Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap

Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap. Cordova A, D'Arpa S, Pirrello R, Brenner E, Jeschke J, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro, 129-90127, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: Vessels in the supraclavicular area and their contribution to skin vascularization have always been studied for flaps planning in head and neck reconstruction and many pedicled flaps have been des…

An innervated retroauricular skin flap for total earlobule reconstruction.

In this article, the authors describe a technique for total earlobule reconstruction in a patient who underwent earlobule excision for basal cell carcinoma. The reconstruction was by means of an innervated retroauricular skin flap, folded double. The flap presented preserved skin sensitivity over all the reconstructed area, which is compromised by those techniques using a cranially or medially based flap which lead to the reconstruction of an insensible earlobule. This is a very important aspect of this technique, especially for those who wear pendant earrings, since a non-sensitive lobule would be more vulnerable to traumas causing laceration. In addition, it allows a good aesthetic result…

PEDICLED PERFORATOR FLAPS IN NASAL RECONSTRUCTION: A REVIEW

The use of perforator flaps in face reconstruction is becoming increasingly common. They are particularly useful in nose reconstruction, where they can be tailored to match the complex three-dimensional structure of the nasal concave and convex subunits. In this paper, we present a review of the literature on the use of pedicled perforator flaps in nose reconstruction, discussing current indications and outcomes. Literature on this topic is still limited, with only 12 studies reporting data on 129 reconstructions. Reconstruction of nasal defects with pedicled perforator flaps is a novel and expanding field. It allows for the achievement of good aesthetic results, with a single operation and…

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

 Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venou…

Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

AbstractSoft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postope…

Validity and reliability of the CatWalk system as a static and dynamic gait analysis tool for the assessment of functional nerve recovery in small animal models

Introduction: A range of behavioral testing paradigms have been developed for the research of central and peripheral nerve injuries with the help of small animal models. Following any nerve repair strategy, improved functional outcome may be the most important evidence of axon regeneration. A novel automated gait analysis system, the CatWalk™, can measure dynamic as well as static gait patterns of small animals. Of most interest in detecting functional recovery are in particular dynamic gait parameters, coordination measures, and the intensity of the animals paw prints. This article is designed to lead to a more efficient choice of CatWalk parameters in future studies concerning the functio…

Reply: Time to Reconsider a Gold Standard of Lymph Flow Imaging: Importance of Reliability to Detect Abnormal Lymphodynamics in Lymphedema Screening after Cancer Treatments

Reply to a Letter to Editor

Segmental anatomy of the vastus lateralis: guidelines for muscle-sparing flap harvest.

Background: The vastus lateralis muscle is a versatile donor site for pedicled and free flaps that, despite great potential, remains unpopular. Although the muscle is classically described as a single belly, evidence exists for a more complex morphology. The aim of this study was to investigate the segmental anatomy of the vastus lateralis muscle and the feasibility of selective flap harvest. Methods: Ten cadaveric lower limbs were investigated. Muscular partitions were identified according to morphologic architecture, vascular supply, and nerve supply; guidelines for selective flap harvest were described. Twenty-three segmental vastus lateralis (n = 14) or chimeric anterolateral thigh-vast…

Reply

Reply to a Letter to Editor

Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures.

AbstractThe concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed. A negative-pressure dressing can be easily and rapidly ap…

Response to ‘The trap door flap: A reliable, reproducible method of anterior pinna reconstruction’

Intratissular expansion–mediated, serial fat grafting: A step-by-step working algorithm to achieve 3D biological harmony in autologous breast reconstruction

Background Breast reconstruction involves the use of autologous tissues or implants. Occasionally, microsurgical reconstruction is not an option because of insufficient donor tissues. Fat grafting has become increasingly popular in breast surgery. The challenge with this technique is how to reconstruct a stable and living “scaffold” that resembles a breast. Methods Breast reconstruction (n = 7) was performed using intratissular expansion with serial deflation–lipofilling sessions. Mean age of the patients was 41 years (22–53). The expander generated a vascularized capsule at 8 weeks, which demarcated a recipient site between the skin and the capsule itself, and functioned as a vascular sour…

Freestyle-Like V-Y Flaps of the Eyebrow: A New Outlook and Indication of an Historical Technique

The eyebrow region is of utmost importance for facial movement, symmetry, and the overall cosmetic appearance of the face. Trauma or tumor resection often leave scars that may dislocate the eyebrow producing an alteration both in static symmetry of the face and in the dynamic expressivity. The authors present a technique for eyebrow’s defects repair using the remaining eyebrow advancement by means of a “freestyle-like” V-Y flap. In the past two years a total of eight consecutive patients underwent excision of skin lesions in the superciliary region and immediate reconstruction with this technique. On histology, six patients were affected from basal cell carcinomas, one from squamous cell ca…

A new one-stage method for nose reconstruction: the supratrochlear artery perforator propeller flap.

LETTER TO EDITOR

Chest Surgery for Transgender and Gender Nonconforming Individuals

Chest surgery can greatly facilitate the experience of living in a gender role. For transfeminine chest surgery, most surgeons recommend a 12-month period of feminizing hormone therapy prior to breast augmentation. For those who already have some breast volume due to hormone treatment, lipofilling can be a good option. Transmasculine chest surgery includes mastectomy and creation of a male chest. Preoperative parameters to be evaluated include breast volume, degree of excess skin, nipple-areola complex size and position, and skin elasticity. The algorithm the authors developed and modified can help choose from 5 techniques, resulting in an aesthetically pleasing male chest.

