) and 89% for independent data (n = 116), which exceeded the performance criterion for model validation of 70% acceptable predictions. Relative contributions of independent variables were 16.8% for serotype, 48.3% for temperature, and 34.9% for time. Differences among serotypes were observed, with Kentucky exhibiting less growth than Typhimurium and Hadar, which had similar growth levels. Temperature abuse scenarios were simulated to demonstrate how the model can be integrated with risk assessment, and the most common output distribution obtained was Pearson5. This study demonstrated that it is important to include serotype as an independent variable in predictive models for Salmonella. Had a cocktail of serotypes Typhimurium, Kentucky, and Hadar been used for model development, the GRNN model would have provided overly fail-safe predictions of Salmonella growth on raw chicken skin contaminated with serotype Kentucky. Thus, by developing the GRNN model with individual strains and then modeling growth as a function of serotype prevalence, more accurate predictions were obtained. PMID:19833030
Studies of the Scottish oil shale industry. Volume 2. Shale workers pneumoconiosis and skin conditions: epidemiological surveys of surviving ex-shale workers. Final report
Louw, S.J.; Cowie, H.; Seaton, A.
The world's largest and richest reserves of oil shale occur in the United States. It has not proved possible to obtain reliable data on the health risks to the work force that such a development might entail. While the risks of accidents, explosions, and local pollution may reasonably be estimated by analogy with similar industries, potential specific hazards of shale oil production itself, such as pneumoconiosis and lung and skin cancer, can only be assessed by study of an established shale industry. The volume describes the use of the Provident Fund form in identifying ex-shale workers and subsequent studies aimed at determining the prevalence and respiratory effects of pneumoconiosis and the prevalence of skin disease amongst them.
Studies of the Scottish oil shale industry. Final report. Volume 2. Shale workers' pneumoconiosis and skin conditions: epidemiological surveys of surviving ex-shale workers
Louw, S.J.; Cowie, H.; Seaton, A.
This report (in 3 volumes) describes the now defunct Scottish oil shale industry and its effects on the health of its workers. This volume investigates the prevalence of skin disease and pneumoconiosis in Scottish ex-oil shale workers. A cross sectional epidemiological survey has been carried base on a population enrolled in the 1950 Scottish Oils Ltd Provident Fund. Investigation of the Fund indicated that it would have included almost all industrial workers employed in the oil shale industry between 1950 and its closure in 1962. It is concluded that workers in the Scottish shale oil industry in its latter years were not at excess risk of skin disease, perhaps because of steps taken within the industry to reduce the known hazards of dermatitis and skin cancer. However, pneumoconiosis was a definite hazard of miners and retort workers and its presence was associated with an impairment of lung function suggestive of fibrosis and possibly emphysema as well. It is suggested that prevention of this hazard might sensibly be based on the strategy used in the coalmining industry and, in the absence of further information on dust and fume exposures of shale workers, standards as applied in coalmining should be appropriate. Radiological surveillance of dust-exposed workers, whether in mines or at retorts or tips, is recommended. 39 refs., 10 figs., 48 tabs.
Laparoscopic treatment of Poland's syndrome using the omentum flap technique
Costa, Sirlei Santos; Blotta, Rosa Maria; Mariano, Mirandolino Batista; Meurer, Luise; Edelweiss, Maria Isabel Albano
OBJECTIVE For patients with Poland's syndrome, a transverse skin fold in the anterior axillary pillar, infra-clavicular depression and an anomalous breast contour are the most uncomfortable disfigurements. This study aims to demonstrate that superior aesthetic results can be achieved by using a laparoscopically harvested omentum flap to treat this condition. METHODS From a prospectively maintained clinical database of patients undergoing a laparoscopic omentum flap procedure for breast reconstruction, all of the patients with Poland's syndrome were identified and their outcomes were studied. RESULTS Thirteen consecutive patients with Poland's syndrome were treated and evaluated regarding breast contour, reconstruction of the anterior axillary pillar and filling of the infra-clavicular depression. Implants were employed beneath the flap in 76% of cases to improve symmetry. In 23% of cases, a contra-lateral mastopexy was performed, and in 15% of cases, a breast implant was used. The consistency of the flap is similar to natural breast tissue and only a small incision in the breast fold is needed. The majority of patients (85%) were female, with a mean age of 26 (18–53). The flap is extremely malleable, adapts to irregular surfaces, and has a long vascular pedicle. Additionally, its removal does not leave a scar at the donor site as the removal of muscular flaps does. For example, the removal of the latissimus dorsi flap causes a deformity in the dorsal contour. The mean operative time was 201 minutes (80–350) and the mean hospital stay was 2.3 days (1–5). CONCLUSIONS The outcomes of these patients revealed that the omentum flap technique provided superior amelioration of the deformities caused by Poland's syndrome when compared with other reconstructive options. PMID:20454498
Design, fabrication, and structural evaluation of an advanced composite hydrofoil control flap
NASA Astrophysics Data System (ADS)
Couch, W. P.
A hydrofoil control flap was designed and fabricated by the Boeing Company under contract to the Naval Sea System Command. It consisted of two graphite epoxy-titanium clad skins bolted and bonded to a titanium crank-spar assembly. It was tested statically at the Boeing Company to calibrate the response of electrical-resistance strain gages to strip loads; installed on the aft inboard foil of the hydrofoil PCH-1 (HIGH POINT) to demonstrate the ability of the composite to withstand the hydrofoil environment and to obtain service loads information; and tested in the laboratory at the David W. Taylor Naval Ship Research and Development Center to demonstrate its compliance with a four times-design-life capability. After being instrumental with 52 strain gages and calibrated for gage response as a function of applied load, the flap was installed on PCH-1. The flap remained on the boat for 26 months, but only saw 18 hours of foilborne operations due to unrelated mechanical difficulty with PCH-1. The 18 hours were dedicated to calm-water trials. Although the flap performed satisfactorily, attempts to relate composite material strains to flap pressure loads proved unsuccessful due to the complex nature of the flap loading, the flap's structural geometry, and the loss of the majority of strain gages just prior to trails data collection. The flap was then prepared for cyclic testing in the Structural Evaluation Laboratory, but failed during the initial static test because of an overload caused by a malfunction of the control system.
Cost-effectiveness of monitoring free flaps.
Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D
Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. PMID:27015730
Flap--edge flowfield measurements
NASA Astrophysics Data System (ADS)
Pye, John D.; Cantwell, Brian J.
Recent studies of airframe noise suggest that the wing and flap trailing--edges as well as the flap side--edge are areas of significant noise generation. To identify the fluid dynamic processes associated with these noise sources, we are examining the flow--field around a NACA 63--215 Mod B main element airfoil configured with a half--span Fowler flap. The tests are performed in a low--speed wind tunnel at a Reynolds number of ~ 6.0×10^5. A hot wire traverse system is used to map the mean velocities and turbulence intensities in the near wake region of the flow. Measurements of the pressure fluctuations along the flap side--edge and in the cove of the airfoil configuration are made with pressure transducers mounted inside the airfoil. The experimental data are in good qualitative agreement with the numerical simulation of a slightly higher Reynolds number flow ( ~ 1.5×10^6) around a geometrically similar airfoil configuration.
Sternocleidomastoid Muscle Flap after Parotidectomy
Nofal, Ahmad Abdel-Fattah; Mohamed, Morsi
Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve. PMID:26491478
Force Generation by Flapping Foils
NASA Astrophysics Data System (ADS)
Bandyopadhyay, P. R.; Donnelly, M.
Aquatic animals like fish use flapping caudal fins to produce axial and cross-stream forces. During WW2, German scientists had built and tested an underwater vehicle powered by similar flapping foils. We have examined the forces produced by a pair of flapping foils. We have examined the forced produced by a pair of flapping foils attached to the tail end of a small axisymmetric cylinder. The foils operate in-phase (called waving), or in anti-phase (called clapping). In a low-speed water tunnel, we have undertaken time-dependent measurements of axial and cross-stream forces and moments that are exerted by the vortex shedding process over the entire body. Phase-matched LDV measurements of vorticity-velocity vectors, as well as limited flow visualization of the periodic vortex shedding process have also been carried out. The direction of the induced velocity within a pair of shed vortices determines the nature of the forces produced, viz., thrust or drag or cross-stream forces. The clapping mode produces a widely dispersed symmetric array of vortices which results in axial forces only (thrust and rag). On the other hand, the vortex array is staggered in the waving mode and cross-stream (maneuvering) forces are then generated.
[Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].
Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F
We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations. PMID:25069828
The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease
Wisenbaugh, Eric S.; Gelman, Joel
The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin. PMID:26664357
A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects.
Prantl, L; Schreml, S; Schwarze, H; Eisenmann-Klein, M; Nerlich, M; Angele, P; Jung, M; Füchtmeier, B
The reconstruction of large soft-tissue defects at the elbow is hard to achieve by conventional techniques and is complicated by the difficulty of transferring sufficient tissue with adequate elasticity and sensate skin. Surgical treatment should permit early mobilisation to avoid permanent functional impairment. Clinical experience with the distal pedicled reversed upper arm flap in 10 patients suffering from large elbow defects is presented (seven male, three female; age 40-70 years). The patient sample included six patients with chronic ulcer, two with tissue defects due to excision of a histiocytoma, and one patient with burn contracture. In the two cases of histiocytoma, defect closure of the elbow's ulnar area was achieved by using a recurrent medial upper arm flap. In the eight other patients we used a flap from the lateral upper arm with a flap rotation of 180 degrees. Average wound size ranged from 4 to 10 cm, average wound area from 30 to 80 cm(2). Flap dimensions ranged from 15 x 8 cm for the lateral upper arm flap to 29 x 8 cm for the medial upper arm flap. The inferior posterior radial and ulnar collateral arteries are the major nutrient vessels of the reversed lateral and medial upper arm flaps. Perforating vessels are identified preoperatively using colour Doppler ultrasonography. Flap failure did not occur. Secondary wound closure became necessary due to initial wound healing difficulties in one patient. Mean operation time was 1.5 h and mean follow-up period 12 months. Good defect coverage with tension-free wound closure was achieved in all cases. Stable defect coverage led to long-term wound stability without any restriction of elbow movement. The lateral and medial upper arm flaps represent a safe and reliable surgical treatment option for large elbow defects. The surgical technique is comparatively simple and quick. PMID:17618845
Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection
Cook, Kyung Hoon; Park, Myong Chul; Lim, Seong Yoon; Jung, Yong Sik
Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862
Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection.
Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik
Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862
Release of severe post-burn contracture of the first web space using the reverse posterior interosseous flap: Our experience with 12 cases.
Kai, Shi; Zhao, Jingchun; Jin, Zhenghua; Wu, Weiwei; Yang, Ming; Wang, Yan; Xie, Chunhui; Yu, Jiaao
We retrospectively assessed outcomes after treating severe contractures of the first web space from burns with the reverse posterior interosseous flaps (RPIF). Twelve consecutive patients (ages 18-58 years) with burns from 10% to 70% (mean, 30.1%) total body surface area and severe contractures of the first web space of the hand (initial thumb to index angles from 10° to 35° [mean, 23°]) underwent contracture release using the RPIF. Seventeen RPIFs were used, with sizes from 9cm×6cm to 14cm×10cm (mean area, 83.6cm(2)). The patients were followed for 5-26 months. All flaps survived completely, rapidly adapted to the recipient beds, and achieved good color and texture harmony. No early complications occurred. Fifteen donor sites were closed with skin grafts. Two donor sites were closed by direct suture. No paralysis of the posterior interosseous nerve was observed in these cases. At last follow-up the mean thumb to index angle was 78°, increasing the web length 260%. All patients regained fundamental hand functions. The RPIF is reliable and safe for releasing severe contractures of the first web space of the hand after burn, with distinct advantages over currently used alternative methods. PMID:23523223
Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up.
Olvera-Caballero, Carlos; Ortiz-Dominguez, Abel
A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112
Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up
Ortiz-Dominguez, Abel
Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112
Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications
Tamburino, Serena; Tracia, Luciano; Tarico, Maria Stella; Perrotta, Rosario Emanuele
Background Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. Methods Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. Results The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. Conclusions Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators. PMID:26848450
14 CFR 23.697 - Wing flap controls.
Code of Federal Regulations, 2013 CFR
... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...
14 CFR 23.697 - Wing flap controls.
Code of Federal Regulations, 2011 CFR
... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...
14 CFR 23.697 - Wing flap controls.
Code of Federal Regulations, 2012 CFR
... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...
14 CFR 23.697 - Wing flap controls.
Code of Federal Regulations, 2014 CFR
... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Wing flap controls. 23.697 Section 23.697... Systems § 23.697 Wing flap controls. (a) Each wing flap control must be designed so that, when the flap... with § 23.145(b)(3) necessitates wing flap retraction to positions that are not fully retracted,...
Modified Facial Artery Musculomucosal Flap for Reconstruction of Posterior Skull Base Defects
Xie, Liyue; Lavigne, Philippe; Lavigne, François; Ayad, Tareck
Objectives The superiorly pedicled facial artery musculomucosal (FAMM) flap has been successfully used for reconstruction of head and neck defects since 1992. Common sites of defects include the oral cavity and oropharynx. This article presents a clinical case in which we have successfully used a newly developed modification of the FAMM flap for bulky nasopharyngeal and skull base reconstruction. Results Our patient is a 71-year-old man who presented with a large parapharyngeal and clival chordoma. After tumor removal through combined endoscopic and cervical approach, the internal carotid artery (ICA) in the nasopharyngeal portion was left exposed. A modified superiorly based FAMM flap measuring up to 10 cm in length and 2.5 cm in width was successfully harvested and used to completely cover the defect and the ICA. The flap survived local radiation therapy at the long-term follow-up. Conclusion We have developed a new modification of the FAMM flap, using the fascia of the masseter muscle. This is the first reported case in the literature using a modified FAMM flap for the reconstruction of nasopharyngeal and skull base defect. PMID:27330928
A toenail flap based on the fibro-osseous hiatus branch for fingernail reconstruction.
Ki, Sae H; Hwang, Kun; Kim, Dong H; Hwang, Sejin; Han, Seung H
This study included two parts: 1) cadaver dissection to elucidate the perfusion of toenail flaps by the fibro-osseous hiatus branch (FHB), and 2) clinical application of the toenail flap for reconstruction of a fingernail defect. Four second toes of two fresh Korean cadavers were dissected. The plantar digital artery (PDA) and terminal segment branch (TSB) were ligated, and red latex was injected distally into the ligated PDA. Perfusion of the dye into the toenail bed through the FHB was observed. From Oct 2004 to Sep 2009, eight toenail flaps based on the FHB pedicle with or without the distal phalanx and pulp were applied to seven patients for finger nail reconstruction. The toenail flap was marked at 5 mm distal to the nail fold and 5 mm lateral to the paronychium. The toenail complex based on the FHB was elevated and transferred to the finger. The nail and matrix were elevated with or without including the distal phalanx. The results of perfusion study showed that one side of the unilateral FHB was identified and traced proximal to the PDA, which was ligated. The distal toenail bed was perfused by the dye through the FHB. In clinical application, all the toenail flaps flourished and survived. We suggest that the toenail flap based on the FHB may be useful for fingernail reconstruction with minimal donor morbidity. PMID:21630332
Application of the submental island flap in the reconstruction of intraoral defects.
Chaudhary, Bikash; Gong, ZhongCheng; Ling, Bin; Lin, Zhaoquan; Abbas, Keremu; Hu, Mei; Liu, Hui
This study was conducted to evaluate the feasibility of clinically applying facial submental island flap in reconstruction of oral cancer ablation in residents of Xinjiang, China. A total of 21 patients with oral cavity cancer underwent surgical resection during 4.4 years. Immediate reconstruction with submental island flap was performed and reviewed. The site, stage, pattern of neck dissection, postoperative complication, and the technique of flap transfer were recorded. The patients were followed up to assess the status of the flap, its function, and the oncologic outcomes. Eventually in this study, all patients had undergone neck dissection and wide excision of the primary lesion. The follow-up period ranged from 3 to 52 months. Of 21 patients, 2 patients had complete flap loss. The overall survival rate in our study is found to be 90.4%. The submental island flap is an excellent alternative for reconstruction of intraoral cancer defect because of its function, reliability, versatility, and relative ease of application. However, further study depends upon the long-term follow-up of the patients and oncologically sound neck dissection. PMID:24978447
Freestyle perforator-based propeller flap of medial arm for medial elbow reconstruction.
Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Ding, Qiang; Guo, Lingling; Liu, Yuanbo
Elbow reconstruction is challenging for reconstructive surgeons. The purpose of this report is to present the results of the use of freestyle perforator-based propeller flap designed from the medial arm region for elbow reconstruction. The defects following soft tissue sarcoma resection at the medial and posterior elbow were repaired in two patients. The dimensions of the defects were 11 × 7 cm(2) and 10 × 7 cm(2). Two perforators were identified in each case using Doppler ultrasound probe in the medial arm, adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel, which was 12-cm and 7-cm proximal to the medial epicondyle. An elliptical flap, extending almost the full length of arm, was raised and rotated 180° to repair medial elbow defects. The sizes of the flaps were 17 × 8 cm(2) and 11 × 7 cm(2). The donor sites were closed directly. Both flaps survived; temporary venous congestion occurred in one case. There were no other postoperative complications. These cases illustrated that the medial arm flap might be used for reconstruction of medial elbow defects with this freestyle perforator-based propeller flap design. PMID:25417774
Peculiar indications for the pedicled or free rectus abdominis flap in reconstructive surgery. A review of our experience.
Sinsel, N K; Guelinckx, P J
Among all known flaps, the rectus abdominis muscle flap possesses an unique diversity in flap designs due to the special vascular supply of the abdominal wall. The axial vascularization of the rectus abdominis muscle gives ofF several musculocutaneous perforators, which are mainly located in the periumbilical region. Abdominal wall skin perfusion is guaranteed by spoke-wheel like vessels arising from these perforators. Subsequently several designs (muscle, myocutaneous and myosubcutaneous) are possible, by varying the included tissue and the position of the skin island. We described 7 cases where the rectus abdominis muscle was used as a muscle or myocutaneous flap for reconstruction of large defects. In most cases a pedicled transfer was necessary, possible and sufficient to reconstruct the difficult defects in various body regions. Great amounts of well perfused tissue can be transferred with still possible primary closure of the donor site. Due to its rich perfusion and constancy of vascular pattern, it represents an excellent and safe pedicled reconstructive procedure for large defects of the thorax, the abdomen, the forearm or the hip and pelvis where free tissue transfers are impossible or contraindicated. No other local transposition would have achieved this goal, due to the lack of volume and mobility. Moreover the flap is ideal for reconstruction of contour deficiencies due to the abundance of fat, as for example in breast or buttock reconstruction. However the flap is not the first choice for traumatic and infected wounds where fat tissue is not desired. PMID:8571724
Shchudlo, N A; Shchudlo, M M; Sbrodova, L I
The aim of this work was to determine the interrelation between the preoperative blood counts and the quality of vascularized adipo-fascio-cutaneous flap survival. In 10 adult male Wistar rats, a flap with the area of 18 cm2 was formed on the basis of superficial inferior epigastric artery; after a 90 min ischemic period it was replanted. 12 days after operation the quality of flap survival was assessed with computer-assisted planimetry. It was found that the combination of preoperative leukocyte, thrombocyte, neutrophil and eosinophil counts as well as reactive lymphocyte counts close to the maximal reference values increased the probability of epidermolysis. PMID:27487668
The vascularized periosteum flap as novel tissue engineering model for repair of cartilage defects.
