scholarly journals Pedicle Temporalis Fascial Flap with Axial Scalp Flap Obviates Need of Free Flap in Extensive Scalp Wound

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
F. W. Nangole ◽  
S. O. Khainga
Keyword(s):  
Wide Local Excision ◽  
Operative Time ◽  
Free Flaps ◽  
Local Flaps ◽  
Donor Side ◽  
Scalp Flap ◽  
Fascial Flap ◽  
Scalp Defect ◽  
Exposed Bone ◽  
Scalp Wound

Extensive scalp defect with exposed bone is best reconstructed with flaps. Majority of these wounds are now routinely reconstructed with free flaps in many centers. Free flaps however require lengthy operative time and may not be available to all patients, where possible less extensive options should thus be encouraged. A sixty-eight-year-old patient presented to us with a Marjolin’s ulcer on the vertex of the scalp. After wide local excision a defect of about 17 cm and 12 cm was left. The defect was successfully covered with a combination of an ipsilateral pedicle temporalis fascial flap and an axial supraorbital scalp flap with good outcome. In conclusion wide defects of the scalp can be fully covered with a combination of local flaps. The axial scalp flap and the pedicle temporalis fascial flap where applicable provide an easy and less demanding option in covering such wounds. These flaps are reliable with good blood supply and have got less donor side morbidity.

Complications and Outcomes of Chimeric Free Flaps: A Systematic Review

2019 ◽  
Vol 161 (4) ◽  
pp. 568-575 ◽  
Author(s):  
Abhinav R. Ettyreddy ◽  
Collin L. Chen ◽  
Joseph Zenga ◽  
Laura E. Simon ◽  
Patrik Pipkorn
Keyword(s):  
Head And Neck ◽  
Complication Rate ◽  
Operative Time ◽  
Donor Site ◽  
Locally Advanced ◽  
Major Complication ◽  
Free Flaps ◽  
Controlled Vocabulary ◽  
Cochrane Central Register ◽  
Complication Rates

ObjectiveAblations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making.Data SourcesThe librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997).Review MethodsCandidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates.ResultsA total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively.ConclusionChimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.

The Temporoparietal Fascial Flap Is an Alternative to Free Flaps for Orbitomaxillary Reconstruction

2010 ◽  
Vol 126 (3) ◽  
pp. 880-888 ◽  
Author(s):  
John Y. S. Kim ◽  
Donald W. Buck ◽  
Sarah A. Johnson ◽  
Charles E. Butler
Keyword(s):  
Free Flaps ◽  
Fascial Flap

scholarly journals Possibility of management of lower leg war burns with free flaps

2003 ◽  
Vol 60 (6) ◽  
pp. 741-745 ◽  
Author(s):  
Ljubomir Panajotovic ◽  
Jefta Kozarski ◽  
Snezana Krtinic-Rapaic ◽  
Bojan Stanojevic
Keyword(s):  
Wound Closure ◽  
Free Flaps ◽  
Lower Leg ◽  
The Other ◽  
Wound Treatment ◽  
Necrotic Tissue ◽  
Local Flaps ◽  
Reconstructive Procedures ◽  
Military Medical Academy ◽  
Medical Academy

Free flaps are used in the surgical treatment of burns for wound closure where the burn is too deep, and in case, when after necrotic tissue excision, the bones, tendons, nerves, and blood vessels remain bare. Covering of the exposed structures is commonly performed in the primary delayed, or in the secondary wound treatment. The possibilities of covering the defects of the lower leg with local flaps are limited. Free flaps are used when all the possibilities of the other reconstructive procedures have been exhausted. The defect of the soft tissue of the lower leg was covered with free flaps in the injured soldiers with deep burns, treated at the Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade. In one patient the wound closing was performed immediately after excision of necrotic tissues, and in the other two in the secondary management. The application of free microvascular flaps enabled the closure of large post excision defects of the lower leg in one operation. Our experience in the treatment of these soldiers point to the possibility of coverage of the exposed deep structures with free flaps as early as possible.

scholarly journals Reconstruction of scalp with local axial flaps

2020 ◽  
Vol 6 (9) ◽  
pp. 1692
Author(s):  
Saket Srivastava ◽  
Pradeep Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Healing Time ◽  
Surrounding Tissue ◽  
Surgical Reconstruction ◽  
Local Flaps ◽  
Transposition Flap ◽  
Scalp Reconstruction ◽  
Scalp Defects ◽  
Scalp Defect

<p><strong>Background:</strong> The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.</p><p><strong>Methods:</strong> From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm<sup>2</sup> in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.</p><p><strong>Results:</strong> The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm<sup>2</sup>) and 28 patients had 90-150 cm<sup>2</sup> defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.</p><p><strong>Conclusions</strong>: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.</p>

scholarly journals Reconstruction of Achilles region defects: a single-center experience

2021 ◽  
Author(s):  
Cengiz Eser ◽  
Ozgün İlke Karagöz Ceylan ◽  
Eyuphan Gencel ◽  
Ibrahim Tabakan ◽  
Ömer Kokaçya ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Graft Loss ◽  
Perforator Flap ◽  
Skin Grafting ◽  
Free Flaps ◽  
Distinct Advantage ◽  
Local Flaps ◽  
Single Center ◽  
Secondary Healing ◽  
Artery Perforator

Background: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to use of free flaps. Method: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single center. Results: Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6), and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Conclusion: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. Use of special digital imaging techniques facilitates flap surgery and helps minimize the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Superthin free flaps offer a distinct advantage in skillful hands. Use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favorable outcomes.

The Exclusive Use of Slit Mini-Micrografting for the Correction of a Large Frontoparietal Scalp Defect

1993 ◽  
Vol 10 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Dominic A. Brandy
Keyword(s):  
Tissue Expansion ◽  
Free Flaps ◽  
Scar Tissue ◽  
Scalp Defect ◽  
Minimal Trauma ◽  
Viable Method ◽  
Punch Hair Grafting

In this article slit mini-micrografting is used exclusively for the correction of a large frontoparietal scalp defect. This method was used as an alternative to tissue expansion, transposition-rotation flaps, free flaps, or conventional punch hair-grafting. The protocol consisted of three well-organized sessions of #15 blade and 18-gauge needle slits made very obliquely into the scarred defect. Mini- and micrografts were then placed into these incisions. This approach yielded a good result which was felt to be due to the combination of the minimal trauma caused by slits and the limited circulation required for the survival of mini- and micrografts. Minigrafts were also much easier to insert into scar tissue when compared with conventional grafts. In conclusion, it was felt that the exclusive use of slit mini-micrografting appears to be a viable method for the correction of frontoparietal cicatrial alopecia.

Heel Reconstruction With Bipedicled Flap: A Salvage Procedure

2020 ◽  
Vol 19 (4) ◽  
pp. 377-381
Author(s):  
Alper Burak Uslu ◽  
Ramazan Erkin Ünlü
Keyword(s):  
Free Flaps ◽  
Salvage Procedure ◽  
Older Individuals ◽  
Peripheral Vascular ◽  
Fat Pad ◽  
Exposed Bone ◽  
Thin Skin ◽  
A New Technique ◽  
Subdermal Fat ◽  
Heel Reconstruction

Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon—or both—should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.

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