ALGORITHM OF PARTIAL BREAST RECONSTRUCTION WITH PEDICLED PERFORATOR FLAPS

INTRODUCTION: The authors present an algorithm of partial breast reconstruction following quadrantectomy that allows to restore the breast volume defect with the use of pedicled perforator flaps. MATERIAL AND METHODS: Between March 2009 and May 2010, at the Plastic and Reconstructive Institute of University of Palermo, pedicled perforator flaps were used to integrate volume and/or breast skin in 12 patients after benign and malignant breast tumors. The flaps used were based on perforators of the thoraco-dorsal artery (TDAP) and of the intercostal arteries (ICAP). TDAP flaps were used to reconstruct defects in any breast quadrant, while ICAP perforator were used to reconstruct lateral and ce…

Propeller Flaps: A Review of Indications, Technique, and Results

In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequate…

Porcine Model for Deep Superior Epigastric Artery Perforator Flap Harvesting: Anatomy and Technique

BACKGROUND Microsurgical training on rats before starting with clinical practice is a well-established routine. Animal model training is less widespread for perforator flaps, although these flaps represent a technical challenge. Unlike other flaps, they require specific technical skills that need to be adequately trained on a living model 1 : a cadaver is not enough because no bleeding, vessel damage, or vasospasm can be simulated. 2 The purpose of this study was to assess the suitability of the porcine abdomen as a training model for the deep inferior epigastric artery perforator (DIEAP) flap, commonly used in human breast reconstruction. METHODS A female swine (Sus scrofa domesticus, ssp;…

Post Surgical Pyoderma Gangrenosum in flap surgery: diagnostic clues and treatment recommendations

Background: Post Surgical Pyoderma Gangrenosum (PSPG) is a neutrophilic dermatosis causing aseptic necrotic ulcerations within surgical sites. It is often misdiagnosed as infection or ischemia and worsened by the inappropriate treatment. Therefore diagnostic clues must be identified and awareness for PSPG raised.Methods: We present two cases of PSPG after flap surgery and a review of the literature.Results: Seventeen cases of PSPG after flap surgery were found. Fever, pain and redness are the most common initial symptoms. In 63%, lesions were on the flap and the adjacent skin. In 63%, the donor site is also involved. Time to diagnosis was nine days to four years. Frequent debridement (89%) …

Exposed Subcutaneous Implantable Devices

Background: Implantable venous and electrical devices are prone to exposure and infection. Indications for management are controversial, but—especially if infected—exposed devices are often removed and an additional operation is needed to replace the device, causing a delay in chemotherapy and prolonging healing time. We present our protocol for device salvage, on which limited literature is available. Methods: Between 2007 and 2013, 17 patients were treated (12 venous access ports, 3 cardiac pacemakers, and 2 subcutaneous neural stimulators). Most patients were operated within 7 days from exposure. All patients received only a single perioperative dose of prophylactic antibiotic. In cases …

VENOUS THROMBOSIS IN FREE FLAPS: A STUDY OF THE PHENOMENOLOGY, HISTORY AND CLINICAL SIGNS IN AN EXPERIMENTAL MODEL OF RATS.

Free Bipedicled Radial Forearm and Posterior Interosseous Artery Perforator Flap Phalloplasty

Abstract Introduction The free radial forearm (FRFA) flap is universally still considered as the gold standard technique in penile reconstruction. Typically, a considerably large flap is required, often involving almost the entire circumference of the forearm. Partial necrosis may occur at the distal-most (dorsoradial) part of the flap as a result of insufficient perfusion. Aim To describe a new technique using the posterior interosseous artery (PIOA) to supercharge FRFA phalloplasty. Methods In a 12-month period, all patients having FRFA flap phalloplasty were enrolled. Perioperative, after complete flap dissection, an indocyanine green perfusion scan was performed. In case of insufficient…

Prophylactic chimera anterolateral thigh/vastus lateralis flap: preventing complications in high-risk head and neck reconstruction

Purpose In high-risk head and neck cases treated with tumor resection and associated radical neck dissection, orocutaneous fistulas and wound breakdowns in the neck are relatively frequent and can have serious consequences, such as carotid blowout syndrome (CBS), the need for salvage reoperations, and prolonged recovery time. The authors present the application of a prophylactic chimeric anterolateral thigh (ALT) and vastus lateralis (VL) flap to prevent complications. Materials and Methods A retrospective review was performed of a historical group (96 patients) of patients with head and neck cancer treated with tumor resection, radical neck dissection, and microsurgical reconstruction of t…

A Propeller Flap for Single-Stage Nose Reconstruction in Selected Patients: Supratrochlear Artery Axial Propeller Flap

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…

Novel fasciocutaneous flaps for the reconstruction of complicated lower extremity wounds