Harhaus, Leila; Huang, Jung-Ju; Kao, Shu-Wei; Wu, Yen-Lin; Mackert, Gina Alicia; Höner, Bernd; Cheng, Ming-Huei; Kneser, Ulrich; Cheng, Chao-Min
Periosteum is a promising tissue engineering scaffold in research of cartilage repair; so far however, periosteum transfers have not been realized successfully because of insufficient nourishment of the graft. In a translational approach we, for the first time, designed a vascularized periosteum flap as 'independent' biomaterial with its own blood supply to address this problem and to reconstruct circumscript cartilage defects. In six 3-month-old New Zealand rabbits, a critical size cartilage defect of the medial femur condyle was created and covered by a vascularized periosteum flap pedicled on the saphenous vessels. After 28 days, formation of newly built cartilage was assessed macroscopically, histologically and qualitatively via biomechanical compression testing, as well as on molecular biological level via immunohistochemistry. All wounds healed completely, all joints were stable and had full range of motion. All flaps survived and were perfused through their pulsating pedicles. They showed a stable attachment to the bone, although partially incomplete adherence. Hyaline cartilage with typical columnar cell distribution and positive Collagen II staining was formed in the transferred flaps. Biomechanical testing revealed a significantly higher maximum load than the positive control, but a low elasticity. This study proved that vascularization of the periosteum flap is the essential step for flap survival and enables the flap to transform into cartilage. Reconstruction of circumscript cartilage defects seems to be possible. Although these are the first results out of a pilot project, this technique, we believe, can have a wide range of potential applications and high relevance in the clinical field. PMID:25754287
Excitation, response, and fatigue life estimation methods for the structural design of externally blown flaps
NASA Technical Reports Server (NTRS)
Ungar, E. E.; Chandiramani, K. L.; Barger, J. E.
Means for predicting the fluctuating pressures acting on externally blown flap surfaces are developed on the basis of generalizations derived from non-dimensionalized empirical data. Approaches for estimation of the fatigue lives of skin-stringer and honeycomb-core sandwich flap structures are derived from vibration response analyses and panel fatigue data. Approximate expressions for fluctuating pressures, structural response, and fatigue life are combined to reveal the important parametric dependences. The two-dimensional equations of motion of multi-element flap systems are derived in general form, so that they can be specialized readily for any particular system. An introduction is presented of an approach to characterizing the excitation pressures and structural responses which makes use of space-time spectral concepts and promises to provide useful insights, as well as experimental and analytical savings.
... are specialized skin cells that produce pigment called melanin. The melanin pigment produced by melanocytes gives skin its color. ... absorbing and scattering the energy. People with more melanin have darker skin and better protection from UV ...
Your skin is your body's largest organ. It covers and protects your body. Your skin Holds body fluids in, preventing dehydration Keeps harmful ... it Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, ...
Composite tissue flap at perforating branches of saphenous artery: a new design for repairing composite tissue defects in anterior knee
Sun, Guangfeng; Nie, Kaiyu; Jin, Wenhu; Wei, Zairong; Qi, Jianping; Wang, Dali
So far it has been difficult to repair and reconstruct the composite tissue defects in knee. Saphenous artery flap has been widely used to repair complex wounds, but the design and clinical application of composite tissue flap at perforating branches of saphenous artery were not reported. In this research, we design a new composite tissue flap by carrying fascial flap in the medial gastrocnemius muscle with perforators flap in saphenous artery to repair and reconstruct the composite tissue defects in knee. By anatomic observation and analysis, we find that there exists blood-supply in netty form among saphenous arteries, medial artery below the knee, intermuscular branch in high-order position of posterior tibial artery and perforating branch in medial artery of calf. We chose saphenous artery as blood-supplying artery; utilized the netty blood-supplying mode in middle-up and medial part of shank; cut the composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle; reconstructed the ligamentum patellae using medial head of gastrocnemius muscle and Achilles's tendon; and covered the wounds at front side of knee with flap. Composite tissues were survived completely, free from infection at wounds and exosmosis of joint fluid. Motion function of knee-joint proved satisfactory, and ambulatory function was recovered. There was no complication in donor site. Composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle is one of the most ideal solutions for repairing the composite tissue defects at front side of knee joint. PMID:26885090
Muscular, myocutaneous, and fasciocutaneous flaps in complex urethral reconstruction.
Zinman, Leonard
The ability to achieve a long-term, stable, stricture-free, hairless urethral lumen in patients with complex anterior stricture and compromised genital skin is one of the ongoing challenges of reconstructive urologic surgery. The conservative approach by endoscopic urethrotomy or dilatation with a self-catheterization schedule rarely affects a definitive cure except in the short filmy superficial strictures of the bulbous portion of the urethra. Genital fasciocutaneous island flaps are currently the golden standard for definitive, reliable resolution of anterior urethral strictures in patients who have not undergone a prior surgical procedure that may alter the penile or scrotal circulation, or those with skin loss from trauma, decubiti, radiation, or balanitis xerotica obliterans. PMID:12371235
Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis
Satake, Toshihiko; Nakasone, Reiko; Kobayashi, Shinji; Maegawa, Jiro
The lumbar artery perforator (LAP) flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast.
Pressure Distribution Over Airfoils with Fowler Flaps
NASA Technical Reports Server (NTRS)
Wenzinger, Carl J; Anderson, Walter B
Report presents the results of tests made of a Clark y airfoil with a Clark y Fowler flap and of an NACA 23012 airfoil with NACA Fowler flaps. Some of the tests were made in the 7 by 10-foot wind tunnel and others in the 5-foot vertical wind tunnel. The pressures were measured on the upper and lower surfaces at one chord section both on the main airfoils and on the flaps for several angles of attack with the flaps located at the maximum-lift settings. A test installation was used in which the model was mounted in the wind tunnel between large end planes so that two-dimensional flow was approximated. The data are given in the form of pressure-distribution diagrams and as plots of calculated coefficients for the airfoil-and-flap combinations and for the flaps alone.
Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy
Chikaishi, Yasuhiro; Kuwata, Taiji; Takenaka, Masaru; Oka, Soichi; Hirai, Ayako; Imanishi, Naoko; Kuroda, Koji; Tanaka, Fumihiro
Background Open window thoracotomy (OWT) as well as its closure are challenging. Transposition of omental pedicle and muscle flaps is often performed for OWT closure; however, the better technique among the two is unknown. The purpose of this series was to evaluate the outcomes of using both omental pedicle and muscle flaps for the aforementioned closure. Methods This was an observational retrospective cohort study on 27 consecutive patients who underwent OWT closure at a single institution between January 2005 and December 2014. The operation was performed using either omental pedicle or muscle flap with thoracoplasty. We compared both techniques in terms of the patient background [sex, age, body mass index (BMI) and C-reactive protein (CRP) before OWT and serum albumin levels before OWT closure], presence of methicillin-resistant Staphylococcus aureus (MRSA) infection, rate of bronchopleural fistula (BPF), duration of OWT, recurrence of local infection, morbidity, duration of indwelling drainage after operation, success, mortality and postoperative hospital stay. Results There were 9 (33.3%) omental pedicle flap procedures and 18 (66.7%) muscle flap procedures. The rate of local recurrence after closure of OWT was significantly higher with muscle flap than with omental pedicle flap (0% vs. 50.0%, P=0.012). The median duration of postoperative hospital stay was significantly shorter with omental pedicle flap than that with muscle flap (16.0 vs. 41.5 days, P=0.037). Mortality was observed in 2 patients (11.2%) in the muscle flap group and no patient in the omental pedicle flap group. Success rate was similar between the two groups (100% for omental pedicle flap vs. 83.3% for muscle flap). Conclusions Omental pedicle flap was superior to muscle flap in terms of reducing local recurrence and shortening postoperative hospital stay. However, mortality, morbidity and success rates were not affected by the choice of flap. PMID:27499959
14 CFR 25.701 - Flap and slat interconnection.
Code of Federal Regulations, 2013 CFR
... flaps or slats retracted on one side and extended on the other, the motion of flaps or slats on opposite...) For airplanes with flaps or slats that are not subjected to slipstream conditions, the structure...
14 CFR 25.701 - Flap and slat interconnection.
Code of Federal Regulations, 2014 CFR
... flaps or slats retracted on one side and extended on the other, the motion of flaps or slats on opposite...) For airplanes with flaps or slats that are not subjected to slipstream conditions, the structure...
14 CFR 25.701 - Flap and slat interconnection.
Code of Federal Regulations, 2012 CFR
... flaps or slats retracted on one side and extended on the other, the motion of flaps or slats on opposite...) For airplanes with flaps or slats that are not subjected to slipstream conditions, the structure...
