V-Y advancement flap for treatment of children with foot spoke injury: Report of 8 cases / 中华显微外科杂志

Objective:To investigate the effect of V-Y advancement flap in the treatment of foot spoke injury in children.Methods:Clinical data of 8 patients, including 6 males and 2 females aged 2.5-5.0 (mean, 3.5) years old with foot spoke injury admitted to the Third Ward of Department of Orthopaedic Surgery, Xingtai General Hospital of North China Medical and Health Group from June 2019 to October 2021, were analysed retrospectively. Soft tissue defect around achilles tendon was 2.0 cm×3.0 cm-2.5 cm×4.0 cm. The size of the flap was 2.5 cm×3.5 cm-3.0 cm×4.5 cm. All patients underwent emergency debridement followed by V-Y advancement flap repair, and direct suture of the skin and tissues at donor site. The blood supply, survival and healing of flap of donor site were observed after operation. The shape of the heel and the functional recovery of the affected limb were examined on regular basis at the outpatient clinic.Results:All 8 flaps survived and the wounds had primary healing. The patients entered the follow-up for 6-12 months, with an average of 8 months. The texture and colour of the flap recipient site were good. The shape of the flap pedicle, the donor site and recipient site were satisfactory. The shoes wearing of the affected foot were not affected after surgery. The ankle function was good. The average extension was 25.8°(20°-30°), plantar flexion 32.5°(25°-40°), and the foot sensation and motion were close to normal. The average foot function score on American Association on Foot and Ankle Surgery(AOFAS) was 91.7±6.4. Five cases were excellent and 3 were good.Conclusion:The V-Y advancement flap demonstrates an ideal alternative method for treatment of small area of soft tissue defect around Achilles tendon, due to the simple operation, satisfactory shape of flap after repair, and favorable limb function.

Repair of fingertip defect with lateral V-Y advancement flap with one side palmar proper digital artery: Report of 27 cases / 中华显微外科杂志

Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.

Repair the donor site of ipsilateral fibular hallux flap with transverse V-Y advancement flap of the great toe / 中华显微外科杂志

Objective:To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods:Form January 2017 to January 2020, the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery, 521 Hospital of Weapon Industry on 20 patients, including 16 males and 4 females with an average age of 33 (18-52) years old. First, the donor site of the fibular hallux flap was sutured to reduce the size of wound. The width of the remaining wound was 0.4 to 1.6 cm, and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm. Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe. The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm, and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm. The end of postoperative follow-up was scheduled in July 2021. The follow-up items included: survival of the transverse V-Y advancement flap, wound infection, appearance, shape, texture and sensation of the V-Y advancement flap, pain on the V-Y advancement flap and the great toe, cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap, the appearance, sensation and flexion and extension of the great toe at the donor site, other discomforts in the donor site of great toe, walking and other functions affected by the discomforts.Results:The postoperative follow-up lasted from 12 to 18(average of 14) months. All the V-Y advancement flaps survived without infection at the donor sites of the great toe, and donor sites healed primarily. The appearance, shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe. The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm. The average score of the Visual analog scale(VAS) was 0.3 and 0.6 respectively in the evaluation of cold tolerance of the advancement V-Y flap and the ipsilateral great toe. The average score of the Vancouver scar scale(VSS) was 0.2 and 1.2 respectively in the scar evaluation of the V-Y advancement flap and the ipsilateral great toe. There was no visual difference between the appearance of the great toe at the donor site and the contralateral toe. There was no pain and other discomfort on the V-Y advancement flap and the ipsilateral great toe. The functions of the donor foot were not affected in walking, running, jumping and tiptoeing in all cases.Conclusion:It is a simple, safe and effective method to repair the donor site of the small-area ipsilateral fibular hallux flap by the transverse V-Y advancement flap of the great toe. It only causes a small wound but the appearance and function of the ipsilateral great toe can be repaired with a transverse V-Y advancement flap of the great toe.