Summary: Reconstruction of the leg is particularly challenging especially when the defect involves its lower third. The options for lower leg reconstruction are very few because of the lack of local soft tissue available for transfer. Novel fasciocutaneous flaps nourished by perforator vessels have been developed and are increasingly used as a valuable local alternative to the local flaps, with their high complication rates, and to the microsurgical flaps, with their more difficult and specialized technique. They provide local tissue, replacing like with like, but they harvest it from a distant, undamaged, region of the leg, which means healthy and well-vascularized tissue. They do not need…

Fat Transplantion: Different Clinical Applications to Achieve Symmetry in Face and Body Contouring

Introduction: Fat autograft was first described in 1893 by Neuber for cosmetic and congenital defects. Nowadays its use is becoming widespread for soft tissue augmentation to improve simmetry and contour in all areas of the face and body. The authors present their experience with face and body contouring by fat autograft in post-oncological, post-traumatic and cosmetic settings. Materials and Methods: Between 2005 and 2008 31 patients underwent fat autografting in the plastic surgery unit of the university of palermo. There were 10 cases of breast asimmetry after reduction mammaplasty, breast augmentation and breast recostruction; 3 cases of post-traumatic and 1 congenital deformities in th…

Sentinel node biopsy for malignant melanoma: a staging procedure only?

Sentinel node biopsy (SNB) is an established staging tool for malignant melanoma. It allows identification of patients with metastatic disease at a very early stage and to collect accurate and complete prognostic information for these patients. Having noted that in a relevant percentage of patients the sentinel node is the only site of metastases, some authors have postulated a therapeutic role for SNB. In this paper, the possibility of a therapeutic role of SNB is evaluated. Relevant literature on the topic has been analyzed. Several findings suggest that not all patients with a positive SNB have further lymph node involvement. The prognostic indicators currently available do not significa…

Introduction to the Current Concepts in Lower Extremity Reconstruction by the Italian Society for Microsurgery

Axial propeller flaps: A proposal for update of the "Tokyo consensus on propeller flaps".

LETTER TO EDITOR

The chimeric ALT-vastus lateralis free flap in reconstruction of advanced BRONJ of the maxilla.

Introduction Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a dangerous complication of bisphosphonates, a class of pharmaceutical agents used in numerous bone disor- ders. No gold standard therapy exists, but recent literature suggests that, in advanced stages, the best results are achieved with aggressive debridement. In this paper, we report our experience of treatment of stage 3 BRONJ of the maxilla with extensive surgical debridement and reconstruction with a chimeric ALT-Vastus lateralis flap. Methods Five selected patients with stage 3 BRONJ underwent partial maxillectomy with dis- ease-free margins followed by immediate reconstruction with a chimeric ALT-Vastus lateralis…

Hyaluronic acid-based two-stage medical therapy to unfold the aged face: The centrifugal approach

Background: Facial aging is a multifactorial process characterized by structural changes to the dermis and ligaments, lipoatrophy in the fat pads and hypodermis, remodeling of the bony skeleton, change in muscle tonicity and tissue descent. Aims: The purpose of this study is to evaluate the efficacy of a hyaluronic acid-based treatment for the aging face that addresses all its causes in a caudal to cranial and medial to lateral direction: the centrifugal technique. Methods: Between March 2015 and January 2018, 187 patients were treated with a high G’ hyaluronic acid in two sessions, one/two weeks apart, to improve signs of facial aging, starting from the lower centrofacial area and progress…

Reply: vascular anatomy of the supraclavicular area revisited

Reply to Letter to Editor

An algorithm to improve outcomes of radial forearm flap donor site

Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site compli- cation rates. Methods: The authors analyzed retrospectively 31 patients who underwent free radial fore- arm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was…

Complications and Solutions in Propeller Flap Surgery

AbstractPropeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluatio…

"Free or Perforator-Pedicled Propeller Flaps in Lower Extremity Reconstruction: Defining the Coverage Failure": Response.

Retroauricular skin: a flaps bank for ear reconstruction.

Retroauricular skin: a flaps bank for ear reconstruction. Cordova A, D'Arpa S, Pirrello R, Giambona C, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro 129, 90127 - Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: The retroauricular skin has always been given much attention by the reconstructive surgeon for ear and face reconstruction because it is richly vascularised, as many anatomical investigations show, it is hidden behind the ear, its skin is very similar to that of ear and face. All these reasons make it an ideal donor site for ear reconstruction.…

The face-lift smas plication (FLISP) flap for reconstruction of large temporal defect. Reconstructive surgery meets cosmetic surgery

A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery.

Abstract Introduction The training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal. Material and methods The sequence has been planned and practiced by the first and last author, recorded perfected and implemented in a two-day surgical course. The sequence was then evaluated by the trainers and the trainees by means of a questionnaire. Results All students were able to complete the sequence of exercises before the end of the second day except two (8/10) who coul…

TECNICHE DI RICOSTRUZIONE DELLA SUPERFICIE POSTERIORE DEL PADIGLIONE AURICOLARE E DELLA MASTOIDE CON LEMBI LOCALI

B a c k g ro u n d. Reconstruction of the posterior auricular surface and of the mastoid has never been given much attention and there are no techniques described. The authors describe two techniques for reconstruction of these areas after cancer excision with local flaps. M e t h o d s . 13 patients have been treated after cancer resection with an advancement flap from the posterior auricular surface and a bilobed flap from the mastoid. R e s u l t s. All flaps healed uneventfully with a satisfactory aesthetic outcome. No relevant complications have been o b s e r v e d . C o n c l u s i o n s. Reconstruction of the posterior auricular surface and of the mastoid with the techniques describ…

Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases.

