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Objective:To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery. Methods:A retrospective analysis was performed on 30 patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2023. The sites and types of defects, intraoperative blood loss, time of flaps preparation, areas of flaps, survival of the flaps and other complications were recorded. Results:A total of 30 patients were enrolled, including 26 males and 4 females, aged 36-82 years. Among them, 22 patients with hypopharyngeal partial defect were repaired （19 patients with ipsilateral defect and 3 patients with contralateral defect）. In addition, 2 patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx, the neck skin defect was repaired in 2 patients, the parotid skin defect was repaired in 2 patients, the temporal bone skin defect was repaired in 1 patient, and the cervical esophageal defect was repaired in 1 patient. The average blood loss during the operation was 8 ml, and the average time was 32 min. The flap areas ranged from 5.0 cm×4.0 cm to 20.0 cm×8.0 cm. 27 of 30 flaps survived（90.0%）, and pharyngeal fistula occurred in 6 patients after operation（4 flaps survived after local dressing）. One patient was complicated with venous thrombosis（the flap necrosis after local dressing）. Shoulder and neck functions（lift, internal rotation and abduction） were not significantly affected in 29 patients, and the function of 1 patient with shoulder infection was not affected after treatment. Conclusion:Supraclavicular island flap is a highly vascularized axial fascial flap. It is easy to make, thin, and soft in texture, and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate. Good results in post-operative repair of head and neck tumors are worth promoting.
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Male , Female , Humans , Plastic Surgery Procedures , Retrospective Studies , Skin Transplantation , Soft Tissue Injuries/surgery , Treatment Outcome , Surgical Flaps , Head and Neck Neoplasms/surgeryABSTRACT
Objective:To investigate the methods and effect of wound repair after partial skin and soft tissue necrosis of middle and lower leg fracture surgery.Methods:Three kinds of island flaps were used to repair the wound after skin and soft tissue necrosis of middle and lower leg fracture surgery in 22 patients. Nine patients were repaired with sural neurotrophic fascial flaps, 7 patients with posterior tibial artery perforator flaps, and 6 patients with peroneal artery perforator flaps. The area of wound defect was 3.0 cm×3.8 cm to 12.0 cm×9.0 cm. The donor area was directly sutured, or free skin grafted.Results:All patients were the cases after partial skin and soft tissue necrosis of middle and lower leg fracture surgery, with bone, internal fixation plate or tendon exposed. The skin flaps in 21 patients were survived, and the wound healed by first intention. The sural neurotrophic fascial flap necrosis in one patient was due to hematoma and entrapment in vascular pedicle. After 5 to 24 months (mean 9 months) follow-up, texture of flaps was good, no ulcer occured, and outlook of the repaired wound was satisfied. The sutured wound of donor site and skin-grafting had healed by first stage intention.Conclusions:Repair with island flap is an ideal way to the defect wound after skin and soft tissue necrosis of middle and lower leg fracture surgery.
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Objective:To investigate the clinical effect of postauricular island flap in reconstruction of anterior auricular defect.Methods:Twelve patients with auricular tumors were retrospectively analyzed in the Department of Aesthetic Plastic and Craniofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. After the tumors were completely removed, the skin defects were repaired with retroauricular island flaps, and the clinical results of the flaps were observed.Results:All the twelve postauricular island flaps were survived postoperatively. One of the flaps had the disorder of blood supply. After puncture with the needle, the congestion was drained out and the flap survived finally. During 1 to 2 years' follow-up, all patients were well satisfied with the surgical results.Conclusions:The posterior auricular island flap in reconstruction of anterior auricular defect has the advantages of simple and easy operation, high survival rate, small scar in the donor area and good aesthetic effect, which is worthy of clinical promotion.