Application of double V-Y advancement of mucosal flap procedure for lower-lip paramedian tubercles plasty / 中华医学美学美容杂志

Objective:To prove the effect of double V-Y procedure for paramedian tubercles plasty in patients with thin lower lips and dissatisfied appearance of lower lips.Methods:From 2013 to 2019, 127 Chinese cases of thin and dissatisfied appearance of lower lips were included. A double V-Y procedure for paramedian tubercles plasty was performed. Objective data of lip morphology before and after operation were measured, and subjective satisfaction survey and long-term follow-up were conducted.Results:The midline lower red lip height, the height of paramedian tubercles of lower-lip and the protrusion of lower-lip were significantly higher than that before the operation. The time of apocatastasis, scar softening of incision, natural expression recovery and local numbness relief were evaluated by following up at 7 d, and 3-24 months after operation, and it showed 73.2% of subjective satisfaction. The time of detumescence was 6-32 (15.2±3.5) days; the time of incision scar softening was 2-10 (5.1±2.3) months; the time of expression recovery was 1-7 (3.1±0.9) months; the time of numbness disappearance was 5 d-2 years (158.2±82.6) days.Conclusions:The double V-Y advancement of vermilion mucosa flap procedure for paramedian tubercles plasty displays a significant effect in improving volume and shape of lower lips. It is recommended for further clinical application.

Evaluation of outcomes in fissurectomy and V-Y advancement flap for the treatment of chronic anal fissure / Avaliação de desfechos na fissurectomia e retalho de avanço em V­Y para o tratamento de fissura anal crônica

ABSTRACT Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V-Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V-Y advancement flap in both groups of patients with low and high anal sphincter tones.

RESUMO A fissura anal crônica tem tratamento difícil. A cirurgia geralmente é recomendada em caso de falha do tratamento medicamentoso. A incontinência fecal em pacientes com esfíncteres mais fracos (pacientes multíparas mais velhas com história de cirurgia pélvica etc.) é uma razão importante para a rejeição da cirurgia. Esses pacientes devem ser submetidos a fissurectomia e retalho de avanço em V-Y no qual a esfincterotomia não é necessária. Neste estudo prospectivo, determinamos os desfechos e complicações da fissurectomia e o retalho de avanço em V-Y em ambos os grupos de pacientes com tônus baixo e alto do esfíncter anal.

Detail repair technique for alar deformity after the first stage reconstruction of alar defect / 中华整形外科杂志

Objective@#To sum up the repair techniques of secondary alar deformity after the first phase reconstruction of alar defect.@*Methods@#From January 2010 to December 2017, 17 patients with secondary alar deformity were included. Secondary alar deformities after the first stage reconstruction of alar defect included the abnormalities of alar groove line, absence of alar-cheek groove and the notch of alar rim. Z-plasty, V-Y advanced flaps, local skin flap and other technologies were introduced to repair details.@*Results@#Infection was found in one case of the reconstruction of the alar-cheek groove and the wound was healed by treatment. There was no necrosis occurred in other flap. The shape of the alar was satisfactory and the anterior nostril was not narrow. Patients were followed up for 1 month to 1 year. The average follow-up time was 5 months. No recurrence of nasal alar tumor was found. The patients were satisfied with the appearance.@*Conclusions@#The symmetrical and satisfactory nasal shape can be obtained with local flaps such as Z-plasty, V-Y advancement of flaps for secondary alar deformities.

V-Y advancement flap based on the double perforators of the posterior tibial artery for reconstruction of small-area tissue defect in the achilles tendon / 中华显微外科杂志

Objective To investigate the clinical effect of the V-Y advancement flap based on double perfo-rators of the posterior tibial artery for reconstruction of small-area tissue defect in the achilles tendon. Methods From June, 2014 to June, 2017, a total of 8 patients with small-area tissue defect in the achilles tendon were repaired by the V-Y advancement flap based on double perforators of the posterior tibial artery. The size of defects ranged from 1.5 cm ×3.5 cm to 3.5 cm ×5.0 cm, and the size of flaps ranged from 2.0 cm ×8.0 cm to 4.0 cm ×12.0 cm. The donor area was directly sutured. Eight cases were followed-up, and the appearance, quality, color and elasticity was raorded. Results All V-Y advancement flaps based on double perforators of the posterior tibial artery survived, and all donor sites were directly sutured. Followed-up for 3 to 12 months. All V-Y advancement flaps were flat with the sur-rounding tissue. The appearance, quality, color and elasticity of flaps were good. According to the related evaluation criteria made by the American Orthopedic Foot and Ankle Surgery Society (AOFAS), the results of 8 patients were ex-cellent in 6 cases, and good in 2 cases. The patients had a high degree of satisfaction. Conclusion Application of the V-Y advancement flap based on the double perforators of the posterior tibial artery is an ideal method to repair the small-area tissue defect in the achilles tendon. This kind of surgery is simple, safe and has minimal donor site mor-bidity.