Background: Despite the widespread use of free perforator flaps, pedicled perforator flaps seem not to be as widely accepted, probably because of the fear of vascular complications caused by transfer of a flap attached only by its vascular pedicle, prone to shearing, kinking, and trauma. In this article, the authors report on their experience with 85 consecutive cases, focusing on incidence, prevention, and management of complications. Methods: Eighty-five consecutive cases were treated over 6 years at the Plastic and Reconstructive Surgery Department of the University of Palermo for defects of different causes that were reconstructed with a freestyle pedicled perforator flap, in every regi…

NECK DISSECTIONS: MISCONCEPTIONS, MALPRACTICE AND COMMON CONTROVERSIES

B a c k g ro u n d. Neck metastases are the single most important prognostic factor in Head and Neck Squamous Cell Carcinoma. Wise approach to neck treatment is then mandatory to give a chanche for cure. Still, there are some issues about neck dissection that need to be clarified. M e t h o d s. Through a review of the literature and of everyday clinical observations, the following issues are discussed: Functional Neck Dissection, biopsies, nodal levels, Selective Neck Dissections, Spinal Accessory Nerve, neck dissection classification. R e s u l t s. Integration of historical, anatomical, clinical and surgical concepts and up-to-date knowledge can allow to understand how to behave in diver…

The foot fillet flap for ischial pressure sore reconstruction: A new indication

Abstract Introduction The main cause of ischial pressure sores in paraplegic patients is prolonged sitting without pressure relief. These wounds are subject to recurrence and may need repeated reconstruction with local flaps. When all options are exhausted, the total thigh flap is the last resort. Disarticulation of the hip joint impairs stability even when sitting and causes subsequently very high discomfort. In this manuscript, we describe an alternative to the total thigh flap to avoid hip disarticulation: the foot fillet flap. Materials & Methods This study was performed on four patients at the department of Plastic & Reconstructive Surgery of the Ghent University Hospital, Belgium. Inc…

Vascular Anatomy of the Supraclavicular Area Revisited: Feasibility of the Free Supraclavicular Perforator Flap

Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap. Cordova A, Pirrello R, D'Arpa S, Jeschke J, Brenner E, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap …

Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls

Background Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls. Methods Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunt…

Free style facial artery perforator flap for one stage reconstruction of the nasal ala.

Summary The nasolabial skin is the ideal donor site for nasal ala reconstruction. The classic techniques involve a two-stage procedure to reconstruct an aesthetically pleasing nasal ala. A one-stage technique for reconstruction of the nasal ala with a free style nasolabial perforator flap is presented in this article. Patients and methods The technique has been used in eight patients between November 2004 and June 2007. In most of the cases (seven out of eight) the whole alar subunit was reconstructed. Results Besides a small distal 2mm necrosis in one flap – which healed without further treatment – all the flaps healed uneventfully with aesthetically pleasing results using the one-stage te…

Propeller Flaps in the Head and Neck

AbstractPropeller flaps have significantly expanded the reconstruction possibilities in the head and neck region. They allow for increased flap mobility and better scar concealing, and/or to perform a one-stage reconstruction with local tissue of similar color and texture, where multiple surgeries would be needed with traditional flaps or even free flaps would be required. This article describes the main propeller flaps for one-stage reconstruction in the head–neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and f…

Pharmacological thrombolysis: one more weapon for free-flap salvage.

Despite the high success rate of free-tissue transfer, thrombosis still complicates 5-30% of cases. Meticoulous technique, careful vessel selection, and pharmacological prophylaxis are not always enough to avoid thrombosis. Early diagnosis and reintervention provide the only way to salvage a thrombosed free flap, in case of either arterial or venous thrombosis. When kinking, torsion, or external compression of the pedicle are ruled out, and thrombectomy and redo of the anastomosis are unsuccessful, the last resort to save the flap is thrombolytic therapy. The authors present their experience with the salvage of two otherwise lost flaps by means of urokinase thrombolysis through direct intra…

The Thin bilateral and bipedicled DIEAP flap for axillary reconstruction in hidradenitis suppurativa

Reconstruction after resection of advanced stage hidradenitis suppurativa is currently performed with pedicled perforator flaps, that allow functional reconstruction and preservation of shoulder function. Skin availability is limited by the possibility of closing the donor site primarily. Bilateral cases need to be treated in two stages, since the operation is carried out in the lateral decubitus. In this manuscript the application of bilateral and bipedicled DIEAP flaps to bilateral and extensive cases is presented.Between October 2008 and October 2018, 39 patients were treated for axillary hidradenitis suppurativa. Of these, 11 patients had bilateral reconstruction with bilateral DIEAP fl…

The role of the vastus lateralis flap in head and neck reconstruction

The Vastus lateralis flap is a very versatile flap, easy to harvest and with a long pedicle. It can be harvested as a muscle, musculo-cutaneous or chimeric flap. It is particularly suit-able for head and neck reconstruction, as it allows for a two-team approach and can be tailored to the complex three-dimensional structure of this district. In this paper, we discuss our experience and a review of the literature on the use of the free Vastus lateralis flap in the head and neck region, analyzing its indications, advan-tages and limitations. We also provide technical tips to minimize donor site morbidity.

