1/14. head and neck reconstruction using lateral thigh free flap: flap design.Eleven lateral thigh free flaps were used in head and neck reconstruction, transferred on the basis of the second perforator as well as the third perforator of the profunda femoris artery. The lateral thigh free flap was useful and reliable in head and neck reconstruction and was versatile in flap design. Due to the wide cutaneous territory of the lateral thigh flap, the skin island could be designed freely in the lateral thigh region. Careful patient selection is mandatory for good results. The pinch test and an understanding of the variety of subcutaneous thicknesses in the lateral thigh region are helpful in designing a skin island of adequate thickness. Other considerations in flap design are discussed.- - - - - - - - - - ranking = 1keywords = island (Clic here for more details about this article) |
2/14. Distinguishing laser Doppler flowmetric responses between arterial and venous obstructions in flaps.This study emphasizes the differences in laser Doppler flowmetric responses between arterial and venous obstruction of flaps, by using an experimental model and a clinical review. Monitoring free flaps in the early postoperative period is valuable in the salvage of failing flaps. When combined with clinical observation, the laser Doppler flowmeter can provide the surgeon with an early indication of impending flap failure, which enhances the success rate of flap salvage. Understanding the difference in laser Doppler flowmetric response between venous and arterial occlusion allows for improved interpretation of the perfusion data. The authors monitored 12 epigastric skin island flaps in six male Sprague-Dawley rats, comparing flow data between venous and arterial occlusion. Arterial occlusion consistently led to an abrupt fall below the critical value within 1 min, while venous occlusion consistently showed a more gradual decline over 15 min and beyond. In the authors' clinical series of 13 failing flaps recorded by the laser Doppler, three cases of arterial occlusion showed an abrupt decline in flow values, while 10 cases of venous obstruction showed a gradual decline to critical value, usually over several hours. When monitoring free flaps using the laser Doppler, it is crucial to pay special attention to any gradual decline in flow values, in order to detect impending flap failure and to expedite reexploration.- - - - - - - - - - ranking = 0.5keywords = island (Clic here for more details about this article) |
3/14. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases.From August 1995 to June 1999, 140 free anterolateral thigh (ALT) flaps were transferred to reconstruct a variety of soft-tissue defects. The size of ALT flap ranged from 10 to 33 cm in length and 4 to 14 cm in width. Based on the anatomic variations of the perforators, the blood supply to the skin island came from the septocutaneous perforators only in 19 patients (13.6%), arising from the descending or transverse branch of the lateral circumflex femoral artery (LCFA), or originating directly from LCFA. The other flaps were supplied by musculocutaneous perforators that were elevated as a true perforator flap via intramuscular dissection (N = 34, 24.3%), or used a cuff of vastus lateralis muscle for added bulk (N = 87, 62.1%). The overall success rate was 92% (129 of 140). After a 2-year follow-up, all flaps have healed unevenffully and donor thigh morbidity is minimal. Anatomic variations must be considered if the ALT flap is to be used safely and reliably.- - - - - - - - - - ranking = 0.5keywords = island (Clic here for more details about this article) |
4/14. Four V-Y islanded flap reconstruction of full thickness defect of chin and labial sulcus.Few techniques are described specifically for reconstruction of full thickness defects involving the chin. We present a new method of reconstruction of a large full thickness defect over the chin and lower labial sulcus with four V-Y island flaps. Two of these were mental neurovascular island flaps. The other two were islanded musculomucosal flap. The mental flaps, previously described for reconstruction of the lower lip, were cosmetically more suitable for reconstruction of tissue defects of the chin. The principle of covering the tissue defect of chin with local tissue to provide good matching and function is achieved.- - - - - - - - - - ranking = 3.5keywords = island (Clic here for more details about this article) |
5/14. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery.The pedicled lower trapezius musculocutaneous flap is a standard flap in head and neck reconstruction. A review of the literature showed that there is no uniform nomenclature for the branches of the subclavian artery and the vessels supplying the trapezius muscle and that the different opinions on the vessels supplying this flap lead to confusion and technical problems when this flap is harvested. This article attempts to clarify the anatomical nomenclature, to describe exactly how the flap is planned and harvested, and to discuss the clinical relevance of this flap as an island or free flap. The authors dissected both sides of the neck in 124 cadavers to examine the variations of the subclavian artery and its branches, the vessel diameter at different levels, the course of the pedicle, the arc of rotation, and the variation of the segmental intercostal branches to the lower part of the trapezius muscle. Clinically, the flap was used in five cases as an island skin and island muscle flap and once as a free flap. The anatomical findings and clinical applications proved that there is a constant and dependable blood supply through the dorsal scapular artery (synonym for the deep branch of the transverse cervical artery in the case of a common trunk with the superficial cervical artery) as the main vessel. Harvesting an island flap or a free flap is technically demanding but possible. Planning the skin island far distally permitted a very long pedicle and wide arc of rotation. The lower part of the trapezius muscle alone could be classified as a type V muscle according to Mathes and Nahai because of its potential use as a turnover flap supplied by segmental intercostal perforators. The lower trapezius flap is a thin and pliable musculocutaneous flap with a very long constant pedicle and minor donor-site morbidity, permitting safe flap elevation and the possibility of free-tissue transfer.- - - - - - - - - - ranking = 2.5keywords = island (Clic here for more details about this article) |