The Adipofascial V-Y Advancement Flap with Skin Graft for Coverage of the Full-Thickness Burns of the Gluteal Region

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.

Comparison between Z-plasty and V-Y Advancement for the Surgical Correction of Cryptotia

BACKGROUND: Cryptotia correction by V-Y advancement of a temporal triangular flap was introduced in 2005. However, despite the several advantages of V-Y advancement, visible scars at the donor site are problematic. As a result, a Z-plasty technique was considered for skin deficiency in mild cases. Therefore, we introduce a new surgical scheme for cryptotia correction based on considerations of techniques and complications that arose in our clinic. METHODS: Between 2000 and 2013, 26 patients (35 cases) of cryptotia were treated. Seventeen patients had unilateral cryptotia and nine had bilateral cryptotia. Two corrective methods were used, Z-plasty or V-Y advancement, based on the severity. In mild cases, Z-plasty was used for correction and in severe cases, V-Y flap advancement was used for more skin supplement. RESULTS: Follow-up periods ranged from 6 months to 1.5 years. The results obtained were relatively favorable. Nine cases of mild deformity were corrected by Z-plasty, and the other 26 cases with mild or severe deformities were corrected by V-Y advancement. In Z-plasty cases, there was one hypertrophic scar and in V-Y advancement cases, seven resulted in visible scarring and three in skin sloughing. CONCLUSION: The main advantage of Z-plasty is a lower likelihood of visible scarring at the donor site. In mild cases, Z-plasty may be a good alternative, but in severe cases, V-Y advancement is probably the best option for more skin supplement.

Reconstruction of the Recurrent Ischial Sore with Modified Gluteus Maximus Myocutaneous V-Y Advancement Flap

PURPOSE: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue has been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V-Y advancement flap from buttock can be successfully used in these circumstances. METHODS: From February 2007 to October 2008, modified gluteus maximus myocutaneous V-Y advancement flaps were performed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V-shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. RESULTS: The patients' mean age was 46.9 and the average follow-up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long-term results were satisfied in proper soft tissue bulk and low recurrence rate. CONCLUSIONS: The modified gluteus maximus myocutaneous V-Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.

Correction of Notching Deformity of Soft Triangle Using V-Y Advancement Flap after Rhinoplasty

Soft triangle of nose is composed of only two skin layer between dome of alar cartilage and nostril. If soft triangle is damaged in rhinoplasty, the notching deformity can be caused by scar contracture. For correction of notching deformity, some methods such as composite graft or filler injection have been introduced, however these methods have some disadvantages like need for donor site or unpredictable long term results. We could correct notching deformity of soft triangle with V-Y advancement flap on the vestibular skin with great ease. Our method was undergone for 3 patients with notching deformity among 120 patients who had rhinoplasty during from March 2004 to February 2007 in our clinic. The elapse of time to definitive deformity was mean 2 months and the corrective procedure was performed 4 months later after formation of definitive deformity. Under the local anesthesia, the triangular flap proximally based was designed on the vestibular skin and this flap was sutured in V-Y fashion. There was no complication and no recurrence. This method is thought to be very useful because of some advantages: easy controlling advancement of flap according to the severity of deformity, no need for donor site, predictable outcome, and economic.

Operative Treatment for Neuropathic Diabetic Foot Ulcer: Usefulness of V-Y Advancement Flap for Unhealing Plantar Ulcer / 대한정형외과학회잡지