An Update on the Surgical Treatment for Transgender Patients.

Abstract Introduction As gender dysphoria is becoming increasingly accepted in the general population, the number of patients seeking gender reassignment surgery is increasing. Although not every patient with gender dysphoria requires surgery, medical practitioners taking care of these individuals should be aware of the different surgical options. Aim To review current gender reassignment surgical techniques and update the clinician. Methods A review of the literature was performed focusing on the most recent techniques of gender reassignment surgery. Main Outcome Measures Main outcomes included a historical review of gender confirmation surgery leading to the techniques of choice in differ…

Re: Technique of internal mammary dissection using pectoralis major flap to prevent contour deformities

One-stage reconstruction of the nasal ala: the free-style nasolabial perforator flap.

no abstract

Posterior compartment of the lower leg reconstruction with free functional rectus femoris transfer after sarcoma resection.

A 72-year-old man with the third recurrence of a low-grade liposarcoma of the right lower leg came to our attention seeking limb-salvage surgery. The tumour was removed en bloc with all the superficial posterior compartment of the leg. Appropriate foot flexion was restored by means of a free-functional rectus femoris musculocutaneous flap harvested from the ipsilateral thigh. The patient was kept on a postoperative splint for 6 weeks. Three months after the operation, clinical and elecromyographic signs of reinnervation were observed. The patient was able to walk, run and climb stairs and no donor-site morbidity was observed. Thigh extension was rated M4, comparable to the contralateral thi…

Complex reconstructive surgery following removal of extra-intracranial meningiomas, including the use of autologous fibrin glue and a pedicled muscle flap

Abstract Background Skull reconstructive surgery is critical to prevent cerebrospinal fluid (CSF) fistulas and infections, and to ensure good aesthetic results in meningiomas surgery. Methods A 65-year-old woman was surgically treated for a bilateral parasagittal meningioma with complete superior sagittal sinus (SSS) involvement, and an intra-extracranial extension, determining a significant cranial defect at the vertex. A Simpson I resection was achieved. Postoperatively a considerable and not conservatively repairable CSF leak was detected. Surgical revision of the wound with repair of the fistula and complex reconstructive operation was performed including a combination of techniques and…

A New Technique for Coronaplasty in Penile Reconstruction.

Abstract Background The coronaplasty is an important step of the phalloplasty procedure as it creates a prominent coronal ridge and a constricted coronal sulcus, resulting in the transformation of a regular skin flap into a flap resembling a circumcised penis. Aim The aim of this article is to describe our new coronaplasty technique that exploits opposing contracting forces of 2 different skin grafts to hold the shape of a thick, distally based skin flap, resulting in a natural looking neo-phallus. Methods A distally based flap is raised at the junction of the middle and distal thirds of the neo-phallus. The dissection continues until adequate mobilization is obtained, so the flap can stand…

Management of large dorsal diffuse plexiform neurofibroma

Abstract Neurofibromas are considered one of the hallmark signs of neurofibromatosis type 1(NF1). Diffuse plexiform neurofibroma is a congenital NF1-associated tumor, characterized by overgrowth and interference with function of the affected area. The rich vascular plexus associated with neurofibromas, together with their infiltrative pattern, makes them difficult to eradicate. Complications of neurofibromas are rare but include malignant transformation and potentially lifethreatening hemorrhages. The use of the term “giant” to define a neurofibroma is controversial because there is no clear consensus and descriptions are limited to few case reports. We report a case of a large dorsal diffu…

Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip.

Background. Large full-thickness defects of the lower lip need free tissue transfer. The free forearm flap is the more widespread technique for free flap lower lip reconstruction, but it results in a static lip. The authors describe a technique of morphodynamic sensate reconstruction of the lower lip with a free gracilis flap and a musculomucosal flap. Methods. Three patients underwent reconstruction with an innervated free muscular gracilis flap, an innervated musculo-mucosal flap for the vermillion (2 cases), and a full-thickness skin graft. Results. No significant complications were observed. Static function and vermillion sensitivity were immediately restored. The skin color match was e…

Gender Confirmation Surgery: Guiding Principles

Abstract Background At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. Aim To propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery. Methods We use expert opinion to provide a “first of its kind” framework for training surgeons to care for transgender and gender nonconforming individuals. Outcomes We describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters. Results This article represents the first step in the development of a structure…

Donor site morbidity of the posterior conchal region.

BACKGROUND The perichondral cutaneous graft (PCCG) from the posterior conchal region is an elegant solution for the coverage of facial defects with particular stability requirements. The donor defect can easily be covered with a transposition flap from the postauricular region. Although this region is a common donor site for skin grafts and has an important supporting function for glasses or hearing aids, little is known about long-term morbidity after graft harvest. OBJECTIVE To assess the morbidity of the posterior concha and the postauricular region in terms of pain, scar formation, and patient satisfaction. MATERIALS AND METHODS A retrospective study of 16 patients who had a PCCG harves…

Nonsurgical treatment of earlobe aging in Mowlavi stages I and II earlobe ptosis with Hyaluronic acid fillers.