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Objective:To investigate the clinical effect of perforator flap of distal cutaneous perforator of medial plantar artery in recon struction of destructive defect in the base plane of proximal phalange of great toe.Methods:Twenty-six patients were treated in the Department of Foot and Ankle Surgery of Xuzhou Renci Hospital from September 2017 to December 2021. The patients were 24 males and 2 females, aged 26 to 60 years old. There were 12 defects in left foot and 14 in right foot. All the defects were the residual wounds at the first metatarsophalangeal joint with the defect at 2.0 cm × 3.0 cm - 4.0 cm × 5.0 cm in size. The flaps pedicled with distal cutaneous perforator of the medial plantar artery were used to repair the defects, with a size at 3.2 cm× 4.2 cm in average. Skin grafts were employed to repair the donor sites. Postoperative patient management including lifting the affected limbs and keeping warm, anti-infection, detumescence, anti-coagulation and pain relief.Results:All patients were entered in postoperative follow-up at outpatient clinic for 1-3 years. Twenty-two flaps survived after surgery, except 4 that had dark purple edge indicating venous congestion. Blood supply of the flap was regained after the tension of the flap was relieved by interval suture removal. Appearance of flaps was good, without obvious swelling nor pigmentation, good in elasticity, in hard texture and with good wear resistance. Patients showed no limp of the affected limbs, and without restriction in wearing shoes or walking. The function of feet was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) I50, with 24 patients in excellent and 2 in good.Conclusion:The anatomy of the flap pedicled with distal cutaneous perforator of the medial plantar artery is relatively constant. It provides a blood supply and does not affect the trunk of major artery. The flap has a thick skin cuticle hence it is wear-resistant. This flap provides a choice to the repair of a defect at proximal segment of great toe.
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Objective:To evaluate clinical efficacy of bipedicled scrotal flaps combined with keystone-design perforator island flaps in repairing postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum.Methods:Clinical data were collected from 6 male patients with extramammary Paget′s disease of the perineum in Dermatology Hospital of Jiangxi Province from February 2018 to March 2019, and analyzed retrospectively. These patients were aged from 70 to 84 years (median, 77.5 years) , skin lesions involved the mons pubis, penis and scrotum, and the area of postoperative skin defects varied from 18 to 133 cm 2 (median, 96 cm 2) in size. In all the patients, mons pubis defects after tumor resection were repaired with abdominal keystone-design perforator island flaps, and scrotal and penile defects were repaired with bipedicled scrotal flaps using the remaining scrotal tissues. These patients were followed up at 1 and 3 months after surgery and every 3 months thereafter. Results:All the 6 patients were followed up for 3 - 36 months, with an average of 10 months. All flaps survived with a good color and texture match, and favorable function and appearance were achieved in both the donor and recipient sites.Conclusions:The bipedicled scrotal flaps combined with keystone-design perforator island flaps can repair postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum. Moreover, the operation is simple, and good blood supply can be achieved.
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@#The facial submental artery island flap (FSAIF) is a fasciocutaneous flap supplied by the facial submental artery. It is in close proximity with many oral and maxillofacial regions, and its tex ture and color are similar to those of the head and face. The flap has a constant and sufficient blood supply, and it is easy to prepare and has high survival rates and few complications. According to the tissue carried, FSAIF can be divided into fasciocutaneous flaps, myocutaneous flaps and simple flaps. The flap can also be made into an osteofasciocutaneous (myocutaneous) flap with a mandible to repair maxillary defects. Because this flap is a pedicled flap, it can greatly shorten the operation time, bed rest time and hospitalization time and has been widely used in repairing medium-sized defects of the oral and maxillofacial region. The indications for FSAIF in repairing maxillofacial defects should be strictly controlled. It can be safely used for benign or malignant tumors without cervical lymph node metastasis. For malignant tumors with cervical lymph node metastasis but without extranodal extension, the flap can be used on the premise of thorough neck dissection. The contraindication is cervical lymph node metastasis and extranodal extension of malignant tumors; therefore, other flaps should be selected for repair.
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Objective:To investigate the surgical method and therapeutic effect on repairing soft tissue defects around ankle with lateral tarsal artery island flap.Methods:From July 2013 to December 2020, the lateral tarsal artery island flap were used to repair the soft tissue defects around ankle in 12 patients in Hand Surgery Department, Jiangnan Hospital Affiliated to Binjiang College. Of which, 6 patients had soft tissue defects complicated with bone or tendon exposure after injury and 6 had skin necrosis with internal fixation after fracture. The area of soft tissue defects was 6.0 cm×4.0 cm-9.0 cm×5.0 cm, and the size of the flaps was 7.0 cm×5.0 cm-10.0 cm×6.0 cm. After the flap was freed, the vascular pedicle was separated up to the origin of dorsalis pedis artery. As the pedicel was not long enough in 1 patient, the dorsal pedis artery was ligated and transected at the origin of the lateral tarsal artery. Full thickness skin graft was used to repair the donor sites. The patients were treated with anti-infection and anticoagulant therapies. The postoperative follow-ups were conducted by outpatient clinic visit, telephone or WeChat interviews or home visit to observe the recoveries in texture, appearance, sensation, donor site and function of ankle.Results:All the flaps and skin grafts survived. The wound healed well without occurrence of ulcer. The follow-up ranged 6-108 months (mean 17 months). Appearance of the flaps was good. It was not bloated and the sensation was restored to S 2-S 3. Conclusion:It is a good method to apply the lateral tarsal artery island flap in repair of the soft tissue defects around ankle. It features a hidden donor site, simple operation and the high level of safety. The texture and appearance of the flap are close to those of the recipient site.
