ABSTRACT
Objective To explore the anatomical basis for clinical application of the compound flap pedicled with arterial arch of palpebral margin by observing eyelid blood supply and anatomical structure and to prove that it is an ideal method of repairing the eyelid defect for clinical application. Methods 15 adult cadavers (30 eyelids) were dissected. The origin, course, branches, diameters and vessel networks of palpebral margin arterial arch were observed particularly. 30 cases of eyelid marginal defect were reviewed and the therapeutic effect of this method evaluated. Results Eyelid was constituted by 5 layers: skin, subcutaneous tissue, muscle, tarsal plate and conjunctival layers. Most eyelid vessels were mutually anastomosed to form a constant vessel network. Palpebral margin arterial arch and peripheral arterial arch were formed by dorsal nasal artery branches and lacrimal artery branches, both of which nourished the eyelid tissue. All the compound flaps of 30 cases survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. Conclusions The arterial arch of palpebral margin is constant and the blood supply of the compound flap is reliable. It can repair full eyelid defect with the same kind of tissue, and obtain satisfactory appearance. It is an ideal method of repairing the eyelid defect.
ABSTRACT
Objective To investigate the method of repairing moderate or severe full defect of eyelid. Methods According to eyelid structure and the defect size, the two composite eyelid flaps were designed beside defect based on the arterial arch of the palpebral margins. If the defective area was too large, the lateral composite flap may be extended to lower or upper eyelid at the outer canthus, then the two flaps were propelled to the defective region to repair it. Results Eleven patients had been cured with this method since 1998. The largest length of eyelid defect was 1.7cm, and the smallest was 0.8cm. All defects exceeded 1/3 length of the upper or lower eyelid. All composite flaps survived completely without any complication. The appearance of the repaired eyelid was satisfactory. Conclusion Using the composite flap to repair the full moderate or severe full defect of eyelid is a new and effective method. It can not only provide enough tissues to repair large full defect of the upper or lower eyelid and to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities, and the blood supply of the composite flap is reliable. The method is worth employing routinely.
ABSTRACT
<p><b>OBJECTIVE</b>To introduce a method of repairing facial tissue defects caused by various factors.</p><p><b>METHODS</b>The reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.</p><p><b>RESULTS</b>This fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.</p><p><b>CONCLUSION</b>This fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Face , General Surgery , Surgical FlapsABSTRACT
Objective To introduce the anatomic basis and evaluat ion of clinical application of the pudendal-thigh island flaps us ing for vaginal reconstruction. Methods The blood supply and innervation to the skin and fascia of the pudendal-thigh region were studied in 5 female cadavers (with 10 sides). 20 patients who underwent vaginal reconstruction with pudendal-thigh island flaps were followed-up, and all the women were married for more than 3 years. Results There were multiple blood supply in the pudendal-thigh area. The cuta neous arterial vessels come from the posterior labial artery, the external pudendal artery and the anterior cutaneous branches of obturator artery. The posterior labial artery was one of the internal pudendal artery branches, a nd the diameter of it was 0.9～1.7 mm (1.3mm in average) in its original site, w hich was 22～35 mm (26mm in average) from the perineal midline. It gave off 4 ～7 branches to the major labia and the pudendal-thigh area while running alon g the lateral site of the major labia accompanying vein and nerve. 20 patients w ho were followed-up satisfied with their perineal appearance and with 10. 2 cm depth of neovagina in average. Twenty neovagina remained supple, and sexually active without difficulty. Conclusions The pedicle of the pudendal-thigh island flaps using for vaginal reconstruction is the post erior labial neurovascular bundle. The flap has reliable blood supply, survive s easily, transfers with partial sensation and few complications. This tech nique introduces a modified approch of vaginal reconstruction using bilateral pudendal- thigh island flaps with satisfactory cosmetic and functional resu lts.
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Objective To introduce the clinical application of the expanded scalp flap in the repair of baldness. Methods Based on area and shape of the baldness, two or three expanders were buried under the normal scalp galea around baldness. The scalp was expanded by intermittence injecting 0.9 % sodium chloride solution into expanders for 3 7 weeks, and then the expanded scalp flaps were used for repair of the baldness. Results Thirty expanders were used in twenty cases of patients with baldness, and all cases were satisfactory except two cases, in which the expanders exposed. Conclusion The treatment on baldness with expanded scalp flap is reliable. The donor site does not need graft skin. The scalp expansion may be the first choice in the repair of baldness.
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Objective To introduce a method of repairing the secondary vermilion defect caused by bilateral cleft lip. Methods The two side vermilion flaps beside the defect were cut along the vermilion boundary, and the lip artery was involved in the flaps. The flap may be extended to lower lip if the defect was much large. Then the two flaps were propelled to repair the defective region. Results This method was used in 15 cases, in which the biggest width of the defect was 1.2 cm, and the smallest was 1.0 cm, with all the flaps survived. The postoperative appearance of the upper lip was satisfactory. Conclusion The lip artery is constant, so the blood supply of the flap is reliable and anatomizing the flap is easy. This is a new method and can be widely used in repairing vermilion defects.
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Objective To report the anatomy and clinical application of the marginal mandibular flap pedicled with facial artery in nose reconstruction. Methods Based on the anatomical study of facial artery, the reversed marginal mandibular island flap pedicled with facial artery was designed, and the nasal reconstruction with the flap was operated in 20 cases. Results In 20 cases, the maximal size of flap was 7.0 cm?6.5 cm, and the minimal size was 6.0 cm?4.5 cm, and except the distal part necrosis in one flap, and wound dehiscence in nasal collumella in another flap, all other flaps survived. Followed up for 3 months to 2 years, all reconstructed noses showed satisfactory shapes. Conclusion The method is a new design technique for nose reconstruction with ideal nose appearance, and worth to be recommended.