Topology optimization of pressure adaptive honeycomb for a morphing flap
NASA Astrophysics Data System (ADS)
Vos, Roelof; Scheepstra, Jan; Barrett, Ron
The paper begins with a brief historical overview of pressure adaptive materials and structures. By examining avian anatomy, it is seen that pressure-adaptive structures have been used successfully in the Natural world to hold structural positions for extended periods of time and yet allow for dynamic shape changes from one flight state to the next. More modern pneumatic actuators, including FAA certified autopilot servoactuators are frequently used by aircraft around the world. Pneumatic artificial muscles (PAM) show good promise as aircraft actuators, but follow the traditional model of load concentration and distribution commonly found in aircraft. A new system is proposed which leaves distributed loads distributed and manipulates structures through a distributed actuator. By using Pressure Adaptive Honeycomb (PAH), it is shown that large structural deformations in excess of 50% strains can be achieved while maintaining full structural integrity and enabling secondary flight control mechanisms like flaps. The successful implementation of pressure-adaptive honeycomb in the trailing edge of a wing section sparked the motivation for subsequent research into the optimal topology of the pressure adaptive honeycomb within the trailing edge of a morphing flap. As an input for the optimization two known shapes are required: a desired shape in cruise configuration and a desired shape in landing configuration. In addition, the boundary conditions and load cases (including aerodynamic loads and internal pressure loads) should be specified for each condition. Finally, a set of six design variables is specified relating to the honeycomb and upper skin topology of the morphing flap. A finite-element model of the pressure-adaptive honeycomb structure is developed specifically tailored to generate fast but reliable results for a given combination of external loading, input variables, and boundary conditions. Based on two bench tests it is shown that this model correlates well
Four Flaps Technique for Neoumbilicoplasty
Lee, Young Taek; Kwon, Chan; Rhee, Seung Chul; Cho, Sang Hun
The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding. PMID:26015893
Cryosurgery - skin; Warts - freezing; Warts - cryotherapy ... Cryotherapy or cryosurgery may be used to: Remove warts Destroy precancerous skin lesions (actinic keratoses or solar keratoses) In rare cases, ...
Craniotomy flap osteomyelitis: a diagnostic approach
Blumenkopf, B.; Hartshorne, M.F.; Bauman, J.M.; Cawthon, M.A.; Patton, J.A.; Friedman, A.H.
Nine cases of suspected craniotomy flap osteomyelitis evaluated by combined bone and gallium scanning are presented. In six cases, the clinical data were inconclusive and evaluation by radionuclide imaging provided an accurate negative diagnosis. The other three cases considered positive by this technique were proven infected at subsequent exploration and flap removal. The use of radionuclide bone and gallium imaging should be considered in cases of possible craniotomy flap osteomyelitis.
Wing flapping with minimum energy
NASA Technical Reports Server (NTRS)
Jones, R. T.
A technique employed by Prandtl and Munk is adapted for the case of a wing in flapping motion to determine its lift distribution. The problem may be reduced to one of minimizing induced drag for a specified and periodically varying bending moment at the wing root. It is concluded that two wings in close tandem arrangement, moving in opposite phase, would eliminate the induced aerodynamic losses calculated
Outcomes following V-Y advancement flap reconstruction of large upper lip defects
Griffin, Garrett R.; Weber, Stephen; Baker, Shan R.
Objective To characterize revision surgery following V-Y subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects. Methods Retrospective review of upper lip skin defects ≥3.0 cm2 that were reconstructed with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center. Depth and area of the defect, as well as involvement of the vermilion and nasal ala, were recorded as independent variables. Revision techniques were analyzed to identify patterns. Results Thirty patients were identified with upper lip skin defects ranging from 3.0 to 14.0 cm2 (mean 7.0 cm2, median 6.25 cm2). The defect involved the nasal ala in four cases and the vermilion in three cases. At least one revision surgery was performed in 14/30 (47%) patients. Alar or vermilion involvement was a significant factor in revision by chi-square analysis (p=0.026). Larger defect size did not predict a need for revision, even among cases where the defect did not involve the ala or vermilion (p=0.68). Conclusion Reconstruction of large upper lip skin defects with a V-Y subcutaneous tissue pedicle advancement flap is associated with a 47% revision rate, and when the defect involves the ala or vermilion, the revision rate is increased. Defect size alone cannot be used to predict the need for revision surgery. Revision techniques are demonstrated. PMID:22801764
The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: a prospective trial.
Munabi, Naikhoba C O; Olorunnipa, Olushola B; Goltsman, David; Rohde, Christine H; Ascherman, Jeffrey A
Mastectomy skin flap ischaemia leading to necrosis is a common occurrence. Laser-assisted indocyanine green (ICG) angiography can assist to locate these poorly perfused areas intra-operatively. Our study aims to identify specific perfusion values produced by ICG angiography that accurately predict mastectomy flap necrosis. A total of 42 patients undergoing autologous or implant-based breast reconstruction had mastectomy flaps imaged using laser-assisted ICG angiography at the completion of reconstruction. Intra-operative perfusion values were correlated with postoperative skin flap outcomes. Risk factors for abnormal perfusion were recorded and analysed. A total of 62 breast reconstructions were imaged, including 48 tissue expander reconstructions, six transverse rectus abdominis myocutaneous (TRAM) flaps, six deep inferior epigastric perforator (DIEP) flaps and two direct-to-implant reconstructions. Eight cases (13%) of full-thickness skin necrosis were identified postoperatively. A SPY Elite(®) value of ≤ 7 accurately predicted the development of flap necrosis at 88% sensitivity and 83% specificity. False-positive cases (those with perfusion values ≤ 7 which did not develop necrosis) were more likely to have a smoking history and/or to have had an epinephrine-containing tumescent solution used during mastectomy. Excluding patients with smoking or epinephrine use, a SPY value of ≤ 7 predicted flap necrosis with a sensitivity of 83% and specificity of 97%. Thus, these data suggest that laser-assisted ICG angiography predicts postoperative outcomes with high accuracy. In our series, a SPY value of ≤ 7 correlated well with mastectomy flap necrosis. Furthermore, smoking and intra-operative injections containing epinephrine should be considered when evaluating low perfusion values as they can lead to false-positive test results. PMID:24507962
A water tunnel study of Gurney flaps
NASA Technical Reports Server (NTRS)
Neuhart, Dan H.; Pendergraft, Odis C., Jr.
Several Gurney flap configurations were tested in the NASA Langley 16 x 24 inch Water Tunnel. These devices provided an increased region of attached flow on a wing upper surface relative to the wing without the flaps. The recirculation region behind the flap was visualized and shown to be consistent with hypotheses stated in previous research. Although the test Reynolds number for this study was several orders of magnitude below those in previous investigations, the effect of the Gurney flaps is in qualitative agreement with them. This is as would be expected from first order effects for high lift devices.
An investigation of the flap edge flowfield
NASA Astrophysics Data System (ADS)
Pye, John David
To identify and understand the fluid dynamic processes associated with flow in the region of a flap side edge, a NACA 63-215 Mod B main element with a half-span Fowler flap was tested in the JIAA Low Speed Wind Tunnel at Stanford University. Measurements were made using a variety of techniques to capture the effects of the flap edge vortex. Pressure sensitive paint was applied to the upper surface of both the flap and main element, as well as to the flap side edge. Fast response pressure transducers were mounted interior to the model to measure surface pressure fluctuations on the flap side edge. Single component hotwire data was taken in the near wake region of the flap edge. In addition to the data experimentally obtained, a computational data set of a geometrically similar model at a flight Reynolds number was used for comparison. The data indicates the presence of a dual vortex structure along the flap side edge. This structure is seen to grow, merge, and ultimately become a single symmetric vortex as it progresses downstream. Surface pressure fluctuations on the side edge scale as three power laws with free stream velocity as different flow regions are encountered. By varying the model rigging, indications of a confined source region for the pressure fluctuations were observed. A spatial survey of the correlation between flap side edge surface pressure fluctuations and the near-wake fluctuating velocity field shows increased correlation coefficients for the region surrounding the vortex core.
Microsurgical free flaps: Controversies in maxillofacial reconstruction
George, Rinku K.; Krishnamurthy, Arvind
Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps. PMID:23662264
Optimal propulsive flapping in Stokes flows.
Was, Loïc; Lauga, Eric
Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds numbers, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propulsion mechanism valid across the whole range of Reynolds numbers. PMID:24343130
A new classification of spreader flap techniques.
Wurm, Jochen; Kovacevic, Milos
The objective of this study was to introduce various spreader flap technique modifications to adjust the width of the middle nasal vault in patients who underwent rhinoplasties with humpectomy. Decisive modifications of current spreader flap techniques were performed to allow a more natural restoration of the middle nasal vault and the internal nasal valve after humpectomy. Additional steps provide tools to adjust the width and shape of the middle nasal vault according to patients' requirements. The techniques were categorized into "basic spreader flaps," "flaring spreader flaps," "support spreader flaps," and "interrupted spreader flaps." The various spreader flap techniques were used during 576 primary septorhinoplasties in patients with hump noses, hump/crooked noses, or hump/tension noses. The average follow-up was 19 months. Patients who received basic spreader flaps or a flaring spreader flaps tended to show a slightly too wide middle nasal vault, revision surgery was necessary in four of these cases. All other patients showed an appropriate width in the middle nasal vault and an aesthetically pleasing course of the dorsal aesthetic lines. No signs of inverted v deformities or collapse of the internal nasal valve were observed in any of the patients. Patients who had reported impaired nasal breathing preoperatively described clearly improved subjective symptoms. The described techniques appear to be appropriate and highly promising as a supplement to existing procedures for reconstructing the middle nasal vault and internal nasal valves. No additional cartilage grafts are needed. PMID:24327250
Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.