Background: Earlobe deflation caused by fat atrophy is normally treated with lipofilling, mostly in the context of facelift surgery. In this report, we aim at reporting on Hyaluronic Acid injections to treat earlobe deflation. Materials and Methods: 16 Mowlavi Grade I and II patients were treated with HA injections, followed by molding to shape the lobule. Results: Effective correction, lasting 14 months on average, is achieved. Five patients needed a touch-up procedure after 4-6 months to improve the result. Conclusions: Earlobe augmentation with HA is an ideal option for correction of earlobe atrophy in cases of Mowlavi Grades I and II ptosis. Long-lasting (about 14 months) correction is …

Cheek Volumization and the Nasolabial Fold.

Sir: We have read the article by Mowlds and Lambros1 with great interest and enthusiasm. The findings of their study show that the nasolabial fold does not improve after cheek injection. By analyzing three-dimensional images of the face before and immediately after cheek injection of high- G′ hyaluronic acid, they demonstrate that the perceived nasolabial fold improvement, reported after cheek injections,2,3 is attributable to overall improvement in facial appearance rather than to actual nasolabial fold improvement. As a consequence, it might be ruled out that the nasolabial fold is a consequence of cheek deflating and it is likely attributable predominantly to change in the corner of the …

Porcine Model for Internal Mammary Vessels Harvesting

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examina…

Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty: A 93-Case Experience

BACKGROUND: Urethral reconstruction in anterolateral thigh flap phalloplasty cannot always be accomplished with one flap, and the ideal technique has not been established yet. In this article, the authors' experience with urethral reconstruction in 93 anterolateral thigh flap phalloplasties is reported. METHODS: Ninety-three anterolateral thigh phalloplasties performed over 13 years at a single center were retrospectively reviewed to evaluate outcomes of the different urethral reconstruction techniques used: anterolateral thigh alone without urethral reconstruction (n = 7), tube-in-tube anterolateral thigh flap (n = 5), prelaminated anterolateral thigh flap with a skin graft (n = 8), antero…

Perioperative antibiotic prophylaxis in plastic surgery: A prospective study of 1100 adult patients.

Summary Background Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate. Methods Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive or cosmetic procedures were enrolled. Procedures were classified into four groups, and prophylactic antibiotics were only administered perioperatively in 23.4%…

Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report.

Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report. Pirrello R, Siragusa S, Giambona C, D'Arpa S, Cordova A, Moschella F. Source Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica e Ricostruttiva, Università di Palermo, Palermo, Italy. Abstract The association between factor VII deficiency and cleft palate has never been described. The case of a child with cleft palate and factor VII deficiency who successfully underwent palatoplasty is described in this article. To allow surgical treatment, through maintenance of a normal prothrombin time, the patient was given 15 microg/kg of recombinant factor VIIa every 12 hours, …

A new mucosal propeller flap (Deep Lingual Artery Axial Propeller): The renaissance of lingual flaps

BACKGROUND: Lingual flaps provide ideal mucosal coverage for intraoral defects but traditionally require two surgical stages. The authors present an axial mucosal propeller flap for single-stage intraoral reconstruction. The flap includes the mucosa of the lateral side of the tongue, islanded on the deep lingual vessels. METHODS: Between 2011 and 2013, 23 patients underwent intraoral mucosal reconstruction with a deep lingual artery axial propeller flap after cancer resection in the cheek (n = 16), floor of the mouth (n = 2), retromolar trigone (n = 2), hard palate (n = 2), and soft palate (n = 1). Mean defect size was 19.5 cm. Preoperative and postoperative intraoral function was evaluated…

The face lift SMAS plication flap for reconstruction of large temporofrontal defects: reconstructive surgery meets cosmetic surgery.

Background: Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap. Methods: Once the defect is outlined, a face-lift–like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen f…

Our Definition of Propeller Flaps and Their Classification

AbstractThe term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the “Tokyo consensus,” we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an “island flap that reaches the …

STATIC TREATMENT OF PARALYTIC LAGOPHTALMOS WITH AUTOGENOUS TISSUES

Static treatment of paralytic lagophthalmos with autogenous tissues. Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Universitá di Palermo, Via del Vespro, 129, 90138 Palermo, Italy. Abstract BACKGROUND: Long-standing facial paralysis is frequently seen in patients who have undergone surgical procedures with sacrifice of the facial nerve and have never been counseled about limiting its consequences. Lagophthalmos must always be treated in these patients to protect vision. The authors describe their techniques of static treatment for lagophthalmos using autologous tissues and their classification…

THE ROLE OF GAMMA-DELTA (γδ) T LYMPHOCYTES IN MELANOMA: BASIC SCIENCE FINDINGS AND CLINICAL CORRELATIONS

INTRODUCTION: Advanced melanoma is associated with a poor prognosis. Numerous clinical trials have focused on the potential of tumor-infiltrating lymphocytes (TILs) for immunotherapy in stage III and IV melanoma, but its treatment remains challenging. Gamma-delta (γδ) T cells are the most represented subpopulation of TILs and have shown therapeutic potentials in many solid tumors, although their role against melanoma has not been fully investigated. MATERIALS AND METHODS: Seventy-four patients with cutaneous melanoma underwent peritumoral skin biopsies and blood sample collection. TILs and circulating lymphocytes phenotype and effector functions were analzyed using immunohistochemistry and …

Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels: Technique, Safety, and Outcomes after 250 Flaps.