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Objective:To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods:From May 2009 to May 2021, a total of 24 patients (24 digits) with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital. The flap was selected according to the patient's wishes and occupation. Of the 24 patients, 13 were repaired by free hallux toe nail flap transfer (group of hallux toe nail flap), and 11 were repaired by combining the proper palmar digital artery island flap of middle (ulnar side) and ring (radial side) fingers with the same volar common digital artery vascular pedicle (group of tile combined flap). Follow-up was performed at the 1st, 3rd, 6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews. The follow-ups focused on the appearance, colour, texture and two-point discrimination (TPD) of the flap, as well as thumb flexion, extension, opposition and grasping functions. Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the 24 flaps survived and all were included in the follow-up. The follow-up lasted 12-60 and 6-18 months, with an average of (18.5±0.5) months and (6.8±0.3) months in group of hallux toe nail flap and group of tile combined flap, respectively. Appearance of thumb body and function at the last follow-up showed: in the group of hallux toe nail flap, the nails, thumbtips and fine sensations were restored, with the TPD at 5-8 mm. The thumb flexion, extension, opposition and grasping functions were good. Apart from without nails and fingerprint, the flaps in the group of tile combined flap had good appearance and texture, and the protective feeling was restored with the TPD at 6-11 mm. The affected thumbs also recovered the basic functions of flexion, extension, opposition and grasping. According to the Trial Standard of Upper Limb Function Evaluation of the Chinese Medical Association Hand Surgery Society, 7 cases were excellent, 5 cases were good, and 1 case was poor in the group of hallux toe nail flap. In the group of tile combined flap, 3 cases were in excellent, 5 in good, and 3 in poor. Appearance of flaps (such as nails and thumbtip fingerprint), fine sensory recovery, and the accuracy and stability of the grasping function, the group of hallux toe nail flap was significantly better than that of the group of tile combined flap. There was no functional impact on the donor site.Conclusion:Both types of flap are classic surgical procedures for repair of distal thumb degloving injury. In order to meet the individual requirement and to improve the efficacy of the treatment, such as for those who have high expectation for digit restoration, especially those who are young with aesthetical or professional requirement, free hallux toe nail flap repair is used to restore the perfect shape and function. And for those who are reluctant to sacrifice their toes or for the middle-aged and elderly people who do not have high expectation for the shape of thumb, a tile combined flap repair is used to restore thumb function.
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Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.
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Resumen La cirugía reconstructiva de cabeza y cuello es una tarea compleja. Existen varias opciones disponibles para lograr buenos resultados, desde colgajos locales hasta colgajos libres microvascularizados. En este reporte presentamos nuestra experiencia utilizando el colgajo en isla submental para la reconstrucción de defectos de tejido blando de base de cráneo lateral posterior a una resección lateral de hueso temporal secundario a diagnósticos oncológicos otológicos. Se presentan datos demográficos, clínicos, quirúrgicos y resultados de dos pacientes intervenidos durante el primer semestre del año 2020, en los cuales se consiguió un adecuado resultado reconstructivo. Este colgajo es una opción confiable y versátil para reconstrucción en cabeza y cuello.
Abstract Reconstructive head and neck surgery is a complex task. There are several options available to achieve good results, from local flaps to free microvascular flaps. In this article, we present our experience using the submental island flap for soft tissue defect reconstruction of the lateral skull base after a lateral temporal bone resection secondary to otologic cancer. Demographic, clinical, surgical and outcome data of two patients operated on during the first semester of 2020 are presented, in whom a good reconstructive result was achieved. This flap is a reliable and versatile option for head and neck reconstruction.
