Reconstruction
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
Flaps elevation and methods of transfer:Peninsular flap: vascular and cutaneous connections are left intact.Advancement flaps − the graft is moved parallel to the pedicle.Rotational flaps − the graft is moved at a right angle to the long axis of pedicle.Island flap: skin is divided, but the vascular connections are maintained.Free flap: tissue + vessels are detached from the donor site and anastomosed to the vessels at the recipient site.
Grafts and Local Flaps in Head and Neck Cancer
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The reconstructive ladder is an important concept in reconstructive surgery. It begins with the simplest option first, which is to allow the wound to heal by secondary intention. As one advances up the rungs of the ladder, more complex reconstructive techniques are encountered, up to the highest rung, which is microvascular free-tissue transfer. When analyzing a defect to be reconstructed, the reconstructive surgeon would start at the bottom rung and work his way up, deciding which reconstructive method should be undertaken. There are some instances, however, where the ‘reconstructive elevator’ should be taken instead and some of the rungs in the reconstructive ladder can and should be skipped. An example of this would be in the reconstruction of a significant defect in the neck following primary tumour excision with exposure of the great vessels. In this case, although a skin graft could theoretically be used and probably would ‘take’, the risk of exposed vessels would warrant the use of a pedicled or free flap for reconstruction. An example is shown in Figure 91.1.
Management of Lower Extremity Burn Injuries
Armstrong Milton B. in Lower extremity Trauma, 2006
Several thin cutaneous, myocutaneous, and fasciocutaneous regional flaps have since been introduced in the soft-tissue reconstruction around the foot. These include the extensor digitorum brevis myocutaneous flap, and the medial and lateral plantar fasciocutaneous flaps. But these flaps are of limited use in burn reconstruction where the injury may affect large and adjacent cutaneous areas (3,59–70). Consequently, the microsurgical transfer of distant tissues has become the gold standard in burn reconstruction around the foot when tendons or other deep structures are exposed. Free flaps have several advantages, including flexibility of design, shortened hospitalization, and decreased need for postoperative immobilization and physical therapy (2,3,6,71–73). The transfer of free muscle flaps resurfaced with split-thickness skin grafts has been acclaimed as most successful in reconstructing the sole of the foot and the heel (1–3,73). Kucan et al. (2,3) described the outcome as much more resistant over time to the shearing forces produced by walking. The free muscle flaps may look bulky initially, but they shrink over time due to the effect of denervation. This should obviate any need for early debulking (3). The latissimus dorsi muscle and myocutaneous free flaps seem to be the workhorse in lower extremity burn reconstruction (45,74–77). However, due to considerations for preservation of contour, the thinner fasciocutaneous and fascial free flaps have been widely used to resurface the dorsum of the foot. The commonly used flaps for this purpose include the radial forearm free flap, the medial and lateral arm flaps, the temporalis fascial flap, and even the omentum (3,52–56).
The Effect of Adipose Derived Stromal Vascular Fraction on Flap Viability in Experimental Diabetes Mellitus and Chronic Renal Disease
Published in Journal of Investigative Surgery, 2022
Burak Özkan, Atilla Adnan Eyüboğlu, Aysen Terzi, Eda Özturan Özer, Burak Ergün Tatar, Cagri A. Uysal
Diabetes mellitus (DM) is still considered one of the leading causes of foot ulcers in the world. Almost one quarter of diabetic patients develop foot ulcers during their life time [1]. The concurrence of diabetes mellitus and chronic renal diseases (CRD) increases the risk of development of diabetic foot compared to diabetic patients with normal renal function. The risk of lower limb amputation in patients with renal failure is 10 times greater than that of diabetic patients without uremia [2]. Reconstruction of chronic wounds in patients with diabetic nephropathy has been a challenge for surgeons due to impaired wound healing capacity and the complexity of the wound itself. Treatment modalities include skin graft, local skin flaps, local or distant muscle or skin flaps. Skin flap surgery is indicated to cover exposed bones or tendons, or to cover deep tissue defects on weight bearing areas under the foot where skin grafts might be thin to withstand the applied pressure by the weight. Success rates in flap surgery are low compared to normal population [3]. Several studies have discussed different strategies to enhance skin flap circulation in diabetic individuals, such as atorvastatin, all-trans retinoic acid and adipose derived stem cells (ADSCs) [4–6].
Therapeutic Effects against Tissue Necrosis of Remote Ischemic Preconditioning Combined with Human Adipose-Derived Stem Cells in Random-Pattern Skin Flap Rat Models
Published in Journal of Investigative Surgery, 2021
Chang Sik Pak, Soo Young Moon, Young Eun Lee, Hyo Jin Kang
We analyzed color changes in skin flaps on PODs 7 and 14. Previous studies reported significant effects, in terms of stem cells and biomaterial, using rIPC in skin flap models on POD 7 [28, 29]. However, in this study, there were no significant effects on POD 7 after either rIPC or hADSCs treatment; although a statistically significant effect was observed on POD 14 after rIPC combined with hADSCs. Analysis of the gross anatomy of skin flap tissue in the control group revealed that the skin flap sites had not healed, and scabbing of flap sites was seen. However, in the rIPC + hADSCs group, most of the skin flap sites had healed; any scabs present had separated from the flap sites. In addition, PKH26-labeled hADSCs were observed in the skin flap subcutaneous tissue, indicating migration to the skin flap site from the injection site. In our study, hADSCs were transplanted into the normal tissue at the skin flap boundary to supply it with sufficient nutrients and oxygen from unharmed tissues. The advantages of MSCs, including hADSCs, have been reported widely. For example, Ballestín et al. reported that hADSCs possess regenerative and immunosuppressant properties. Moreover, they involve minimally invasive procedures with simple isolation and culturing techniques [30]. hADSCs treatment significantly increased flap survival and improved neovascularization under an ischemia–reperfusion condition [5, 31]. The histopathologic results of the present study showed that the epithelial tissue had mostly regenerated, while epidermal appendages, such as sweat glands and hair follicles, were observed in the hADSCs groups.
Porcine dermal matrix sandwich graft for lower eyelid reconstruction
Published in Orbit, 2021
Philip L. Custer, Robi N. Maamari
During the 5-year study period, 13 procedures were performed on 12 patients following Mohs surgery. One patient underwent repair of bilateral lower eyelid defects in two separate operations. Average age of the seven male and five female patients was 65.4 years (range: 42.3–90.5 years). The width of the marginal eyelid defect ranged from 6 to 16 mm (mean: 11.7 mm), while the width of the dermal matrix graft varied from 5 to 9 mm (mean: 7.7 mm). The vertical height of the grafts ranged from 4 to 7 mm (mean: 5.2 mm). In the seven cases with a small amount of remaining tarsus at the top of the conjunctival flap, the graft was positioned just inferior to the tarsal edge. The graft was covered anteriorly with a rhomboid transposition skin flap in 12 procedures. An advancement skin flap was used in one individual.
Related Knowledge Centers
- Autotransplantation
- Lymph Node
- Mastectomy
- Microsurgery
- Necrosis
- Rotation Flap
- Tissue
- Skin Grafting
- Plastic Surgery
- Flap