BACKGROUND: The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. In bilateral cases, both flaps are often anastomosed to the internal mammary vessels on either side of the sternum. The authors propose a method in which both flaps are anastomosed to only the right side internal mammary artery and vein. METHODS: Between November of 2009 and March of 2018, 125 patients underwent bilateral DIEP flap breast reconstruction with this technique. One flap is perfused by the anterograde proximal internal mammary artery and the second one by the retrograde distal internal mammary artery after presternal tunneling. Patient demog…

Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients.

Summary Background Extensive soft tissue deficiencies involving the limbs can be difficult to reconstruct and may require more than one microsurgical flap transfer to cover the defect. This can be particularly challenging in male patients, where the sacrifice of a donor muscle could result in considerable comorbidity. This paper describes the use of the bipedicled deep inferior epigastric artery perforator (DIEAP) flap to perform a one-stage reconstruction of extensive soft tissue defects in male patients. Methods By using preoperative multidetector computed tomographic (MDCT) angiography, the dominant perforators of the abdominal wall were identified and the bipedicled DIEAP flap was used …

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THe role of autologous nerve fragments implantation in enhancing peripheral nerve regeneration

ntroduction: The aim of this study was to assess the effect of seeding a nerve suture with autologous nerve fragments. Our hypothesis is that the fragments could improve axonal regeneration. Back to Top | Article Outline Material and Methods: On 20 Sprague-Dawley rats a 15mm sciatic nerve defect was created and grafted. In the study group (n=10) a 1mm nerve segment was minced and seeded around the distal suture. In the control group (n=10) no fragments were seeded. Rats were sacrificed at 4 (n= 10) and 12 weeks (n= 10) and number of regenerated fibers, fiber area and density, Soleus and Gastrocnemius muscles mass indexes, and walking track analysis in the 12 weeks group were evaluated. The …

Perforator mapping in the trunk: a guide for freestyle flap surgery and an introduction to the sustainable anatomical study

Introduction: Freestyle Perforator flaps minimize flap harvest morbidity and can be harvested anywhere in the body if perforators anatomy is well known. A study of trunk perforator vessels has been performed on recycled CT scans avoiding cadaver investigations or unnecessary radiation exposure. Materials and Methods: 200 CT scans, performed for the study of liver or pancreatic disease, were examined. No unnecessary radiation was administered. Previous abdominal surgery was reason of exclusion. The trunk between the xyphoid process and Downloaded by: Biomedische Bibliotheek 193.191.170.2 - 10/8/2014 8:35:28 AM Abstracts Eur Surg Res 2012;49:130–216 215 the umbilicus was studied. On axial sca…

Porcine Model for Gluteal Artery Perforator Flap: Anatomy and Technique

Although flap anatomy is well studied on cadavers and microsurgical techniques are well practiced on rats, still there are few training models for learning the techniques of perforator flap harvesting. The cadaver has no bloodstream, so accuracy of dissection cannot be evaluated and flap viability cannot be verified. Training on humans carries a high risk of flap damage. A living model for perforator flap harvest is needed to learn the technique before starting with its clinical application.

Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis

Summary: Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subse…

Seeding nerve sutures with minced nerve-graft (MINE-G): a simple method to improve nerve regeneration in rats

Background: The aim of this study was to assess the effect of seeding the distal nerve suture with nerve fragments in rats. Methods: On 20 rats, a 15 mm sciatic nerve defect was reconstructed with a nerve autograft. In the Study Group (10 rats), a minced 1 mm nerve segment was seeded around the nerve suture. In the Control Group (10 rats), a nerve graft alone was used. At 4 and 12 weeks, a walking track analysis with open field test (WTA), hystomorphometry (number of myelinated fibers (n), fiber density (FD) and fiber area (FA) and soleus and gastrocnemius muscle weight ratios (MWR) were evaluated. The Student t-test was used for statistical analysis. Results: At 4 and 12 weeks the Study Gr…

Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series.

Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series. Cordova A, Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: On the basis of a previously published anatomic study on the superior auricular artery (SAA) and on a series of 52 consecutive cases, the authors propose a new superior pedicle retroauricular island flap (SP-RIF) for defects of the upper half of the ear and for temporal region or superficial helical defects. ME…

Neurophysiological and ultrasonographic exams in nerve patologies: diagnostic work-up and monitoring.