Sato, Tomoya; Ichioka, Shigeru
Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot. PMID:26190780
Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects
Background: Reconstruction of extensive lower lip defects is challenging, and functional outcomes are difficult to achieve. Methods: A modified bilateral neurovascular cheek (MBNC) flap has been described. The data of patients with cancer of the lower lip treated with wide excision and reconstructed with the MBNC flap in the Plastic Surgery Unit, Srinagarind Hospital, Khon Kaen University, from 1966 to 2012 were reviewed. Results: Of the total of 143 patients included, 90.91% were women, and their age ranged from 32 to 100 years. All defects involved 70% or greater of the lower lip, which included oral commissure, buccal mucosa, or cheek skin and upper lip. All 20 patients who were followed up demonstrated good outcomes of intercommissural distance, interlabial distance, sulcus depth, and 2-point discrimination compared with normal lip parameters according to age group and satisfaction with treatment. Conclusions: Reconstruction of extensive lower lip defects with the MBNC flap provided good oral competence and functional outcomes. The flap provided adequate lip height and width, with proper position of oral commissure and vermilion reconstruction. The awareness about neurovascular anatomy of the lip and cheek and gentle dissection preserve the lip function. The flap overcomes the drawbacks of Karapandzic technique, which is microstomia, and of Bernard technique, which is a tight adynamic lower lip. It can be used in defects of more than two-thirds of the lip, extending to the cheek, commissural reconstruction, and secondary reconstruction.
Acute Deep Hand Burns Covered by a Pocket Flap-Graft
Pradier, Jean-Philippe; Oberlin, Christophe; Bey, Eric
Objective: We evaluated the long-term outcome of the "pocket flap-graft" technique, used to cover acute deep burns of the dorsum of the hand, and analyzed surgical alternatives. Methods: This was a 6-year, retrospective study of 8 patients with extensive burns and 1 patient with a single burn (11 hands in all) treated by defatted abdominal wall pockets. We studied the medical records of the patients, and conducted a follow-up examination. Results: All hands had fourth-degree thermal burns caused by flames, with exposure of tendons, bones, and joints, and poor functional prognosis. One third of patients had multiple injuries. Burns affected an average of 36% of the hand surface, and mean coverage was 92.8 cm2. One patient died. The 8 others were seen at 30-month follow-up: the skin quality of the flap was found to be good in 55% of the cases, the score on the Vancouver Scar Scale was 2.4, the Kapandji score was 4.5, and total active motion was 37% of that of a normal hand. Hand function was limited in only 2 cases, 8 patients were able to drive, and 3 patients had gone back to work. Conclusion: The pocket flap-graft allows preservation of hand function following severe burns, when local or free flaps are impossible to perform. Debulking of the flap at the time of elevation limits the need for secondary procedures. PMID:17268577
Salvage of failed local and regional flaps with porcine urinary bladder extracellular matrix aided tissue regeneration.
Kruper, Gregory J; Vandegriend, Zachary P; Lin, Ho-Sheng; Zuliani, Giancarlo F
Local and regional flap failure can be a major complication in head and neck surgery, which continue to be prevalent for a number of reasons including poor flap design, improper surgical technique, and poor tissue vascularity. Dealing with these failures can be quite difficult. Surgical debridement, flap revisions, and complex wound regimens are necessitated to reestablish appropriate tissue coverage. Traditional use of wet to dry dressing to enable proper wound granulation and possible closure with additional flaps or skin grafts is a laborious process. Such treatments place great time burdens on the patient, physicians, and nurses. Because the face and neck possess a complex three-dimensional topography, wound dressings are inherently complex to design and change. Many patients also require postoperative treatments such as radiation and chemotherapy to treat aggressive malignancies, and delay in wound healing leads to a delay in adjuvant treatment. Recently, advances in regenerative medicine, specifically xenogeneic extracellular matrix compounds, have been shown to promote tissue growth while limiting scar tissue formation (Badylak 2004). To our knowledge, this paper is the first case series using the porcine extracellular matrix bioscaffold (MatriStem ACell, Columbia, MD, USA) to salvage flaps with extensive wound breakdown on the face and neck. PMID:24191216
de Lima, Sérgio José; Domingos da Costa, Ricardo Pereira; de Oliveira, Emanoel; Prudente, Fabrício Guimarães; Mendonça, Marcelo Paris; Soares de Camargo, Christiano
To assess the results achieved with posterior interbone artery flap covering serious injuries of the distal third of the forearm, wrist and hand, evaluating the degree of effectiveness of this procedure. Methods: 35 patients with serious injuries of the distal third of upper limbs were studied. We assessed the kind of trauma, injury site, flap size, skin coverage need, clinical outcome and complications. Results: The most frequent mechanism of trauma was motorcycle accident. The most commonly affected regions were: dorsal hand, wrist volar regions and the first commissure. In all patients, the flap size was enough to cover key tissues exposed by the injury. The donor area did not show complications, being primarily closed in 23 cases. The outcomes were good for 31 cases. In 22 patients, no complication was found, and the flap was completely lost in four. Conclusion: Posterior interbone artery flap provides good outcomes in covering serious injuries of the distal third of upper limbs, leading to a stable and reliable coverage, not compromising key irrigating arteries of the hand, enabling the performance of reconstruction procedures. Therefore, this is a useful alternative in such cases. PMID:26998451
Salvage of Failed Local and Regional Flaps with Porcine Urinary Bladder Extracellular Matrix Aided Tissue Regeneration
Kruper, Gregory J.; VandeGriend, Zachary P.; Lin, Ho-Sheng; Zuliani, Giancarlo F.
Local and regional flap failure can be a major complication in head and neck surgery, which continue to be prevalent for a number of reasons including poor flap design, improper surgical technique, and poor tissue vascularity. Dealing with these failures can be quite difficult. Surgical debridement, flap revisions, and complex wound regimens are necessitated to reestablish appropriate tissue coverage. Traditional use of wet to dry dressing to enable proper wound granulation and possible closure with additional flaps or skin grafts is a laborious process. Such treatments place great time burdens on the patient, physicians, and nurses. Because the face and neck possess a complex three-dimensional topography, wound dressings are inherently complex to design and change. Many patients also require postoperative treatments such as radiation and chemotherapy to treat aggressive malignancies, and delay in wound healing leads to a delay in adjuvant treatment. Recently, advances in regenerative medicine, specifically xenogeneic extracellular matrix compounds, have been shown to promote tissue growth while limiting scar tissue formation (Badylak 2004). To our knowledge, this paper is the first case series using the porcine extracellular matrix bioscaffold (MatriStem ACell, Columbia, MD, USA) to salvage flaps with extensive wound breakdown on the face and neck. PMID:24191216
Reconstruction of Chopart's Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap
Shimizu, Mari; Takeuchi, Masaki
Summary: A 63-year-old man dropped a metal chunk onto his left foot during his work and suffered a crush injury of the left forefoot. He underwent Chopart's amputation followed by stump coverage with sole skin at the orthopedic department on the same day. He was referred to our department for reconstruction because of poor vascularization and subsequent necrosis of tissue at the stump. After the necrotic tissue was debrided, exposure of the talus bone was noted. An artificial dermis was then applied to the stump wound, followed by local negative pressure wound therapy. After 3 weeks, the generation of a strong dermis-like tissue was observed at the site of artificial dermis grafting. We then performed flow-through free anterolateral thigh flap grafting to reconstruct the stump wound. This procedure involved suturing of the peroneal muscle group and tibialis anterior muscle, which were cut off during Chopart's amputation, and suturing the soft tissue surrounding the calcaneus firmly to the fascia lata of the anterolateral thigh flap, followed by suturing of the flap to the skin defect of the left foot. There were neither postoperative complications, such as skin ulcer and equinus/varus deformity, nor need for secondary repair of the grafted flap, so the patient was able to smoothly enter a rehabilitation program including gait training. The current reconstruction technique for the tissue defect following Chopart's amputation, consisting of artificial dermis grafting, negative pressure wound therapy, and flow-through free anterolateral thigh flap grafting, enabled safe and smooth gait rehabilitation with a forefoot prosthesis. PMID:26893983
Breast reconstruction with single-pedicle TRAM flap in breast cancer patients with low midline abdominal scar
Wu, Jun-Dong; Huang, Wen-He; Qiu, Si-Qi; He, Li-Fang; Guo, Cui-Ping; Zhang, Yong-Qu; Zhang, Fan; Zhang, Guo-Jun
Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average flow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year. Eight breast cancer patients with low midline abdominal scar (scar group) and 20 without (control group) underwent immediate breast reconstruction with SP-TRAM flaps consisting of zone I and III and zone II tissues. Flap complications, donor-site complications, and cosmetic results were compared between the two groups. All flaps survived and both groups presented similar flap and donor site complications, including fat necrosis, seroma, hematoma, infection, delayed wound healing, and abdominal hernia, and patients in both groups had similar aesthetic results (p > 0.05). Thus, the study demonstrated that breast reconstruction using SP-TRAM flap was a safe approach in carefully selected patients with low midline abdominal scar. PMID:27406872
Total upper and lower eyelid replacement following thermal burn using an ALT flap--a case report.