PURPOSE: This study examined the results of a single or double V-Y advancement flap, which was found to be technically simple for the management of chronic plantar ulcer in patients with neuropathic diabetic foot. MATERIALS AND METHODS: From January 2004 to December 2005, 29 patients who were hospitalized for the management of a neuropathic diabetic foot plantar ulcer were examined. All patients underwent single- or double-V-Y advancement flap for the management of the ulceration. Hematological, hemodynamic, diabetic, bacteriologic, and radiological tests wereperformed prior to surgery. The condition of the wound was checked during surgery, and the healing rate, healing time and recurrence during the follow-up examinations were evaluated after surgery. RESULTS: The mean age of the patients was 53.4 years (36-69). The plantar ulcers were the most commonly found in the forefoot area (12 cases). Nine cases showed ulcers in the hindfoot area, 6 cases were found are in the lateral foot area, and 2 cases were identified in the medial foot area. The area covered with the V-Y advancement flap averaged 2.05 cm(2) (0.8-3.9). The mean healing time of the wound was 4.7 weeks (3-8). One day after surgery, there were 7 cases of partial circulation disturbance that were managed with a partial stitch out and secondary intension wound healing. There were 5 cases of recurrence of the wound. CONCLUSION: A V-Y advancement flap to manage chronic diabetic plantar ulcers can produce excellent or good results. However, a high incidence of delay in healing of the surgical wound can be expected, and a longer period is needed to protect the wound comparing with normal patients.

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.

Correction of Inverted Nipple Using Modified Teimourian Method

Inversion of nipple is a common condition occurring with an incidence of 2% in women. It not only causes irritation and inflammation, but also causes aesthetic problems, affecting sexual relationships and psychological well-being of the patients. Several methods have been introduced to treat this condition in the past century, but the major principle of correction is based on the concept suggested by Schwager, that inverted nipple develops because of the lack of connective tissue located directly beneath the nipple. Based on this concept, many surgeons including Broadbent, Teimourian, and Elshy etc. have proposed that adding bulk of connective tissue and scarifing the ductal system is the principle of the treatment. Author`s method is also based on such a concept, and we have modified the Teimourian method. First, an intraglandular section in the shape of an inverted cone was performed. The crator-like glandular section was closed using horizontal mattress suture, leading to circumglandular V-Y advancement. Second, the donor sites on the areolar area were closed with V-Y advancement. Third, purse-string suture was performed to achieve neck tightening and to compensate for the lack of connective tissue beneath the nipple. Dermal flap suture was done by Foot-plate manner. We operated on 52 cases using this method, 28 patients during past 2 years. After 1 year following the operation, there were just two cases of relapse and virtually no complications. We obtained satisfactory projection of the nipples in all patients except in 2 cases. The resulting shapes and scars were acceptable to all patients.

Correction of Whistle Deformity Using Modified V-Y Advancement Flap

Whistle deformity is deficiency of vermilion of the upper lip. It is a common sequelae of primary lip repair. Many methods have been devised to correct this deformity, most using neighbouring normal tissue of the upper lip. Methods such as Z-plasty, Double rotation, V-Y advancement flap, etc., have been commonly used for the correction of unilateral whistle deformity. We found that the V-Y advancement flap with transposition of deepithelialized tissue was more effective for the correction of whistle deformity than the original V-Y advancement flap. We named this new method 'Modified V-Y advancement flap'. The technique has been performed in 5 patients, 9 to 23 years of age, each with a whistle deformity. One years and six months was the longest follow-up period. Satisfactory results have been obtained and here the authors reported along with a review of the current literature.

Vulvoperineal Reconstruction Using Various Fasciocutaneous Flaps

The reconstruction after radical vulvectomy presents a difficult challenge. Ideal flap for vulvoperineal reconstruction has thin character, constant vascular supply, and presents concealed scar after reconstruction. Various flaps are used for reconstruction of the vulvar area, have their own advantages and disadvantages. The authors performed 15 vulvoperineal reconstructions using three kinds of different 28 fasciocutaneous flaps. Gluteal fold fasciocutaneous island flap seems like labia major and remains concealed donor scar along the gluteal fold. But secondary debulking procedure is sometimes required. Vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated, and matches with regional skin quality, but donor site scar is conspicuous on medial thigh. Gluteal fold V-Y advancement fasciocutaneous flap is also reliable, easily elevated, and matches with regional skin quality with thin flap and concealed donor scar on gluteal fold. Also, it can be advanced even a long distance. Through our experiences, these flaps are very useful for vulvar reconstruction, but in the aspect of donor site scar, thickness, and degree of advancement, gluteal fold V-Y advancement fasciocutaneous flap is superior to the other two patterns for the reconstruction of the large sized vulvoperineal defect.