Introduzione: le patologie dei nervi sono causa di disabilità nella popolazione giovane adulta affetta e motivo di contenzioso medico-legale per molti chirurghi. Obiettivi: valutare la rilevanza dell’ecografia del nervo e dell’esame neurofisiologico nella valutazione prechirurgica e nel follow-up post-chirurgico ai fini diagnostici, prognostici e di adeguata programmazione terapeutica. Materiali e Metodi: pazienti con patologia da intrappolamento o post-traumatica sono stati sottoposti a valutazione clinica, neurofisiologica ed ecografica. Risultati: abbiamo studiato 50 neuropatie (25M, 25F): 23 nervi mediani, 1 interosseo anteriore, 14 nervi ulnari, 3 plessi brachiale, 2 interossei posteri…

Advancement Perforator Cheek Flap for Aesthetic One-Stage Reconstruction of Postoncological Extended Split-Thickness Defects of the Nasal Sidewall

Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. Numerous techniques are described in the literature, but a primary reconstruction with a final good result is not often possible. The authors develop an advancement cheek flap for an aesthetic one-stage reconstruction of postoncological extended nasal sidewall defects. Between January 2009 and July 2012, 16 patients (mean age, 63.3 yr) underwent excision of skin tumors of nasal sidewall and immediate rec…

Safe pedicle tunnelling in maxillary reconstruction.

The Deep Lingual Artery Axial Propeller flap in intraoral reconstructions

Editorial

The "Tokyo" consensus on propeller flaps

Background: Overthepastfewyears,theuseofpropellerflaps,whichbasetheir blood supply on subcutaneous tissue or isolated perforators, has become in- creasingly popular. Because no consensus has yet been reached on terminology and nomenclature of the propeller flap, different and confusing uses of the term can be found in the literature. Methods: Inthisarticle,theauthorsreporttheconsensusonthedefinitionand classification of propeller flaps reached by the authors that gathered at the First Tokyo Meeting on Perforator and Propeller Flaps in June of 2009. Some peculiar aspects of the surgical technique are discussed. Results: A propeller flap can be defined as an “island flap that reaches the reci…

Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty.

The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity because it avoids the well-known scars of the radial forearm flap. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Preexpansion of the ALT flap allows primary donor site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT donor site, but also the skin graft donor site scar. Preoperative perforator location by means of computed tomography angiography allows safe expander placement through 2 small remote incisions.

Further application of the bilobed flap: the split bilobed flap for reconstruction of composite posterior auricular and mastoid defects

In this article a modified bilobed flap from mastoid and lateral neck skin for reconstruction of complex defects of the posteromedial surface of the auricle and mastoid skin, with the preservation of the retroauricular sulcus, is described. Reconstruction of the postero-medial auricular surface has almost never been a concern for reconstructive surgeons. It is in fact a shaded area with little aesthetic relevance and direct closure, skin grafting and even secondary healing are used for skin cancer defects repair. Also mastoid skin defects can be repaired with simple techniques such as skin grafts or transposition flaps from the remaining mastoid skin or from the neck. On the other hand, can…

Contribution of ultrasound and clinical neurophysiology in 119 entrapment, post-traumatic/post-surgical neuropathies and tumors

ADVANCEMENT CHEEK FLAP FOR A SINGLE STAGE RECONSTRUCTION OF POST-ONCOLOGICAL NASAL SIDEWALL LARGE DEFECTS 

Objective: Reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. Numerous techniques are described in the literature but a primary reconstruction with a final good result is not often possible. The authors present an advancement cheek flap for a single-stage reconstruction of post-oncological nasal sidewall large defects. Methods: Between January 2009 and July 2012, sixteen patients with age ranged between 54 and 74 years underwent excision of skin tumors of the nasal sidewall and immediate reconstruction with an advancement cheek flap nourished by perforators from the facial branch of the superficial temporal artery. The defects size ra…

Retrospective Analysis in Lower Limb Reconstruction: Propeller Perforator Flaps versus Free Flaps.

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 an…

Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction

Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (si…

Viable tumor in postchemoradiation neck dissection specimens as an indicator of poor outcome

Management of the neck in patients treated with primary chemoradiation for cancer of the laryngopharynx with a clinically positive neck remains an area of controversy. The neck may be managed in 1 of 3 ways: by observation, by planned neck dissection, or by salvage neck dissection. Observation of the neck can be done in patients who have a complete or near-complete response to treatment and have a negative positron emission tomography (PET) scan result. Evidence for this approach comes from recent studies that have reported low regional recurrence rates.1–6 Planned neck dissection was carried out in the past in patients with N2 and N3 neck disease irrespective of the response to chemoradiat…

Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

In 2009, we have described the use of freestyle facial artery perforator flaps for one-stage nose reconstruction. Since then, several articles have reported the use of facial artery perforator flaps for nose reconstruction. The purpose of this article is to provide an update of the published technique after 10 years of experience. Since 2004, 21 patients have been treated with a freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala. The flaps were 16 propellers, 4 V-Y, and 1 island transposition. A single venous congestion leading to a minor flap tip necrosis and a wound dehiscence was observed. All other flaps healed uneventfully. The V-Y design and multiple…

Variability and reliability of the vastus lateralis muscle anatomy.

The aims of this study are to investigate the variability of the morphological and neurovascular anatomy of the vastus lateralis (VL) muscle and to describe the relationships among its intramuscular partitions and with the other muscles of the quadriceps femoris. Clinical implications in its reliability as a flap donor are also discussed.In 2012, the extra- and intramuscular neurovascular anatomy of the VL was investigated in 10 cadaveric lower limbs. In three specimens, the segmental arterial pedicles were injected with latex of different colors to point out their anastomotic connections. The morphological anatomy was investigated with regard to the mutual relationship of the three muscula…