Orthoplastic approach in lower leg and foot reconstruction / 中华显微外科杂志

The reconstruction of lower leg and foot is very challenging due to their anatomical characteristics. In the last half century, we assisted to a dramatical change in thinking and approaching the lower leg and foot complex tissue defects. This became possible due to the new knowledge in vascular anatomy and advances in microsurgical techniques and instrumentation. The main way to well treat this kind of lesions is to ensure a multidisciplinary approach by collaboration between the specialists involved in approaching them. That’s why, in the later part of the last millennium, a new specialty appeared: Orthoplastic Surgery. Orthoplastic extremity reconstructive surgery may be addressed to the treatment of traumatic, oncologic, and septic conditions. This paper will discuss the timing of tissue transfer and the armamentarium of tissue reconstructive techniques for surgery of the lower leg and foot, from traditional flaps to the modern perforator flaps.

Colgajos Locales en Reconstrucción Facial. Alternativas de Tratamiento

RESUMEN: Los defectos faciales de piel son frecuentemente secuelas producto de carcinomas basoceulares, carcinomas espinocelulares, melanomas, grandes tumores benignos o traumatismos de tejidos blandos. Las unidades y subunidades estéticas de la cara, la textura y color de la piel, junto a otros parámetros deben ser considerados durante la planificación de la reconstrucción mediante colgajos locales. El objetivo de este artículo de revisión bibliográfica fue describir y definir las técnicas más relevantes en los de colgajos locales aplicados en la reconstrucción facial y sus algoritmos actuales, en relación con la unidad o subunidad facial involucrada; sus consideraciones estéticas y cirugía complementaria. Las unidades y subunidades estéticas de la cara se dividen en regiones de la frente, párpados, mejillas, nariz, labios y mentón. Los colgajos de rotación, en isla, de avance y transposición son la base para la mayoría de los colgajos faciales; los más conocidos según la zona donante son: el colgajo frontal, colgajo de rotación y avance de mejilla; colgajo cérvico-facial, y colgajos nasolabiales, entre otros. La elección del colgajo depende de la zona y la unidad estética facial involucrada, siendo importante elegir y usar las líneas, los surcos y márgenes de estas unidades cuando sea posible con el fin de mejorar los resultados estéticos y reducir la posibilidad de secuelas. La cirugía complementaria y los procedimientos estéticos pueden lograr un buen camuflaje de algunas complicaciones estéticas o secuelas.

ABSTRACT: Skin face defects are frequently sequels of basal cell carcinomas, squamous cell carcinomas, melanomas, and large benign tumors or soft tissue trauma. Aesthetics units and subunits of the face, texture, color, and other parameters must be considered in the local flaps reconstructive planning. This review article aims to describe and define the most relevant techniques of facial local flaps in facial reconstruction and their current algorithms, regarding the unit or subunit, involve, their aesthetics considerations and complementary surgery. The aesthetics units and subunits of the face are divided into forehead, eyelids, cheek, nasal, lips, and chin. There are several well-known concepts and flaps used in these proceedings as rotation, island, advancement, and transposition flaps, and they are the basis for facial local flaps; The most relevant are: forehead flap, cheek advancement, and rotate flap; rhomboid, cervicofacial and bilobed flap, nasolabial flaps. The flap election depends on the zone and unit involve; it is important to choose the lines, sulcus, and borders of these units when is possible to enhance these aesthetics outcomes. These concerning improve the aesthetics outcomes and reduce the aesthetics sequels. Complementary surgery and aesthetics proceedings may accomplish a good camouflage of some aesthetics complications or sequels.

Pelvic limb reconstruction failed by propeller flap resolved with microsurgery

Reconstruction of lower limb defects is a constant challenge for surgeons, the etiology of the defect can be very variable from diabetic ulcers, traffic accidents, fall from height, oncological resections and many others. Free flaps have always been an important option because it has great results in complex reconstructions in lower limbs, it is a microvascular technique, so it has a higher level of complexity. This technique is usually reserved for extensive perilesional wide defects. On the other hand, the propeller flap, which is considered less invasive and easier as it does not involve microvascular surgery. An 18-year-old patient who had a fracture of the right tibial pylon due to a 7-meter drop, who after orthopedic treatment had a defect with exposure of ostesynthesis material of 3 cm in circumference in the medial malleolus. This defect was first managed with a propeller flap complicated with necrosis at 48 hours which was treated with sub atmospheric pressure system for 5 days and later with an ultra-thin anterolateral flap of the pelvic limb. Complete pedicled propeller flap failure is very rare but, because necrosis develops distally, even partial necrosis can expose bone, tendons, or other tissue. Some surgeons consider that propeller flap placement is risky in this location, especially the distal third of the lower leg a prefer to use free flaps. Whenever any pelvic member reconstruction plan fails in the distal third, the best and safest is the use of microsurgery even with the failure of a previous micro vascular flap.

