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Objective@#To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery.@*Methods@#From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed.@*Results@#The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches.@*Conclusion@#The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue.
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Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal dig鄄ital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected.The ra鄄dial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 seg鄄ment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface.The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries.The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6 ±0.4 cm and the diameter was 0.2±0.1 mm.Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue de鄄fect on the thumb and purlicue.
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Fifteen patients with sinus-type pressure ulcer in ischial tuberosity were admitted to our unit from April 2013 to April 2017, including 12 patients of unilateral pressure ulcer and 3 patients of bilateral pressure ulcer. The wounds were with infection of different degrees. The outer wound area of pressure ulcer before debridement ranged from 1.5 cm×1.0 cm to 6.0 cm×5.0 cm. Fifteen patients with 15 pressure ulcers were treated with vacuum sealing drainage for 3 to 13 days after debridement and sinus wall resection. Unilateral pressure ulcer was repaired with posterior femoral bilobed flap. One side of bilateral pressure ulcer was repaired with posterior femoral bilobed flap, and the other side was repaired with gluteus maximus muscle flap combined with local flap. The size of flaps ranged from 11.0 cm×7.5 cm to 15.0 cm×10.0 cm. Epidermis of the distal part and edge of the main flap was removed to make complex dermal tissue flap to fill the deep cavity. The other part of the main flap was applied to cover wound, and another flap of the bilobed flap was applied to cover the donor site where main flap was resected. The donor sites were sutured directly. The posterior femoral bilobed flaps in 15 patients survived after operation. Pressure ulcers of 12 patients were healed well. Incision of 2 patients ruptured and healed 15 days after second sewing. One pressure ulcer with infection under the flap healed on 16 days post second completely debridement. During follow-up of 3 to 18 months, flaps were with soft texture, good appearance, and no recurrence.
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Objective To discuss the method and clinical effect of bilobed DIEP flap for repair of degloving injuries of the hand.Methods From June, 2013 to January, 2015, the bilobed DIEP flap were designed to repair 6 cases of degloving injuries of hand, of which the small leaf flap repaired separately defect of thumb, larger leaf flap repair 2nd-5th finger and palm and dorsum.The bilobed DIEP flap design were based upon anatomic study on deep inferior epigastric artery, superior epigastric artery, intercostal artery and its anastomosis.Results The largest area of main flap was 35 cm × 12 cm, and the deputy leaves of flap was 10 cm× 7 cm.All of the 6 flaps survived.One of them experienced distal end necrosis of epidermis.But it was healed by dressing changes.All of the 6 cases were followed up for average of 12 months (range, 6-20 months).All flaps were seen with good appearance, fully recovered protectve sensation and the active motion of the thumb was recovery.Moreover, the donor sites were closed directly and the appearance were satisfactory.Conclusion The bilobed DIEP flap is a satisfying choice in repairing degloving injuries of the hand in that it has reliable blood supply, can obtain the larger area of skin and leaves small injuries in targeted area.
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Background: The repair of defects secondary to excision of basal-cell epitheliomas can be a challenge. Aim: To report the experience with the repair of nasal defects using bilobed flaps. Material and Methods: Review of medical records of 10 patients in whom a basal-cell epithelioma was excised and the nasal defect was repaired using a bilobed flap. Results: In all patients, the flap allowed the repair of the defect using the own patient nasal skin, without complications. Conclusions: The bilobed flap is an excellent technique for the repair of medium size nasal defects secondary to excision of basal-cell epitheliomas.
Objetivo: La nariz es el área corporal con mayor incidencia de epiteliomas basocelulares y la reparación de los defectos secundarios a su resección, puede ser un desafío. El objetivo es presentar nuestra experiencia en la reparación de defectos nasales, empleando colgajos bilobulados. Material y Método: Se realizó una revisión retrospectiva de 10 pacientes con epiteliomas basocelulares nasales en que empleamos este colgajo. Resultados: En todos los pacientes el colgajo bilobulado permitió la reparación del defecto, con la propia piel nasal y sin complicaciones. Conclusiones: Consideramos al colgajo bilobulado como una excelente técnica para la reparación de defectos nasales de mediano tamaño, secundarios a la resección de epiteliomas basocelulares.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Carcinoma, Basal Cell/surgery , Nose Neoplasms/surgery , Surgical Flaps , Retrospective StudiesABSTRACT
Objective To present the therapeutic effect of the free bilobed posterior interosseous flap for soft tissue reconstruction of two fingers.Methods According to the distance between the defects of two adjacent fingers,combining the cutaneous branches of different regin,the free bilobed flaps pedicded with posterior interosseous artery were applied for soft tissue reconstruction of 20 fingers in 10 patients.The defects of digits was on thumb and index( 1 case),index and middle(2 cases),middle and ring(4 cases),ring and little (3 cases).The size of defect was ranged from 2.5 cm × 2.0 cm to 9.5 cm × 3.0 cm.The size of single flap was from 3.0 cm × 2.5 cm to 10.0 cm × 3.5 cm.Results The flaps on 19 fingers were completely survived and the flap on 1 finger had the pointed end necrosis which healed by dressing changing.After 6 to 22 months (the average was 13.8 months ) followed-up visit,all flaps were with excellent colour and texture.The flaps in 8 cases were thin and the flap in 2 case was a little thick.Eight single flaps in which the cutaneous nerve was sutured recovered 2-PD of 10 to 15 mm (the average was 12.8 mm).There was no affection in motor function on donor site of all cases.Conclusion The free bilobed posterior interosseous flap is the valuable option for two fingers soft tissue reconstruction and it can achieve the cosmetically and fuctionaly acceptable result with low morbidity on donor site.