Rubino, C; Farace, F; Puddu, A; Canu, V; Posadinu, M A
Upper and lower eyelid unilateral full thickness reconstruction in a patient with no available adjacent tissues because of burns or trauma sequelae is a surgical challenge. A case of severe thermal burn with unilateral complete defect of both upper and lower eyelids is reported, together with the surgical technique of reconstruction. The patient was a 65-year-old man who sustained deep burns of the head and neck with upper airway burns after falling into a fireplace. After tracheostomy and acute resuscitation, he underwent escharectomy and coverage of his head and neck burns with split thickness skin grafts and with full thickness skin grafts to the eyelids. There was incomplete take of the skin grafts to the upper and lower left eyelids. In these areas, infection and loss of the tarsum and subsequent eyelid retraction led to exposure keratitis and blurred vision. After healing and respiratory rehabilitation, he was referred to our microsurgical unit for upper and lower eyelid reconstruction. A free forearm flap was first considered, but the Allen test was negative. Therefore, a free anterolateral thigh (ALT) flap was chosen to provide skin eyelid coverage. The flap was harvested including fascia and centred on one perforator. The levator muscle stump and conjunctiva from both upper and lower cul-de-sacs were dissected and advanced. Flap vessels were anastomosed to the superficial temporal artery and vein. The conjunctiva and the fascia replaced the new inner upper and lower lamella. To our knowledge, this is the first report of the use of a perforator flap, the ALT flap, in full thickness reconstruction of both upper and lower eyelids and may be a reliable option in such selected and challenging situations. PMID:17954041
First dorsal metacarpal artery adiposofascial flap for venous conduit and soft tissue cover in an avulsed thumb: case report.
Dodakundi, Chaitanya; Hattori, Yasunori; Doi, Kazuteru
Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit. PMID:22517573
Simple and easy reconstruction of nail matrix lesion using lateral finger flap after excision of digital mucous cyst
Okochi, Masayuki; Saito, Masami; Ueda, Kazuki
Abstract We treated nine patients with skin defect produced by digital mucous cyst (DMC) excision on the finger and toe using lateral finger flap (LFF). The postoperative scars were esthetically acceptable and no recurrence of mucous cysts was observed. Our LFF is a simple method to repair minor distal dorsal finger defects. PMID:27583263
Simple and easy reconstruction of nail matrix lesion using lateral finger flap after excision of digital mucous cyst.
Okochi, Masayuki; Saito, Masami; Ueda, Kazuki
We treated nine patients with skin defect produced by digital mucous cyst (DMC) excision on the finger and toe using lateral finger flap (LFF). The postoperative scars were esthetically acceptable and no recurrence of mucous cysts was observed. Our LFF is a simple method to repair minor distal dorsal finger defects. PMID:27583263
The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient.
Avery, C M E; Crank, S T; Neal, C P; Hayter, J P; Elton, C
A retrospective review of seventy-one PPM flaps used between 1996 and 2010 primarily for oral and oropharyngeal squamous cell carcinoma presenting as either advanced stage IV primary disease (41/43), extensive recurrent (10) or metastatic (9) neck disease. The PPM flap was most commonly used following resection of the mandible (23) or the tongue/oropharynx (19). When the PPM flap was the preferred reconstruction option (54) the main indication, in addition to advanced disease, was significant medical co-morbidity (23). The majority of PPM flaps (75%) were used in the latter half of the series for an increasing number of patients in poor health with advanced disease. There was no evidence of an increase in age, ASA grade or extent of disease during this period. Approximately one quarter (17) of the flaps were used after failure of a free flap, most commonly a DCIA (7) or radial (6) flap. The 30day mortality in this group of compromised patients undergoing major surgery for advanced disease was 7% (5/71). The overwhelming majority had significant co-morbidity (94% grade 2 or higher with 63% ASA grade 3) and 90% had already undergone previous major surgery and/or radiotherapy. The 1-year, 3-year and 5-year overall survival rates were 65.5%, 39.1% and 11.0% respectively with cancer-specific survival rates of 82.0%, 65.5% and 65.5%. The majority died of disease related to the underlying co-morbidity. We recommend an aggressive approach to the surgical resection of advanced and recurrent disease but a pragmatic approach to reconstruction. The PPM major flap is reliable for reconstruction of defects of the mandible, tongue and oropharynx with a complete flap failure rate of 2.8%. Lateral defects of the mandible were managed without a plate and with an acceptable outcome in the context of limited life expectancy. This is the largest study of the use of the PPM flap for this type of patient group. The flap retains a major role in the management of advanced primary or
Fyhrquist, N; Salava, A; Auvinen, P; Lauerma, A
The cutaneous microbiome has been investigated broadly in recent years and some traditional perspectives are beginning to change. A diverse microbiome exists on human skin and has a potential to influence pathogenic microbes and modulate the course of skin disorders, e.g. atopic dermatitis. In addition to the known dysfunctions in barrier function of the skin and immunologic disturbances, evidence is rising that frequent skin disorders, e.g. atopic dermatitis, might be connected to a dysbiosis of the microbial community and changes in the skin microbiome. As a future perspective, examining the skin microbiome could be seen as a potential new diagnostic and therapeutic target in inflammatory skin disorders. PMID:27056560
Role of (99m)Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies.
Srivastava, Madhur Kumar; Penumadu, Prasanth; Kumar, Dinesh; Pandit, Nandini
Osteo-cutaneous flap are commonly used for reconstruction of bone defect after oncology surgery. The success of surgery depends on the viability of the bone flap. Bone scan is a known, but less performed method, to look for viability of bone flaps. We describe a case of 50-year-old lady, presenting with squamous cell carcinoma of left buccal mucosa (cT4N1M0) involving the skin and mandible. She underwent left segmental mandibulectomy and upper alveolectomy with neck dissection, followed by reconstruction using a fibular osteo-cutaneous flap and anterolateral thigh free flap. On postoperative day 10, the intraoral flap showed signs of nonviability. The patient was sent to nuclear medicine for assessment of viability of the free fibula flap. The patient underwent three phase (99m)Tc-methylene diphosphonate (MDP) bone scan and single-photon emission computerized tomography. Computerized tomography showing good tracer uptake in fibula confirming viability. The case reflects the use of (99m)Tc-MDP in viability assessment of the bone flap. PMID:26170579
[The super extended sub-mental flap or combo sub-mental flap].
Martin, D
The author presents a technical variation of the sub-mental flap including in a conventional pedicled flap both sub-mental axes and their anastomoses on the midline. The assessment of the first flaps raised according to this method confirms the improvement of the distal blood supply. It allows the possibility to harvest "super extended" flaps reaching the contralateral auricular lobula. This variation can be considered as an axial flap which only the tip, located beyond the mandibular angle, is at random. The evolution of the sub-mental flap from its original description to this variation called "combo sub-mental flap" is then presented. Its reliability and the technical simplification it provides will have to be assessed in the future. PMID:24840945
Secondary onlay free flap reconstruction of glossectomy defects following initial successful flap restoration.
Rihani, Jordan; Lee, Thomas; Ducic, Yadranko
Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy. PMID:23625797
Exposed tibial bone after burns: Flap reconstruction versus dermal substitute.
Verbelen, Jozef; Hoeksema, Henk; Pirayesh, Ali; Van Landuyt, Koenraad; Monstrey, Stan
A 44 years old male patient had suffered extensive 3rd degree burns on both legs, undergoing thorough surgical debridement, resulting in both tibias being exposed. Approximately 5 months after the incident he was referred to the Department of Plastic and Reconstructive Surgery of the University Hospital Gent, Belgium, to undergo flap reconstruction. Free flap surgery was performed twice on both lower legs but failed on all four occasions. In between flap surgery, a dermal substitute (Integra(®)) was applied, attempting to cover the exposed tibias with a layer of soft tissue, but also without success. In order to promote the development of granulation tissue over the exposed bone, small holes were drilled in both tibias with removal of the outer layer of the anterior cortex causing the bone to bleed and subsequently negative pressure wound therapy (NPWT) was applied. The limited granulation tissue resulting from this procedure was then covered with a dermal substitute (Glyaderm(®)), consisting of acellular human dermis with an average thickness of 0.25mm. This dermal substitute was combined with a NPWT-dressing, and then served as an extracellular matrix (ECM), guiding the distribution of granulation tissue over the remaining areas of exposed tibial bone. Four days after initial application of Glyaderm(®) combined with NPWT both tibias were almost completely covered with a thin coating of soft tissue. In order to increase the thickness of this soft tissue cover two additional layers of Glyaderm(®) were applied at intervals of approximately 1 week. One week after the last Glyaderm(®) application both wounds were autografted. The combination of an acellular dermal substitute (Glyaderm(®)) with negative pressure wound therapy and skin grafting proved to be an efficient technique to cover a wider area of exposed tibial bone in a patient who was not a candidate for free flap surgery. An overview is also provided of newer and simpler techniques for coverage of
Free flap pulse oximetry utilizing reflectance photoplethysmography.
Zaman, T; Kyriacou, P A; Pal, S K
The successful salvage of a free flap is dependent on the continuous monitoring of perfusion. To date there is no widely accepted and readily available post-operative monitoring technique to reliably assess the viability of free flaps by continuously monitoring free flap blood oxygen saturation. In an attempt to overcome the limitations of the current techniques a reflectance photoplethysmographic (PPG) processing system has been developed with the capability of real-time estimation of arterial oxygen saturation (SpO2) levels implemented in LabVIEW. This system was evaluated in clinical measurements on five patients undergoing breast reconstruction using Deep Inferior Epigastric Perforator (DIEP) flap. Good quality PPG signals were obtained from the flaps and fingers simultaneously. The estimated free flap SpO2 values were in broad agreement with the oxygen saturation readings from the commercial pulse oximeter. The results suggest that reflectance free flap photoplethysmography can be used as a continuous monitoring technique to non-invasively monitor the perfusion of free flaps. PMID:24110620
14 CFR 23.701 - Flap interconnection.
Code of Federal Regulations, 2010 CFR
... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap interconnection. 23.701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap...
14 CFR 23.701 - Flap interconnection.
Code of Federal Regulations, 2012 CFR
... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Flap interconnection. 23.701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.701 Flap...
Use of free flaps in burn trauma.