Evolving a System of Classification for Scalp Defects and Methods of Reconstruction

Background: Scalp wound closure requires good understanding of scalp anatomy, knowledge of a algorithm for reconstruction ofscalp defects, good planning, adequate debridement, proper execution and proper post-operative care. Aim and objective: Theaim of the study was to use a simple algorithm to reconstruct scalp defects of various sizes and to study the efficacy of thealgorithm in reconstruction of scalp defects. Materials and Methods: All patients with scalp defect who presented to theDepartment of Burns Plastic and Reconstructive surgery at Kilpauk government medical college were studied. Reconstructionof scalp defect was planned based on the algorithm. All patients were followed up for a period of 1 year post operatively.Results: The scalp defects were reconstructed based on the algorithm. Smaller defects were managed with primary closureand SSG. Larger size defects and defects without periosteum were given local or distant flap. All patients recovered well withlesser rate of complications. Conclusion: Reconstruction of scalp defect is made easy with the use of the algorithm for choiceof treatment based on the defect size.

Clinical treatment of nostril stenosis deformities secondary to bilateral cleft lip nasal correction / 中华医学美学美容杂志

Objective This article reported a patient with severe bilateral nostril stenosis secondary to bilateral cleft lip nasal deformity correction surgery.Methods The surgical procedure included columellar flap and local soft tissue flap was transferred to nasal inside,columellar was narrowed,reconstruction of nasal dome,increased nostrils height and nasal vestibular mucosa area.Results Effective improvement of nasal profile and reduction of ventilation features obstacles was observed.Nasal retainer was used for half a year postoperatively.After two years' follow-up,it showed good results.Conclusions This article is to introduce the therapeutic process and detailed literature review of clinical study of nostril stenosis abnormalities.

Application of local flaps in repair of defects after resection of nasal skin tumors / 中华皮肤科杂志

Objective To evaluate the effect of local flaps on repair of defects after surgical removal of nasal skin tumors.Methods A total of 65 patients with nasal skin tumors were enrolled from Department of Dermatology,People's Hospital of Xinjiang Uygur Autonomous Region between March 2015 and August 2016,and subjected to surgical removal of the nasal skin tumors.According to the location,size,shape and surrounding skin of the nasal defects,nasolabial fold flaps,modified rhomboid flaps,bilobed flaps or frontal nasal flaps were chosen to repair skin and soft tissue defects.Results Of the 65 patients with nasal skin tumors,38 had basal cell carcinoma,20 pigmented nevus,5 keratoacanthoma,and 2 had squamous cell carcinoma.The lengths of the defects after resection were all below 2.5 cm.Nasolabial fold flaps were used in 32 cases,modified rhomboid flaps in 16,bilobed flaps in 12,and frontal nasal flaps in 5.All the flaps survived after the surgery,and no obvious deformation of the nose was observed.No recurrence was observed during 1 year of follow-up.Conclusion For skin defects with the length ≤ 2.5 cm after resection of nasal skin tumors,nasolabial fold flaps,modified rhomboid flaps,bilobed flaps and frontal nasal flaps can be used to repair wounds,with satisfactory efficacy.

Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique.</p><p><b>METHODS</b>Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6).</p><p><b>RESULTS</b>In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis.</p><p><b>CONCLUSION</b>Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.</p>

Utilidad de colgajos locales para reconstrucción de mejillas en lesiones oncológicas de piel / Usefulness of local flaps for cheek reconstruction in skin cancer lesions

Introducción: el cáncer de piel afecta con frecuencia la región facial por su alta exposición a la radiación ultravioleta. La mejilla es un sitio frecuente y como consecuencia de la exéresis, quedan amplios defectos que requieren de técnicas reconstructivas. Este estudio tuvo como objetivo evaluar la utilidad del uso de colgajos locales para la reconstrucción de mejilla en pacientes intervenidos de lesiones tumorales de piel. Métodos: se realizó un estudio prospectivo en 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología desde julio de 2013 hasta julio de 2015. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 67-77, el tipo histológico que predominó fue el carcinoma basocelular. Predominó la mejilla izquierda. El colgajo que más se realizó fue el de rotación (Mustardé) y la complicación más frecuente fue el ectropión. Conclusiones: todos los casos fueron reconstruidos de forma inmediata, independientemente del tamaño del defecto(AU)

Introduction: Skin cancer frequently affects the facial area, due to high exposure to ultraviolet radiation. The most frequent affected area is the cheek. The wide excisions resulting from excision require reconstructive techniques to repair them. Objective: to evaluate the usefulness of local flaps for the cheek reconstruction in skin cancer lesions. Methods: A prospective study was conducted in 27 patients seen at the National Institute of Oncology and Radiobiology from July 2013 through July 2015. Results: The predominant age group comprised women aged 67-77 years, being the basal cell carcinoma the predominant one. The left cheek was the most affected. The most used flap was the rotation flap(Mustarde) and the most common complication was ectropion. Conclusions: All the cheek defects were immediately reconstructed regardless of their size(AU)

Reconstrucción de defectos oncológicos palpebrales con colgajos regionales sin aporte condromucoso / Reconstruction of oncologic eyelid defects with local flaps with no condromucuos

Objetivo: caracterizar la reconstrucción palpebral de los defectos oncológicos de espesor total con colgajos regionales sin aporte condromucoso. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal con 30 pacientes, en los Servicios de Oftalmología y Cirugía Reconstructiva del Instituto Cubano de Oncología y Radiobiología, en el período 2009-2012. Se utilizaron las siguientes variables: edad (30-90 años), sexo, color de la piel, párpado afectado, histología del tumor (carcinoma basocelular o epidermoide), tamaño del defecto (desde 25 por ciento hasta 100 por ciento), tipo de reconstrucción, complicaciones, resultados funcionales que fueron buenos si el párpado tuvo posición y apertura normal y resultados estéticos que fueron buenos si tuvieron adecuada simetría con el otro párpado, buena función y poca cicatriz. Resultados: en la muestra predominó el sexo masculino; la edad media fue de 67 años y el tumor más frecuente fue el carcinoma basocelular. El colgajo más utilizado fue el de la región frontoglabelar. En cuanto a la funcionabilidad y estética de la reconstrucción, se obtuvieron buenos resultados en el 86,7 y 76,7 por ciento respectivamente. Las principales complicaciones estuvieron relacionadas con la técnica empleada y fueron el simbléfaron y el ectropión, con el 13,3 por ciento del total de la muestra. Conclusiones: la reconstrucción palpebral sin aporte condromucoso ofrece buenos resultados estéticos y funcionales, así como altas probabilidades de satisfacción de los pacientes, con un mínimo de complicaciones quirúrgicas(AU)

Objective: to characterize the reconstruction of full-thickness oncologic eyelid defects by using local flaps with no condromucous addition. Methods: prospective, descriptive and longitudinal study was carried out with 30 patients in the ophthalmology and reconstructive surgery services of the Cuban Institute of Oncology and Radiobiology from 2009 to 2012. The following variables were used: age (30-90 years), sex, race, affected eyelid, tumor histology (basal cell or epidermoid carcinoma), defect size (25-100 percent), reconstruction type, complications, functional results that were rated as good if the lid had normal position and opening, and aesthetic results that were considered good if they show adequate symmetry with the other eye lid, good function and small scar. Results: males predominated in the sample; the mean age was 67 years and the most common tumor was basal cell carcinoma. The flap in the frontal and glabelar region was the most used. As for functionality and aesthetics of the reconstruction, good results were achieved in 86.7 percent and 76.7 percent of cases, respectively. The main complications were related with the surgical techniques, namely simblepharon and ectoprion accounting for 13.3 percent of the sample. Conclusions: eyelid reconstruction with no condromucosous addition offers good aesthetic and functional results, as well as great possibilities for attaining higher levels of patient's satisfaction, with minimal surgical complications(AU)

Management of human bite injury of the upper and lower eyelids: a rare case report

Human bite injury to the eyelid is extremely rare and poses a significant challenge in surgical reconstruction. We report an extremely rare case of human bite injury to the eyelid in a 43-year-old male with approximately 60% full thickness loss of the upper eyelid and 80% to 90% full thickness loss of the lower eyelid and its successful reconstruction using the local advancement cheek flap.

Local Flaps for Reconstruction of Nasal Defects / 대한피부과학회지

BACKGROUND: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. OBJECTIVE: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. METHODS: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. RESULTS: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. CONCLUSION: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.