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Objective:To investigate the method and outcome of reconstruction of thumb soft tissue defect by index finger proximal dorsal island flap supplied by the second dorsal metacarpal artery (SDMA).Methods:From August, 2015 to December, 2017, 12 cases of thumb soft tissue defect were treated by index finger proximal dorsal island flap supplied by SDMA. The site of defect ranged from 2.0 cm×2.4 cm to 5.5 cm×3.0 cm, and the flap area ranged from 2.2 cm×2.6 cm to 6.0 cm×3.3 cm. The donor site was repaired by split-thickness skin graft from the forearm of the injured limb. All patients received regular outpatient follow-up after surgery. The appearance, texture, sensory recovery and donor site of the flap were observed.Results:All the 12 flaps had 5-16 (8.8 in average) months follow-up and survived, the donor site and wounds healed in primary stage. The appearance, sensory and function of the flaps were good. There were no scar contracture on the donor sites, and no pain and limitation of motion in the joints. At the last follow-up, according to the Criteria for Function Assessment of Upper Limbs by the Branch of Hand Surgery of Chinese Medicine Association, the thumb functions were excellent in 11 cases and good in 1 case.Conclusion:Index finger proximal dorsal island flap supplied by SDMA is easy to operate, and has constant blood supply, improved rotation angle of the flap vessel base. It is a good method to repair the soft tissue defect of thumb.
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Objective To explore the clinical effect of gluteal pressure sore repaired by superior and inferior perforating artery island flap with rotation and joint propulsion.Methods From January 2014 to April 2018,37 patients (27 males,10 females,aged 35～79 years) with hip decubitus were admitted to the First People's Hospital of Yulin City for treatment of hip decubitus.According to the situation of the wound surface,the perforating site of superior and inferior perforator arteries and the local soft tissue,the corresponding perforator arteries were selected as the pedicle to form island skin flap,and the wound surface was transferred by rotation and propulsion.Results All the flaps sur vived well.33 cases healed in the first stage,but 4 cases dehisced and infected in the incision.After dressing change,the wounds healed in the second stage and the wounds were locally smooth.Conclusions The rotational combined push type gluteal superior and inferior perforator island flap is a good method to repair gluteal pressure sore.
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Objective To investigate the therapeutic effect of modified dorsal metacarpal artery island flap of index finger without skin graft in repairing different types of soft tissue defect of thumb tip.Methods From August,2015 to October,2017,25 patients with soft tissue defect of the thumb tip were included in the study.Sixteen cases were males and 9 cases were females.Seventeen defects were in thumb dorsal and 8 cases were in thumb pulp.A modified dorsal island flap of index finger was used and the dorsal metacarpal superficial vein fascial flap could be harvest and combined to repair the thumb pulp defect if necessary.A relaying perforator flap pedicled on the second dorsal metacarpal artery was raised through the same incision to cover the donor site without skin graft.Followed-up was made by clinic,telephone and WeChat.Results The patients were followed-up for 6 to 18 months.All flaps survived completely without complications.The color,texture and contour of the flaps was good.Only 1 linear scar was left in the dorsum of the hand and no skin grafts.The second dorsal metacarpal artery flap was used to cover the donor site.Twenty-one cases (84％) were satisfied with the postoperative appearance of the thumb.The function was assessed as excellent in 16 fingers,good in 6 fingers and fair in 3 fingers.No complication occurred in the donor site.Conclusion It is possible to use the modified dorsal island flap of index finger to repair different types of thumb tip defects.A second dorsal metacarpal artery flap can be used as a relaying flap to cover the donor site without skin grafts.