The Effect of V-Y Advancement Flap after Vulvectomy in Patients with Vulvar Cancer / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the clinical effect of V-Y advancement flap after vulvectomy in patients with vulvar cancer. Local and systemic morbidity, the degree of satisfaction after operation, length of hospital stay were evaluated. PATIENTS AND METHODS: From March 2001 to september 2002, five patients with invasive vulvar cancer were eligible for this study. All the patients underwent radical vulvectomy with groin lymph nodes dissection. All of them were reconstructed by the same surgeon using ischial fasciocutaneous V-Y flaps based on perforators from the inferior border of the gluteous maximus muscle. RESULTS: Flap survival was 100%. There were no major complication including wound infection, wound disruption, urinary tract infection, and seroma in the femoral triangle. Functional outcome was excellent in all patients. CONCLUSION: The V-Y advancement flap provides a straight-forward and simple safe reliable method as a common approach in radical vulvectomy.

Surgical Correction of Cilio-corneal Touch Combined with V-Y Advancement Flap

PURPOSE: The purpose of this study is to evaluate the functional and cosmetic results of V-Y advance-ment flap procedure to correct medial cilio-corneal touch. METHODS: The 8 patients with corneal erosion induced by medial cilio-corneal touch, whose post-operative follow up periods were longer than 3 months, were reviewed retrospectively. RESULTS: All patients underwent V-Y advancement flap procedure. Five patients (10 upper eyelids) under-went slinging procedures and 2 patients (3 lower eyelids) underwent epiblepharon repair simul-taneously. One patient (1 lower eyelid) showed recurrence of cilia touch but reoperation did not undertake. CONCLUSIONS: V-Y advancement flap procedure produced satisfied results functionally and cosmetically.

Correction of Cryptotia Using Lotus Flower Shaped V-Y Advancement Flap and Auriculocephalic Sulcus Percutaneous Cinch Sutures

In cryptotia the upper part of the auricle is buried beneath the temporal scalp, so the upper auriculocephalic sulcus is absent and auricular cartilage deformity is accompanied. The goals of surgical correction of cryptotia are to release the upper ear from temporal scalp to restore auriculocephalic sulcus, and to correct the cartilage deformity. Authors have experienced 23 auricles in 14 patients with cryptotia to correct cryptotia using lotus flower shaped V-Y advancement flap for the upper auricular skin deficiency and scoring for cartilage deformity. Lotus flower shaped flap is designed above superior pole of auricle. Designed flap has wider lower third than conventional V-Y flap. After complete exposure of upper auricular cartilage, cartilage deformity is corrected by scorings on lateral surface of the scapha and medial surface of the superior crus of antihelix. For construction of auriculocephalic sulcus, the flap is advanced inferiorly about 1 cm and 3 stab incisions on the flap are made at the expected auriculocephalic sulcus. The cinch suture is done between dermal layer of the stab incisions and auriculocephalic sulcus cartilage with 4-0 Prolene . Packing gauze is tied at corrected scapha for contour maintenance. A satisfactory contour of scapha and antihelical crus and deep auriculocephalic sulcus were maintained postoperatively. However, hypertrophic scar formation was found due to tension. Our method is similar to Ono's method in triangular flap shape. But the lotus flower shaped flap has wider lower 1/3 than Ono's triangular flap and provides sufficient skin for formation of auriculocephalic sulcus without additional rhomboid flap elevation in front of the ear.

The Closure of Radial Forearm Flap Donor Site Using Local Ulnar Advancement Flap / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The radial forearm flap is thin, pliable, and versatile, and it forms a relatively long and large vascular pedicle which facilitates the microvascular anastomosis much easier. Additionally, it can act as a sensate flap to transprt sensory innervation to the grafted site. But, there are a number of problems associated by skin graft regarding the donner site such as the delayed wound healing due to poor skin graft reception, disability of the hand and esthetically unpleasing appearance, etc. To avoid these potential problems, we used V-Y ulnar advancement flap method to close the donor defect of the radial forearm flap directly and compared this procedure with skin graft method. MATERIALS & METHOD: We reviewed retrospectively 3 cases of floor of mouth cancer and 1 case of tonsil cancer. They were 3 female patients and 1 male patient aged from 60 to 73. RESULTS: We obtained successfully results, both functionally and cosmetically, except for one who died of acute respiratory failure on the second postoperative day. CONCLUSION: This method avoids the complications of the split skin grafting for the radial flap donor site, and the donor site sequelae of the split skin graft. It can be used in the reconstruction of small defects in the oral cavity and oropharyngeal defects after tumor excision.