Tvrdek, M; Nejedlý, A; Kletenský, J; Pros, Z; Broz, L
The present currently used method of treating and reconstructing injuries caused by electric current and deep thermal injuries is compared with the method of early reconstruction using free flaps. Brief summary of present experience substantiating this method is presented. The three presented clinical cases show subacute reconstruction in this type of injury by free flaps transfer. PMID:7618395
Code of Federal Regulations, 2013 CFR
... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....
Code of Federal Regulations, 2010 CFR
... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....
Code of Federal Regulations, 2012 CFR
... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....
Code of Federal Regulations, 2011 CFR
... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....
Code of Federal Regulations, 2014 CFR
... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....
Piezoelectrically actuated insect scale flapping wing
NASA Astrophysics Data System (ADS)
Mukherjee, Sujoy; Ganguli, Ranjan
An energy method is used in order to derive the non-linear equations of motion of a smart flapping wing. Flapping wing is actuated from the root by a PZT unimorph in the piezofan configuration. Dynamic characteristics of the wing, having the same size as dragonfly Aeshna Multicolor, are analyzed using numerical simulations. It is shown that flapping angle variations of the smart flapping wing are similar to the actual dragonfly wing for a specific feasible voltage. An unsteady aerodynamic model based on modified strip theory is used to obtain the aerodynamic forces. It is found that the smart wing generates sufficient lift to support its own weight and carry a small payload. It is therefore a potential candidate for flapping wing of micro air vehicles.
Scrubbing noise of externally blown flaps
NASA Technical Reports Server (NTRS)
Fink, M. R.
An experimental study was conducted to examine the aeroacoustic mechanism that produces externally blown flap (EBF) scrubbing noise, i.e. a surface-radiated noise which is generally strongest normal to UTW deflected flaps. Scrubbing noise was not radiated from portions of the surface adjacent to strong, locally coherent turbulent eddies. Instead, scrubbing noise seemed to come from weak loading fluctuations that were coherent along the scrubbed span. These loading fluctuations probably were induced by the convected large-scale vortex structure of the attached exhaust jet. Deflecting a UTW flap would reduce the distance between the vortex trajectory and the flap surface, increasing the resulting dipole noise and rotating its directivity. In contrast, deflecting a USB flap would increase this distance, so that observable scrubbing noise would be radiated only from the undeflected forward portion of the wing.
Lung tissue flap repairs esophagus defection with an inner chitosan tube stent
Chen, Gang; Shi, Wen-Jun
AIM: To repair the partial esophagus defect with a chitosan stent, a new esophageal prosthesis made of pulmonary tissue with vascular pedicle. METHODS: Fifteen Japanese big ear white rabbits were divided into experimental group (n = 10) and control group (n = 5). Esophagus defect in rabbits of experimental group was repaired using lung tissue flap with a chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation. Esophagus defect of rabbits in control group was repaired using lung tissue flap with no chitosan tube stent, gross and histological appearance was observed at week 2, 4 and 8 after operation, and barium sulphate X-ray screen was performed at week 10 after operation. RESULTS: In the experimental group, 6 rabbits survived for over two weeks, the lung tissue flap healed esophageal defection, and squamous metaplasia occurred on the surface of lung tissue flap. At week 10 after operation, barium sulphate examination found that barium was fluent through the esophagus with no stricture or back stream, the creeping was good. In the control group, 4 rabbits survived for two weeks, the lung tissue flap healed esophageal defection with fibrous tissue hyperplasia, barium sulphate examination found that barium was fluent through the esophagus with a slight stricture or back stream, and the creeping was not good at week 10 after operation. CONCLUSION: Esophagus defect can be repaired using lung tissue flap with an inner chitosan tube stent. PMID:19322927
The figure-of-eight radix nasi flap for medial canthal defects.
Seyhan, Tamer
Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars. PMID:20079658
Intraoperative laser-assisted indocyanine green angiography for the evaluation of mastectomy flaps in immediate breast reconstruction.
Newman, Martin I; Samson, Michel C; Tamburrino, Joseph F; Swartz, Kimberley A
Skin-sparing mastectomy has been associated with flap ischemia and necrosis. Current clinical methods for assessment of flap viability following mastectomy are largely subjective and lack objective data to guide intraoperative decisions. Intraoperative laser-assisted indocyanine green angiography (LA-ICGA) was performed on 20 skin sparing mastectomy flaps. LA-ICGA data were retrospectively compared with clinical outcome. Preoperative, intraoperative, and postoperative digital photographs along with clinical course were evaluated in an effort to identify potential complications. LA-ICGA was performed on 20 breasts in 12 patients. Eleven breasts (55%) demonstrated no wound-healing issues. Nine breasts (45%) experienced wound-healing issues, which were stratified as follows: 1 (5%) mild, 1 (5%) moderate, and 7 (35%) severe. Of these seven severe wound-healing issues, 5 (25%) required debridement and 2 (10%) required complete removal of the prosthetic device. Retrospective analysis demonstrated a 95% correlation between intraoperative imaging and clinical course with 100% sensitivity and 91% specificity. There was a false-positive rate of 9%. This series suggests LA-ICGA is a useful adjunct to determine mastectomy flap viability. Further quantitative advances in this technology may provide objective numerical thresholds to guide intraoperative mastectomy flap debridement when indicated. PMID:20539977
Heinrich von Pfalzpaint, Pioneer of Arm Flap Nasal Reconstruction in 1460, More Than a Century Before Tagliacozzi.
Greig, Aina; Gohritz, Andreas; Geishauser, Max; Mühlbauer, Wolfgang
Heinrich von Pfalzpaint (circa 1415-1465) was a Bavarian military surgeon of the Teutonic Order who treated more than 4000 casualties during the siege of Marienberg Fortress (1454-1457). In 1460, he reported "How to create a new nose if it has been chopped off and the dogs have eaten it" in his treatise on wound care Bündt-Ertznei. He used opium-soaked sponges for anesthesia, described the surgical extraction of bullets and cleft lip repair. Pfalzpaint would have been the first author to describe nasal reconstruction in Europe if his treatise had not been lost. Only 5 copies of his manuscript existed. One was rediscovered and printed in 1868. Pfalzpaint's technique for nasal reconstruction was performed in 2 stages using an undelayed skin flap from the upper arm, which was sutured to the nasal defect and the arm was bandaged to the head. After 8 to 10 days, he divided the pedicle; inset the flap; and fashioned the nasal dorsum, alae, and columella. Tagliacozzi described arm flap nasal reconstruction more than a century later in 1597. He used delayed skin flaps, with at least 6 operative stages over 4 months. Pfalzpaint was ahead of his time regarding his knowledge of wounds, insistence on surgical cleanliness, and his technically easier arm flap rhinoplasty, compared with Tagliacozzi. Pfalzpaint, who is rarely referenced in the literature, should be remembered as a great pioneer of reconstructive surgery in Europe. PMID:26080150
Polyamines and nonmelanoma skin cancer
Gilmour, Susan K.
Elevated levels of polyamines have long been associated with skin tumorigenesis. Tightly regulated metabolism of polyamines is critical for cell survival and normal skin homeostasis, and these controls are dysregulated in skin tumorigenesis. A key enzyme in polyamine biosynthesis, ornithine decarboxylase (ODC) is upregulated in skin tumors compared to normal skin. Use of transgenic mouse models has demonstrated that polyamines play an essential role in the early promotional phase of skin tumorigenesis. The formation of skin tumors in these transgenic mice is dependent upon polyamine biosynthesis, especially putrescine, since treatment with inhibitors of ODC activity blocks the formation of skin tumors and causes the rapid regression of existing tumors. Although the mechanism by which polyamines promote skin tumorigenesis are not well understood, elevated levels of polyamines have been shown to stimulate epidermal proliferation, alter keratinocyte differentiation status, increase neovascularization, and increase synthesis of extracellular matrix proteins in a manner similar to that seen in wound healing. It is becoming increasingly apparent that elevated polyamine levels activate not only epidermal cells but also underlying stromal cells in the skin to promote the development and progression of skin tumors. The inhibition of polyamine biosynthesis has potential to be an effective chemoprevention strategy for nonmelanoma skin cancer.
Complications of skin-sparing mastectomy followed by immediate breast reconstruction: a prospective randomized study comparing high-frequency radiosurgery with conventional diathermy.
Meretoja, Tuomo J; von Smitten, Karl A J; Kuokkanen, Hannu O M; Suominen, Sinikka H H; Jahkola, Tiina A
Skin-sparing mastectomy (SSM) followed by immediate breast reconstruction delivers superior cosmetic and functional outcome. However, SSM is vulnerable to complications of the native skin envelope. This study aims to compare the effects of radiofrequency coagulation and conventional diathermy on complications of SSM. Sixty consecutive patients suitable for SSM were randomized into conventional diathermy and radiosurgery groups. These groups were compared and the risk factors for SSM flap complications were evaluated. The SSM flap complication rate was 23.4%. There was no difference between the study groups regarding the SSM flap complications. Increased SSM flap complication rate was associated with smoking and the type of skin incision used. This study shows that high-frequency radiosurgery is comparable to conventional diathermy in terms of complication rates of SSM. Furthermore, this study reports an association between the tennis-racquet-type incision and an increased SSM flap complication rate compared with the round periareolar type incision. PMID:18281791
Antioxidant support in composite musculo-adipose-fasciocutaneous flap applications: an experimental study.