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Objective@#To explore the therapeutic effect of salvianolic acid B (Sal B) on rat abdominal island flap after ischemia-reperfusion injury, and to explore the related mechanisms.@*Methods@#Fifty-four male Sprague-Dawley rats were randomly divided into 3 groups and rat lower abdomen island flap models were established: ①Sham-operated group (Sham group): non-blocking blood vessels, intraperitoneal injection of equal volume of saline as Sal B group; ②Model group: blocking blood vessels for 8 h, intraperitoneal injection of the same volume of saline as Sal B group; ③salvianolic acid B group (Sal B group): blocking blood vessels for 8 h, intraperitoneal injection of 40 mg/Kg of Sal B per day. Seven days after continuous drug administration, the survival rate of the flaps in each group was evaluated, and then the animals from each group were sacrificed for the specimens which were used for the following tests: HE staining was performed to evaluate the microvessel density (MVD), and immunohistochemistry was used to detect the level of vascular endothelial growth factor (VEGF) and superoxide dismutase 1 (SOD1). The contents of superoxide dismutase SOD and malondialdehyde (MDA) in flap tissue were tested using the corresponding kit.@*Results@#Seven days after flap operation, the survival rate of Sal B group flap[(65.62±13.20)%] was significantly higher than that of the model group, while HE staining showed an increase in MVD in Sal B group [(28.27±3.19)/mm2 and (15.79±6.12)/mm2, respectively]. The differences were statistically significant (P<0.05) . Moreover, immunohistochemistry demonstrated that the expression of VEGF and SOD1 obviously increased in Sal B group, and the content of SOD increased significantly. In addition, the expression of MDA decreased after Sal B treatment. The differences were statistically significant (P<0.05) .@*Conclusion@#Sal B is able to increase the expression of VEGF and SOD in the rat abdominal island flaps after ischemia-reperfusion injury, to reduce the content of MDA, and then to promote survival rate of rat abdominal island flap.
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Objective@#To compare the pedicled supraclavicular artery island flap (SCAIF) and the pectoralis major myocutaneous flap (PMMF) for oral reconstruction after cancer resection.@*Methods@#This is a retrospective study from May 2007 to May 2017. Sixty-one patients from the Jiangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanchang University, were included. All the patients underwent oral squamous cell carcinoma resection and pedicled flap reconstruction. Sixteen patients were performed SCAIFs (group A), and 45 were performed PMMFs (group B). The flap survival rate, flap size, flap preparation time, the presence of scar hyperplasia, pigmentation and dysfunction (temporary or permanent) were compared between these two groups.@*Results@#The survival rate of flaps in group A was 93.75% (15/16), and the survival rate of flaps in group B was 95.56% (43/45). There was no statistically significant difference in the survival rate of flaps, the average skin flap size or flap produce time between these 2 groups. There were no scar hyperplasia, pigmentation and dysfunction was observed in group A. However, scar hyperplasia (n=11), pigmentation (n=10) and dysfunction (n=12) occurred in group B. The difference was statistically significant (P<0.05).@*Conclusions@#This study suggests that SCAIF is more reliable, and brings more satisfied outcome, when compared with the PMMF.
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Objective@#To discuss the clinical outcome of submental island flap used in reconstruction of nearly half tongue defect after resection of tongue cancer.@*Methods@#From June 2015 to November 2017, 16 submental island flaps were used to reconstruct nearly half tongue defect after resection of tongue cancer. Tissue flap with submental artery as vessel pedicle and suitable for the defect with anterior belly of digastric muscle was prepared in submental area and transferred to the defect area through the mandibular hyoid muscle tunnel to repair the defect.@*Results@#All submental flap transfers were successful.The areas of flaps were 3.0 cm×4.0 cm-4.5 cm×7.5 cm. No local recurrence of tongue SCC was found and no death was noted during 3-24 months of follow-up.The functional and esthetic result such as feeding, speeching, head raiseing were satisfied for patients.@*Conclusions@#Higher success rate and scars decrease make submental island flap an reliable choice for reconstruction of nearly half tongue defect after resection of tongue cancer. It can restore appearance of tongue and improve oral function effectively.