6/14. Pectoralis major musculocutaneous flap with nipple-areola complex in head and neck reconstruction: preliminary results of a new modified method.Pectoralis major musculocutaneous flap remains the workhorse tool for head and neck reconstruction. Flap failure in head and neck reconstruction is a devastating complication with a high morbidity and mortality. Inclusion of nipple-areola complex on the skin paddle stabilizes the blood circulation in the skin island of the pectoralis major musculocutaneous flap. A modified use of pectoralis major musculocutaneous flap with nipple-areola complex on the skin island was performed in 11 male patients in head and neck reconstructions with success without partial or total skin island necrosis.We recommend the inclusion of nipple-areola complex on the skin island of the pectoralis major musculocutaneous flap in head and neck reconstructions to increase the blood supply of the skin paddle. We concluded that the skin island of the pectoralis major musculocutaneous flap might include the areola and nipple complex in patients with large defects of the head and neck, which stabilize the blood circulation in the skin island.- - - - - - - - - - ranking = 3keywords = island (Clic here for more details about this article) |
7/14. Donor side selection in mandibular reconstruction using a free fibular osteocutaneous flap.While the free fibular osteocutaneous flap is indispensable for mandibular reconstruction, reliable setting is often difficult because relative positions of the bone, skin island, and vascular pedicle are critical. We have an algorithm for donor-side selection of free fibular osteocutaneous flap.From July 2002 to March 2004, we performed 15 mandibular reconstructions using free fibular osteocutaneous flaps. We retrospectively classified these procedures as follows. In type I (flap harvested ipsilaterally to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle emerged from the anterior aspect of the fibula. In type II (flap contralateral to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle arose from the posterior aspect. In type III (flap contralateral to defect, n = 4), the skin island was fixed to the facial skin and the vascular pedicle arose from the anterior aspect. In type IV (flap ipsilateral to defect, n = 1), the skin island was fixed to the facial skin and the vascular pedicle arose from the posterior aspect. Flaps took completely except in 1 group II case with partial necrosis. Close attention to geometric characteristics of a free fibular osteocutaneous flap facilitates reconstruction of mandibular defects and selection of donor side.- - - - - - - - - - ranking = 2.5keywords = island (Clic here for more details about this article) |
8/14. Keystone island flap: an alternative reconstructive option to free flaps in irradiated tissue.BACKGROUND: The Keystone Flap is an island flap that is very useful for repairing skin defects of the integument. Described as a keystone, this arc-shaped flap in fact consists of a schematically designed, perforator-based reconstructive unit which serendipitously resembles two conjoined VY flaps. This facilitates closure because of the multiple VY points at the extremes, where the surrounding tissue is advanced to close the defect while the flap size remains basically static. methods: A consecutive series of nine cases involving the head and neck and inguinal regions were examined to show the use of the Keystone Flap in irradiated tissue for recurrent disease. They are described by using a combination of clinical illustrations and diagrams to explain the surgical technique. RESULTS: The average age of the patients in the series is 74 years. A low complication rate and rapid wound healing with no significant flap necrosis was shown in this series. Additionally the short operation time is quite beneficial, particularly for the elderly. CONCLUSION: There is a low complication rate using Keystone flaps (this double VY is a clinical development from Diffenbach's original work of 1848(1)) and this technique is particularly useful in achieving wound healing especially after irradiation treatment. This surgical technique once mastered is easy to perform. Another bonus is that there is minimal use of postoperative analgesia. Additional XRT is well tolerated by the patients with minimal evidence of wound complications, while achieving an acceptable aesthetic appearance.- - - - - - - - - - ranking = 2.5keywords = island (Clic here for more details about this article) |
9/14. Primary cutaneous mucinous carcinoma: report of two cases treated with Mohs' micrographic surgery.We present a 72-year-old woman who presented with a slowly enlarging, asymptomatic, cystic nodule on the right eyebrow, and a 66-year-old woman who had a reddish, nodular lesion on the left lower eyelid. Incisional biopsy from the two neoplasms showed dermal epithelial cell islands embedded in mucin pools. Tumour cells stained positive for cytokeratin 7, oestrogen and progesterone receptors, and negative for vimentin and S-100 protein. These findings were consistent with a diagnosis of mucinous carcinoma. Extensive work-ups excluded cutaneous metastases from primary visceral mucinous carcinomas. To ensure complete tumour removal, both patients underwent Mohs' micrographic surgery (standard fresh-frozen technique). They remain disease-free 42 and 26 months after surgical excision, respectively. Mohs' micrographic surgery appears to be a rational and effective treatment for this uncommon malignancy.- - - - - - - - - - ranking = 0.5keywords = island (Clic here for more details about this article) |
10/14. The pectoralis major myocutaneous island flap for reconstruction of the head and neck.The anatomy, design, and blood supply of the pectoralis major myocutaneous island flap are described. This versatile, nondelayed flap has, for the most part, replaced the usual cutaneous flaps. Clinical examples of its use in head and neck reconstructive surgery are presented.- - - - - - - - - - ranking = 2.5keywords = island (Clic here for more details about this article) |
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