Oropharyngeal, hypopharyngeal and cervical esophageal reconstruction: an experience of pedicle flaps

Objective: To review the experience of single-stage reconstruction following pharygolaryngectomy and cervical esophageal defect with pedicle flaps in a tertiary care centre

Study Design: Retrospective study

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from June 2007 to June 2017

Methodology: All patients who underwent oropharyngeal, hypopharyngeal and cervical esophageal reconstruction with pedicled flaps were included

Results: Thirty-two reconstructions were done, of which 16 [50.0%] were supraclavicular flaps, 12 [37.5%] were pectoralis major myocutaneous flaps [PMMF] and 4 [12.5%] platysma myocutaneous flaps [PMF]. Among these, 24 [75%] were males and 8 [25%] females. The mean hospital stay was 18.75 +5.45 days. Complications were noted in 12 [37.5%], salivary fistula being the most frequent found in 6 [18.75%]. Wound dehiscence was noted in 4 [12.5%], partial flap necrosis and wound infection present in 1 [3.1%] each

Conclusion: Oropharyngeal, hypopharyngeal and cervical esophageal reconstruction with pedicle flaps is still very useful and safe to perform, associated with minimal flap and donor site complications

Extended islanded reverse sural artery flap for staged reconstruction of foot defects proximal to toes

Objective: To assess the outcome of extended delayed reverse sural artery flap for reconstruction of foot defects proximal to toes in terms of flap survival, complication and extended area

Study Design: Case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from February 2015 to April 2017

Methodology: Cases who underwent delayed sural artery flap were inducted. Preoperative hand-held doppler was done to confirm the location of perforator. Two suitable perforators were chosen to raise the extended flap by crossing the proximal limit in all cases. The pedicle was kept minimum 3 cm wide and perfusion was assessed. Flap was delayed for one week and vaccum-assisted closure [VAC] dressing was applied over wound. The second surgery was performed after one week. Proximal perforator was clamped and ligated after checking adequate perfusion of flap. Flap was insetted into defect

Results: Thirty-two patients were reconstructed with delayed reverse sural artery flap. The mean age of the patients was 26.5 +12.2 years. Twenty-four [75%] patients were males and 8 [25%] were females. Twenty-two [68.7%] cases were degloving wounds after road traffic accidents [RTA], 6 [18.7%] were diabetic foot wounds, 4 [12.5%] sustained injury after falling from height and 7 [21.8%] patients had fracture of metatarsals. Twenty-eight flaps were transferred after one week delay, and only in 4 cases, flap were transferred after two weeks. All flaps survived completely. Complications of infection noted in 3 [9.3%] flaps, 3 [9.3%] flaps showed tip necrosis, 2 [6.2%] flaps undergone epidermolysis and only 2 [6.2%] showed venous congestion

Conclusion: Delayed islanded reverse sural artery perforator flap is a reliable and versatile option for resurfacing soft tissue defects of lower limb proximal to the toes with lesser complications and extended coverage area

Quantification and further refinements of dorsal metacarpal artery perforator flap for reconstruction of wounds of fingers up to distal interphalangeal joints

Objective: to assess the outcome of dorsal metacarpal artery perforator flap for coverage of finger defects extending up to distal interphalangeal joint [DIPJ]

Study Design: case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from March 2015 to May 2017

Methodology: our study was carried out in two parts. 1st part of study was to measure average flap length in our population. Five hundred cases were enrolled to measure flap length, from pivot point of the flap to the distal border of extensor retinaculum. This length was traced to fingers to determine its coverage area. This was followed by clinical study in 35 cases. All patients with wounds over dorsal surface of fingers up to distal interphalangeal joint and volar surface of fingers up to mid of middle phalanx, single or multiple finger defects with exposed tendon joints or bones were included in the study. Patients with history of trauma to the dorsum of hand, metacarpal head or neck fracture and patients with history of diabetes or peripheral vascular disease were excluded

Results: flap length decreased from radial to ulnar side of hand. Average length of flap based on the second metacarpal artery was 7cm while of the third was 6.6 cm and the fourth was 6.1 cm. This flap length covered up to mid of middle phalanx in border digits while up to PIPJ in central digits. This data was confirmed in 35 patients in whom 36 flaps were raised to cover finger defects. Thirty-four flaps survived completely while tip necrosis was seen in 2 cases

Conclusion: the dorsal metacarpal artery perforator flap is a thin, pliable flap, which has minimal donor-site morbidity. It can reliably cover soft tissue defects of dorsum of fingers up to mid of middle phalanx in border digits and up to PIPJ in central digits