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PURPOSE: We report 2 cases treated with bilobed flap surgery for medial canthal reconstruction. METHODS: Two patients with black and painless lid mass, 1 x 1 cm size, developed at medial canthal area were excised, and medial canthal reconstruction was performed. Biopsy was done before the surgery, showing basal cell carcinoma. We designed and rotated bilobed flap to reconstruct medial canthal defect caused by the radical excision, and sutured it at the incision margin of the skin. RESULTS: Pathologic examination was done after the surgery, confirming basal cell carcinoma. No marginal cancer cell were detected. Cancer relapse did not occur during 12 months of follow-up. We obtained satisfactory results in all patients, not only clinically but also cosmetically. CONCLUSIONS: It is considered that the bilobed flap procedure is effective for reconstruction of medial canthal defect developed after eyelid tumor excision and offer a good prognosis.
Subject(s)
Humans , Biopsy , Carcinoma, Basal Cell , Eyelids , Follow-Up Studies , Prognosis , Recurrence , SkinABSTRACT
The bilobed flap is often used when the primary closure of a skin defect is difficult. We applied a simple and rational method to design a bilobed flap for closure of scalp defect that reconstruction was comparatively difficult. In our method, two triangle flaps are designed; the angle of the first flap is three-fourths the angle of a rhombus at the defect site, and the angle of the second flap is also three-fourth that of the first flap. We applied it to five patients with scalp defect and obtained favorable result. The location of the defect was the parietal region in two cases. the occipital region in two cases. the frontal region in one case. We found that the alopecia by scar formation could be minimized with the designed bilobed flap. The suture line, being "Z" shape, was unnoticeable due to hair line stream. There are several advantages of this method for use in reconstruction of scalp defect such as, easy design and elevation of the flap and short operation time.
Subject(s)
Humans , Alopecia , Cicatrix , Hair , Rabeprazole , Rivers , Scalp , Skin , SuturesABSTRACT
BACKGROUND: The skin over the lower one third of the nose is less mobile and cannot be easily recruited for the closure of even small defects. In addition, the texture and color of the nose are so unique that neither distant nor nearby skin can always provide a good match. Therefore, when we reconstruct the surgical defect of lower one third of the nose, we must consider the reconstruction method, defect site or size, recurrence of the lesion such as basal cell carcinoma, patient age, general health state, and functional and cosmetic aspects. The bilobed flap is a useful tool for reconstruction of the nose but is occasionally complicated by pincushioning effect or trapdoor deformity. OBJECTIVE: The propose of this study was to evaluate the usefulness of a geometric design of bilobed flap for use in reconstructing defect on the lower one third of the nose. METHODS: From Februrary 1999 to March 2001, we reconstructed defects on the lower one third of the nose after Mohs surgery of basal cell carcinoma in 6 patients using the geometrical design of bilobed flap. Patients were reviewed for complications and cosmetic results. RESULTS: Cosmetically acceptable results were seen in all patients. Significant pincushioning and trapdoor deformity were not presented postoperatively in any patients. CONCLUSION: The geometrical design of bilobed flap is an excellent choice for reconstruction of defects of the lower one third of the nose, particularly around the nasal tip, because of the good skin match and low incidence of complication.
Subject(s)
Humans , Carcinoma, Basal Cell , Congenital Abnormalities , Incidence , Mohs Surgery , Nose , Recurrence , SkinABSTRACT
Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.
Subject(s)
Carcinoma, Basal Cell , Cicatrix , Congenital Abnormalities , Nose , PhysiologyABSTRACT
BACKGROUND AND OBJECTIVES: The traditional form of reconstruction of multiple defects after head and neck cancer ablation has been the two-combined regional flaps or that of one regional flap and skin graft. Such flaps, however, have functional and aesthetic problems such as donor site morbidity, and post-operative stenosis and fistula. MATERIALS AND METHODS: We reviewed clinical data of eleven head and neck cancer patients who have been reconstructed with bilobed flaps or gemini flaps after ablation from November 1988 to October 1998. The patients were divided into four groups. Type I flap is bilobed flap consisting of one bed and fused skin, type II flap is gemini flap consisting of one bed and separated skin, type III flap is gemini flap consisting of separated skin and bed, and type IV flap is bilobed flap or gemini flap composed of free bone graft. RESULTS: The survival rate of bilobed flaps and gemini flaps was 91%. The most common complication was fistula, followed by donor vein thrombosis and total loss of flap. CONCLUSIONS: The advantages of bilobed flaps and gemini flaps were one-stage operation, and aesthetic effect for reduced bulk of thinned radial free forearm flap, and diminished morbidity of donor site. Bilobed flaps and gemini flaps were also used for salvage operation of the patients who had been treated with concomitant chemo-radiotherapy, or combined chemo-radiotherapy, or radiotherapy alone for malignant tumors of head and neck.
Subject(s)
Humans , Constriction, Pathologic , Fistula , Forearm , Head and Neck Neoplasms , Head , Neck , Radiotherapy , Skin , Survival Rate , Thrombosis , Tissue Donors , Transplants , VeinsABSTRACT
A 30-year-old man developed basal cell carcinoma 3 years ago which showed as a pea sized, crusted nodule with extending pigmentation and telangiectasia on the inner side of the right lower eyelid. Five stages of Mohs micrographic surgery were required for the complete eradication of all tumor cells in the lesions of the nodule and extending pigmentation. The defect following the surgery was 4.5 × 3.5cm and was too large to repair with a primary closure or simple single flap. So, the defect was repaired with a combined flap of glabellar bilobed and cheek rotation. We report that the combined flap of glabellar bilobed and cheek rotation is a useful and relatively simple method for the reconstruction of a large defect on the inner side of the lower eye-lid area.