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

Distally based medial hemisoleus flap: reliable option for distal tibial wounds

Objective: To determine the success [flap survival as a whole without necrosis or dehiscence up to two months as judged clinically] of distally based medial hemisoleus muscle flap for the coverage of distal tibial defects

Study Design: Case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, AIMC, Lahore, from July 2014 to July 2017

Methodology: Patients with middle and distal third tibial defects were enrolled and stratified according to the site of the wound in middle or distal third of tibia. Soft tissue coverage was provided with distally based medial hemisoleus muscle flap on which split thickness skin graft was applied. Postoperatively, patients were followed-up after one week of discharge and then fortnightly for at least 2 months. Outcome variable was taken as flap success

Results: Out of 37 cases, flap was successful in 33 patients as complete flap survived with primary wound healing. Partial flap necrosis without dehiscence was seen in 3 cases and partial necrosis of flap with dehiscence in only one case that required another surgery for the defect. Complete flap loss was not seen in any case

Conclusion: Distally based medial hemisoleus muscle flap is reliable coverage option for middle and distal third of tibial defects