Bozkurt, Mehmet; Kapi, Emin; Kulahci, Yalcin; Gedik, Ercan; Ozekinci, Selver; Isik, Fatma Birgul; Celik, Yusuf; Selcuk, Caferi Tayyar; Kuvat, Samet Vasfi
Free radicals are chemicals that play roles in the etio-pathogenesis of ischaemia-reperfusion injury. Various antioxidants have been used in an attempt to mitigate the damage induced by these chemicals. In the present study, the antioxidative effects of grape seed extract (proanthocyanidin), tomato extract (lycopene), and vitamin C (ascorbic acid) on a composite re-established-flow inferior epigastric artery based rectus abdominis muscle-skin flap model on which experimental ischaemia was induced were investigated. The rats have been administered antioxidants for 2 weeks prior to the surgery and for 2 more weeks thereafter. Macroscopic, histopathological, and biochemical analyses were carried out at the decision of the experiment. It was found that flap skin island necrosis was significantly reduced in the proanthocyanidin, lycopene, vitamin C groups (p < 0.001). Statistical analyses showed significant decreases in inflammation, oedema, congestion, and granulation tissue in the proanthocyanidin and lycopene groups compared to the vitamin C and control groups (p < 0.001). When the viability rates of fat and muscle tissues were examined, significant improvements were found in the proanthocyanidin and lycopene groups in comparison to the other groups (p < 0.001). Serum antioxidant capacity measurements revealed significant differences in the lycopene group compared to all other groups (p < 0.001). It is concluded that lycopene and proanthocyanidin are protective antioxidants in rat composite muscle-skin flap ischaemia-reperfusion models. PMID:23731129
Pudendal thigh flap for repair of rectovaginal fistula.
Sathappan, S; Rica, M A I
The pudendal thigh flap or the Singapore flap is a versatile flap that can be used in the repair of recto-vaginal fistulae. Apart from the potential problem of hair growth, this neurovascular flap proves to be surprisingly simple in technique, robust and has a high potential for normal or near-normal function. PMID:17240589
Total 'rib'-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video
Rosich-Medina, Anais; Bouloumpasis, Serafeim; Di Candia, Michele; Malata, Charles M.
Introduction The total 'rib'-preservation method of dissecting out the internal mammary vessels (IMV) during microvascular breast reconstruction aims to reduce free flap morbidity at the recipient site. We review our five-year experience with this technique. Patients & methods An analysis of a prospectively collected free flap data cohort was undertaken to determine the indications, operative details and reconstructive outcomes in all breast reconstruction patients undergoing IMV exposure using the total 'rib'-preservation method by a single surgeon. Results 178 consecutive breast free flaps (156 unilateral, 11 bilateral) were performed from 1st June 2008 to 31st May 2013 in 167 patients with a median age of 50 years (range 28–71). There were 154 DIEP flaps, 14 SIEA flaps, 7 muscle-sparing free TRAMs, 2 IGAP flaps and one free latissimus dorsi flap. 75% of the reconstructions (133/178) were immediate, 25% (45/178) were delayed. The mean inter-costal space distance was 20.9 mm (range 9–29). The mean time taken to expose and prepare the recipient IMV's was 54 min (range 17–131). The mean flap ischaemia time was 95 min (range 38–190). Free flap survival was 100%, although 2.2% (4 flaps) required a return to theatre for exploration and flap salvage. No patients complained of localised chest pain or tenderness at the recipient site and no chest wall contour deformity has been observed. Discussion & conclusion The total 'rib'-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the 'rib'-sacrificing techniques. PMID:26468373
Hydrodynamic schooling of flapping swimmers.
Becker, Alexander D; Masoud, Hassan; Newbolt, Joel W; Shelley, Michael; Ristroph, Leif
Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing-wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups. PMID:26439509
Hydrodynamic schooling of flapping swimmers
Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif
Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in amore » group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. Lastly, these results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.« less
Hydrodynamic schooling of flapping swimmers
NASA Astrophysics Data System (ADS)
Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif
Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing-wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.
Hydrodynamic schooling of flapping swimmers
Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif
Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups. PMID:26439509
Hydrodynamic schooling of flapping swimmers
Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif
Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. Lastly, these results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.
A Novel Pilot Study Using Spatial Frequency Domain Imaging to Assess Oxygenation of Perforator Flaps During Reconstructive Breast Surgery
Nguyen, John T.; Lin, Samuel J.; Tobias, Adam M.; Gioux, Sylvain; Mazhar, Amaan; Cuccia, David J.; Ashitate, Yoshitomo; Stockdale, Alan; Oketokoun, Rafiou; Durr, Nicholas J.; Moffitt, Lorissa A.; Durkin, Anthony J.; Tromberg, Bruce J.; Frangioni, John V.; Lee, Bernard T.
Introduction Although various methods exist for monitoring flaps during reconstructive surgery, surgeons primarily rely on assessment of clinical judgment. Early detection of vascular complications improves rate of flap salvage. Spatial frequency domain imaging (SFDI) is a promising new technology that provides oxygenation images over a large field of view. The goal of this clinical pilot study is to use SFDI in perforator flap breast reconstruction. Methods Three women undergoing unilateral breast reconstruction after mastectomy were enrolled for our study. The SFDI system was deployed in the operating room, and images acquired over the course of the operation. Time points included images of each hemiabdominal skin flap before elevation, the selected flap after perforator dissection, and after microsurgical transfer. Results Spatial frequency domain imaging was able to measure tissue oxy-hemoglobin concentration (ctO2Hb), tissue deoxyhemoglobin concentration, and tissue oxygen saturation (stO2). Images were created for each metric to monitor flap status and the results quantified throughout the various time points of the procedure. For 2 of 3 patients, the chosen flap had a higher ctO2Hb and stO2. For 1 patient, the chosen flap had lower ctO2Hb and stO2. There were no perfusion deficits observed based on SFDI and clinical follow-up. Conclusions The results of our initial human pilot study suggest that SFDI has the potential to provide intraoperative oxygenation images in real-time during surgery. With the use of this technology, surgeons can obtain tissue oxygenation and hemoglobin concentration maps to assist in intraoperative planning; this can potentially prevent complications and improve clinical outcome. PMID:23945533
Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region.
Fukunaga, Yutaka; Miyamoto, Shimpei; Kobayashi, Eisuke; Sakuraba, Minoru
The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer. PMID:25193397
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Aerodynamic characteristics of a wing with Fowler flaps including flap loads, downwash, and calculated effect on take-off
NASA Technical Reports Server (NTRS)
Platt, Robert C
This report presents the results of wind tunnel tests of a wing in combination with each of three sizes of Fowler flap. The purpose of the investigation was to determine the aerodynamic characteristics as affected by flap chord and position, the air loads on the flaps, and the effect of flaps on the downwash.
The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases
Georgescu, Alexandru V.; Matei, Ileana R.; Capota, Irina M.
Background Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds. PMID:23050066
AB024. The penile dermal flap* for defect reconstruction in Peyronie's disease (PD) deformities
Krishnamurti, Sudhakar
Objective Generally speaking, historically, two main types of surgical treatments have been used to straighten penis deformity in Peyronie's disease (PD)*: viz. (I) plication procedures; and (II) assorted graft materials to close defects in the tunica albuginea after plaque/deformity excision/release. Many different techniques have been described under each category. Curiously, flaps* (cf. free grafts), which are widely used in many other surgical applications, have hardly been tried in PD. The first description of a pedicled, epidermis-free, dermal penile skin flap for covering the tunica albuginea defect after plaque incision/excision in PD was made by this author in 1992 at the Milan ISSM meeting. In 1994, at the Singapore ISSM meeting, the penile dermal flap operation was awarded the ISSM's prestigious biennial Herbert Newman award for best paper in original clinical research in the field of sexual health. In this talk, attention is drawn to the biological and cost advantages of having and using biological auto flaps, and it's operative technique, advantages and long term results. S. KRISHNAMURTI: 'Penile dermal flap for defect reconstruction in Peyronie's disease: operative technique and four years' experience in 17 patients.' Int J Impotence Res (1995) 7, 195-208.' In this presentation, the operative technique in both, circumcised and uncircumcised Peyronie's disease patients will be shown with slides and videos. Methods Operative technique video and PPT slides to be shown. Results Presented in body of talk. Conclusions When available, simple, autologous local pedicled flap ideal material for PD defect closure.
The reverse sural artery flap for the reconstruction of distal third of the leg and foot.
Olawoye, Olayinka Adebanji; Ademola, Samuel Adesina; Iyun, Kayode; Michael, Afie; Oluwatosin, Odunayo
Soft tissue defects around the distal third of the leg and the foot present a major reconstructive challenge. There is limited expertise with free tissue transfers in many developing countries, necessitating consideration of other options for the closure of such defects. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. Twenty patients comprising of 13 males and 7 females with soft tissue defects of the lower third of the leg and foot requiring soft tissue cover were treated between January 2006 and December 2010. The age range was 7-58 years with a mean age of 30 years. Nineteen (95%) of the defects were post-traumatic while one (5%) was post-infective. All the defects were covered with reversed sural artery flaps, which were raised on the posterior aspect of the junction of the upper and middle third of the leg. The smallest flap was 4 × 4 cm(2) while the largest measured 20 × 12 cm(2). The donor defect was closed directly in 7 (35%) patients, while split skin graft was applied in the remaining 13 (65%) patients. There was satisfactory flap healing in 17 patients (85%), while 3 patients (15%) had complete flap necrosis. Two of these patients had significant comorbidities of haemoglobinopathy and poorly controlled diabetes mellitus. Sural artery flap remains a viable option for the reconstruction of soft tissue defects of the distal third of the leg and foot. Caution should, however, be exercised in patients with some significant systemic diseases. PMID:23050798
... caused a large amount of skin loss Burns Cosmetic reasons or reconstructive surgeries where there has been skin damage or skin ... anesthesia are: Reactions to medicines Problems with breathing Risks for this surgery are: Bleeding Chronic pain (rarely) Infection Loss of ...