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Objective To explore the therapeutic effect of salvianolic acid B (Sal B) on rat abdominal island flap after ischemia-reperfusion injury, and to explore the related mechanisms. Methods Fifty-four male Sprague-Dawley rats were randomly divided into 3 groups and rat lower abdomen island flap models were established: ①Sham-operated group (Sham group): non-blocking blood vessels, intraperitoneal injection of equal volume of saline as Sal B group;②Model group: blocking blood vessels for 8 h, intraperitoneal injection of the same volume of saline as Sal B group; ③salvianolic acid B group (Sal B group): blocking blood vessels for 8 h, intraperitoneal injection of 40 mg/Kg of Sal B per day. Seven days after continuous drug administration, the survival rate of the flaps in each group was evaluated, and then the animals from each group were sacrificed for the specimens which were used for the following tests: HE staining was performed to evaluate the microvessel density (MVD), and immunohistochemistry was used to detect the level of vascular endothelial growth factor (VEGF) and superoxide dismutase 1 (SOD1).The contents of superoxide dismutase SOD and malondialdehyde (MDA) in flap tissue were tested using the corresponding kit. Results Seven days after flap operation, the survival rate of Sal B group flap[(65.62±13.20)%] was significantly high鄄er than that of the model group, while HE staining showed an increase in MVD in Sal B group [(28.27±3.19)/mm2 and (15.79±6.12)/mm2, respectively]. The differences were statistically significant (P＜0.05). Moreover, immunohistochem鄄istry demonstrated that the expression of VEGF and SOD1 obviously increased in Sal B group, and the content of SOD increased significantly. In addition, the expression of MDA decreased after Sal B treatment. The differences were sta鄄tistically significant (P＜0.05). Conclusion Sal B is able to increase the expression of VEGF and SOD in the rat abdominal island flaps after ischemia-reperfusion injury, to reduce the content of MDA, and then to promote survival rate of rat abdominal island flap.
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La reconstrucción posterior a la resección de tumores en la cabeza y el cuello es un reto para la cirugía reconstructiva. El colgajo supraclavicular es un excelente recurso quirúrgico por su fácil disección, poca morbilidad y adecuada extensión. En el presente artículo presentamos 2 casos de reconstrucción exitosa con esta alternativa.
Reconstruction after resection of lesions in the head and neck are a challenge for reconstructive surgery. The supraclavicular flap is an excellent surgical alternative because it´s easy dissection, low morbidity and adequate extension. In this work, we present two cases of successful reconstruction with this flap.
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Humans , Male , Female , Adult , Aged , Surgical Flaps , Plastic Surgery Procedures , Head and Neck NeoplasmsABSTRACT
Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects.Methods From January 2015 to December 2016,there were 35 patients with fingertip defects underwent surgical treat-ment in our hospital,including 14 cases underwent surgery with anterograde digital artery island flap(anterograde group)and 21 cases under-went surgery with reverse digital artery island flap(reverse group).The anterograde group used proper palmar digital artery and nerve as the pedicle of flap,then took forward the finger pulp flap to the injured site.The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx.Results All the flaps of the 35 cases were survived.In the anterograde group,reflux obstacle of vein appeared in 1 case,and it was cured with scarification procedures.In the reverse group,there were 3 cases of vascular crisis.After dressing release and partial remove of the stitching,2 cases of them return to normal.The other 1 case suffered from flap edge necrosis,and then the wound healed after dressing change.The operation time of anterograde group was(107.5 ±18.4)min and it was(139.5 ±18.0)min in the reverse group, which showed significant difference between the two groups(P<0.05).All the 35 cases were followed up for 6 to 12 months,with an average of 8.5 months.At the last follow-up,it showed that patients in both of the two groups had ruddy color,good texture and no significant bloated flap appearance.In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3.Meanwhile,in re-verse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1.The two-points discrimination of the antero-grade group was(4.22 ±0.67)mm,and it was(7.04 ±1.25)mm in the reverse group,which was significantly different(P<0.05).The in-terphalangeal joint motion was(102.67 ±7.35)°at the distal end and(64.46 ±8.37)°at the proximal end in anterograde group.And it was (100.64 ±10.29)°and(60.81 ±10.80)°respectively in the reverse group,with no significant difference between the two groups (P>0.05).The excellent and good rate was 92.8%in the anterograde group and 80.9%in the reverse group by the criteria for functional evaluation,and there was no statistically significant difference(P>0.05).Conclusion For fingertip defects(IshikawaⅠ~Ⅲ)treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy.But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.
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Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from(5 cm×3 cm)to(12 cm×5 cm).The mean operation time was(350.5±50.5)min.The vein of the flap was found to drain into the facial vein,and then returned to the internal jugular vein in 17 patients(68.0%), into the external jugular vein in 4 patients(16%),and into the anterior jugular vein in 4 patients(16%).Twenty-four flaps survived completely,and 1 flap failed due to the damage of the submental artery.Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases.The prevalence of occult lymph node metastasis involving level Ⅰwas 16.0%.The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap.Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein,which are previously overlooked,should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss.Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases.