Reconstrucción de defecto de órbita con colgajo prelaminado de fascia temporal superficial / Orbit defect reconstruction with pre-laminated temporal superficial fascia flap

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado

The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap

Establishing the rabbit dorsal prefabricated flap model with lead oxide microangiography / 中华整形外科杂志

Objective@#This study aims to establish a model of prefabricated flaps on the back of rabbits, with the purpose to explore the optimal concentration of lead oxide suspension for microangiography.@*Methods@#Twenty clean grade male New Zealand white rabbits, with the weigh at 3.5-4.0 kg, were selected for the prefabricated flap model, pedicled with thoracodorsal vascular bundles, through 2-staged surgeries. Traditional flap model was established on the back of 2 rabbits. Small pieces of flap were taken for HE stain at 7th and 14th day after initial surgery. The time of second operation was determined by this result. Prefabricated flap models were established on the remained 18 rabbits, and divided into 9 groups. Nine different concentrations of lead oxide suspension (60%, 50%, 40%, 37%, 33%, 30%, 27%, 23%, and 20%) were injected through the aorta for each group, on 7 days after the 2nd surgery. The microangiographic results of gross specimen and prefabricated flap were observed by X-ray imaging.@*Results@#Microvascular lumens were observed by HE stain, on 14 days after the initial surgery. The number of microvessels in each 200× high power field, increased from 1-2 on day 7 to 10-20 on day 14. The vascularization process was mature. These suggest the prefabricated flap is ready for second surgery. Lead oxide perfusion angiography showed that there was non-development of tertiary arteries at 60% and 50% concentration. Tertiary arteries were not well developed at 40%, 37% or under 30% concentration. Clear arteriole development could only be obtained at 33% and 30% concentrations.@*Conclusions@#In this study, a rabbit model of prefabricated flap pedicled with thoracodorsal vascular bundles was successfully constructed by 2-staged surgeries. The microvasculature of the flap could be clearly displayed using lead oxide suspension with the concentration of 30%-33%.

Advances in the revascularization of prefabricated flap / 中华整形外科杂志

The principle of prefabricated flap is to establish a new blood supply system, in order to supply the free flap or random flap. The key to produce a prefabricated flap is the establishment of blood supply. Currently, a series of methods could be used to promote vascular regeneration and flap survival, including chemical stimulation, stem cell transplantation, hyperbaric oxygen therapy, biomaterials application, nerve implantation, tissue expansion and microsurgical technique. The reasonable combination of multiple methods could better promote the angiogenesis of the prefabricated flap, and ultimately realize the survival of the flap, thus create a new way for the repairment of complex tissue defects.

Monitoring the post-operative lymphedema in prefabricated flap after resurfacing for facial scar / 中华显微外科杂志

Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.

The Effective Duration of the Delay Period on the Survival and Vascularization of the Prefabricated Cutaneous Flap

This study was designed to investigate the effective duration of delay period, and to study what changes were induced in the vasculatures of the prefabricated cutaneous flap. Abdominal skin flaps in six groups were fabricated by the subcutaneous implantation of a skeletonized saphenous pedicle using fourty-eight male Sprague-Dawley rats. Forty flaps were elevated at six weeks after fabrication, based solely on the implanted pedicle. Group 1 was used as the control without delay. A surgical delay was carried out at 24, 48, 72 hours, and 7 days prior to flap elevation in the group 2, 3, 4, and 5, respectively. Eight flaps of the group 6 were elevated without delay at 8 weeks after fabrication. Three days later, the flap viability and the numbers of vessels were analyzed quantitatively, and the flap vasculature was evaluated with microangiograms. Flap viabilities of the group 3(95.3+/-7.04) and 4(98.5+/-2.90) were higher than that of the control(83.4+/-11.17, p<0.05). In microangiographic study, the connection between dilated large vessels via choke vessels is dominant finding during the first 24 hours after delay. Dilatations of preexisting small choke vessels started to be appear at 48 hour after delay, and vascular networks of small vessels were progressively developed over the whole flap at 72 hours after delay. The number of vessel, in the flap itself, was increased after 72 hours of delay(p<0.05), but new vessels around the pedicles were more developed at 48 hours after delay(p<0.05). In conclusion, the delay procedure enhances the viability of the prefabricated flap, and the optimal duration is 48 - 72 hours to obtain maximal survival in rats.

Área viável e vascularização, pós autonomização cirúrgica, de retalho pré-fabricado por implante vascular em ratos

The aim of this study was to evaluate the effect of delay procedure on the survival and vasculature of a skin prefabricated flap with mean area rate of the 48.2cm² in a rat abdominal wall donnor site model. The skin flap was prefabricated by implantation of a distally ligated femoral pedicle into subdermal layer of the skin. Skin of the abdominal wall donnor site of 25 Wistar rats were compared in three groups of flaps receiving (A) pedicle implantation with no delay and (B) and (C) delay performed at the time of pedicle implantation. Three weeks later, the flaps in the group A and B were raised as an island flap, based on the implanted pedicle. In the group C, the implanted pedicle was severed when the flaps were raised. Seven days later, survival area in groups A, B and C were marked and the percentage survival area, with regard to whole flap area, calculated by Auto Cad R-14. The vascular density around the implanted pedicle, in groups A and B, was assessed by histological study. The mean percentage survival rate of the skin flap was 9.6 percent in the nondelayed group, 44.8 percent in the delayed group and 0.3percent in the group with implanted pedicle severed. The results of this study showed that delay procedure significantly increased (p 0.01, two-tailed Mann-Whitney test) the percentages survival of the flap and was found to have no influency over vascular density (p=0.307 two-tailed Mann-Whitney test) developed around the pedicle implantation three weeks after prefabrication.

Os objetivos do presente estudo foram avaliar os efeitos da autonomização cirúrgica sobre a extensão da área viável e da vascularização de retalhos cutâneos pré-fabricados com área média de 48,2cm² na parede abdominal de ratos. Os retalhos de pele eram pré-fabricados por implante de um pedículo femoral ligado distalmente e implantado diretamente na camada subdérmica. A pele da parede abdominal de 25 ratos Wistar foi comparada em três grupos de retalhos: grupo A, implante vascular sem autonomização e grupos B e C, implante vascular com autonomização no mesmo tempo cirúrgico. Três semanas após, os retalhos dos grupos A e B foram elevados como retalhos em ilha, nutridos pelo pedículo implantado. No grupo C, o pedículo implantado foi seccionado no momento da elevação do retalho. Sete dias após, a extensão das áreas viáveis nos grupos A, B e C foi delimitada e o percentual da área viável, em relação à área total do retalho, calculado por meio do Auto Cad R 14. A densidade vascular em torno do pedículo implantado, nos grupos A e B, foi avaliada por estudo histológico. O valor médio do percentual de área viável dos retalhos de pele foi de 9,6% no grupo onde os retalhos não foram autonomizados, 44,8% no grupo onde os retalhos foram autonomizados e 0,3% no grupo onde o pedículo implantado foi seccionado. Os resultados mostraram que o procedimento de autonomização aumentou significativamente (p 0,01, teste bicaudal de Mann - Whitney) os percentuais de área viável e não alterou estatisticamente (p = 0,307, teste bicaudal de Mann - Whitney) a densidade vascular em torno do pedículo, três semanas após o mesmo ter sido implantado.