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Perineal Hernia
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The gluteal myocutaneous rotation flap gained popularity as it does not necessarily require a plastic surgeon to raise and inset the flap, which can be bilateral if there is a large defect to fill.23 A curved skin incision based in the buttock crease ascends on the lateral side of the buttock (Figure 16.3). The dissection includes the subcutaneous tissues and divides the gluteus muscle approximately halfway from its medial border lengthways. Ideally both the inferior and superior gluteal vessels should be preserved but the flap will survive if one needs to be divided to gain adequate length. The flap is then turned in to the pelvic defect and the portion of the skin that will sit inside is de-epithelialised (Figure 16.3). Care must be taken to protect the sciatic nerve which runs under the medial edge of the muscle. If bilateral flaps are required then one is usually formed inferiorly and the other curves superiorly and they rotate in alternate directions into the defect (Figure 16.4). While there is often no need for a plastic surgeon, gluteal flaps do slow down post-operative recovery as the patient needs to remain relatively immobile for up to 2 weeks so as not to disturb the flap and it should be noted that herniation past a small volume gluteal flap can still occur (Figure 16.2).
General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Rotation flap – a semicircular flap that rotates about a pivot point through an arc of rotation into an adjacent defect. The donor site either closes directly (buttock rotation flap) or with a skin graft (e.g. scalp rotation flap). Back cuts and lengthening the leading edge are often useful.
Case 64
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
Given the size of the lesion and its position, and following the reconstructive ladder, a full-thickness skin graft would be the most appropriate first line of management if there is some soft tissue present on the bed of excision (skin graft does not survive over bare bone or cartilage). Other options include using local flaps. Options might be a forehead flap, a nasolabial flap, a bilobed flap, rhomboid flap or a dorsal nasal rotation flap.
Application of secondary intention for the restoration of the apical triangle after Mohs micrographic surgery
Published in Journal of Dermatological Treatment, 2021
Byung Ho Oh, Yeongjoo Oh, Kyoung Ae Nam, Mi Ryung Roh, Kee Yang Chung
A total of 24 Korean patients (14 women, 10 men; mean age: 67.8 years [range: 53–87 years]) underwent MMS for basal cell carcinoma in the AT area between 2008 and 2018. After MMS, the defects were immediately restored using ATF (IC group, n = 15) or SI after partial closure (SI group, n = 9). In the IC group, the AT area was preserved or reconstructed using the upper lip advancement flap (n = 10) or island pedicle flap (n = 5) with flap modification (Figures 1 and 2). In the SI group, an initial lip rotation flap was applied by drawing an incision line on the upper side of the natural nasolabial fold, which enabled reconstruction of the greater part of the defect with a spiral shape (Figures 3 and 4). The average healing time to fully granulated status with minimal discharge was 9.3 ± 5.9 days (range: 1–17 days).
Closure Of Thoracic Wall Defect Using Breast Implant Capsule Tissue As A Rotation Flap - A Case Report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Michael Josiassen, Madeline T. Kudibal, Christina Gramkow, Stig-Frederik Trojahn Kølle
The standard treatment of pneumothorax is highly dependent on the patient’s clinical condition, size of pneumothorax and underlying disease [4]. To use the highly vascularised breast implant capsule tissue for reconstructive purposes was first described in the early 1993 by Bengtson [5] and its use has since been described as appropriate as both as a flap and as a graft [3]. The indication for using the capsule tissue is mainly to address breast implant related issues, however permanent lip augmentation and a myocapsular flap for pharyngeal reconstruction has also been described [3,6,7]. Advantages of creating local flaps from capsular tissue include sparing functional tissue such as muscles and to avoid placement of non-biological material. The thin but rigid structure of the capsule can be used for addressing a number of issues related to breast implants including repositioning and coverage. When considering using the capsule for flaps or grafts it is important to consider vascularity and thickness. Both are dependent on the time from primary breast implant placement and vascularity has been found to be higher in contracted capsules than non-contracted capsules. A disadvantage of using the capsular tissue is that the persistence is unknown, as available studies have reported varying results [3]. In this case we performed a novel treatment method due to the unique perioperative problem but also due to the patient’s strong desire for re-implantation. The anterior capsule rotation flap proved tight, re-implantation was successful and the patient suffered no postoperative complications. We thus report a potential solution to closing a pleural defect with an anterior capsule rotation flap; however, similar examples are yet to be described.
Occurrence of major complications after cochlear implant surgery in Ireland
Published in Cochlear Implants International, 2018
Hannes Petersen, Peter Walshe, Fergal Glynn, Rosemary McMahon, Conall Fitzgerald, Jyoti Thapa, Cristina Simoes-Franklin, Laura Viani
Ikeya et al. (2013) reported flap-related problems such as infection and/or necrosis in three patients (0.7%, n = 406), with two patients requiring re-implantation and in one patient, a scalp rotation flap to cover the implant package. Loundon et al. found cutaneous issues that required surgery in 3.5% and Cullen et al. in 2.1% (Cullen et al., 2008; Loundon et al., 2010). Mean time to cutaneous complication after initial CI surgery was 28 months (range: 1.5 months–7 years) (Loundon et al., 2010).