Hemodynamic factors related to complications of trans pedicled peroneal perforator flap / 中华整形外科杂志

Objective@#To analyze the causes of local necrosis and hemodynamics after pedicle peroneal perforator flap and try to find out prevention strategies.@*Methods@#Retrospective 17 tissue defect cases admitted by Plastic and Reconstructive Surgery of Ningbo First Hospital, which treated by pedicle perforator flap with kinds of complications. 3 of 17 were naked the perforators to reduce reverse pressure. Patients involved 12 male, 5 female, ages from 22 to 46, with defected area from 5.0 cm×11.0 cm to 8.0 cm×14.0 cm, located in lateral ankle.@*Results@#3 to 5 days postoperative 12 cases with distal local necrosis, all of which were designed interregional, one with performator naked, turned back after drainage and wound dressing, 3 cases were gradually swelling and purple postoperative, two of them were perforator naked. 1 weeks later, the distal skin of flap necrosis and were gradually turning black scab appeared.With scab cutting and fascia survived, no bony tissues exposure, after 0.5% povidone iodine wet dressing regularly, endothelial cells crawled to cover. 2 cases with larger ranger of swelling and purple, not be better even pedicale releasing was conducted, 2 weeks later most part of the flap necrosis and the distal turned black eschar. After debridement and skin grafting, wounds healed later.All patients were followed up for 3 months with no flap transplantation required.@*Conclusions@#Coaxial homology, within 2 choke vessel areas, perforator skeletonization, kick out the small saphenous vein, might be the ways to reduce the complication of the cross area designing trans pedicled peroneal perforator flap.

Flapless versus open flap techniques of implant placement: A 15‑month follow‑up study.

Aim: To evaluate and compare the effect of flapless and “open flap” techniques of implant placement on crestal bone height (CBH) around implants. Materials and Methods: This prospective study comprised of 32 implants placed in 16 subjects with a bilateral missing mandibular first molar. In each subject, one implant was placed with “flapless” and other using “open flap” technique. Radiographic assessment of CBH was carried out using standardized intraoral periapical radiograph of the site at baseline, 3 months, 9 months and 15 months after implant placement. Statistical Analysis: Data were analyzed using STATA 11.0 statistical software. To determine the changes in CBH from baseline, at 3‑, 9‑, and 15‑month, repeated measures analysis of variance followed by post‑hoc Bonferroni was used for each of the two techniques for mesial and distal aspects separately. For both techniques, changes in CBH from baseline to 15 months were compared using an independent t‑test with a confidence interval of 95%. Results: For “flapless” technique, there was no statistically significant (P > 0.05) reduction of CBH in initial 9 months but was significant for the 9–15 months period while for “open flap” technique, statistically significant (P < 0.05) reduction was observed up to 15 months. Comparison of both techniques showed significantly lesser reduction with “flapless” than “open flap” technique. The overall average crestal bone loss was 0.046 ± 0.008 mm on mesial aspect, 0.043 ± 0.012 mm on distal aspect with “flapless” technique and 1.48 ± 0.085 mm on mesial aspect, 1.42 ± 0.077 on distal aspect “open flap” technique. Conclusions: Both techniques showed a reduction in CBH with time but the flapless technique showed a lesser reduction. Therefore, the flapless technique can be considered as a better treatment approach for placement of implants, especially where adequate width and height of available bone are present.

Alveolar cleft graft

Reconstruction of Defect Adjacent to the Buttock with Gluteal Perforator Flap: Free Style Flap Design

PURPOSE: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. METHODS: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. RESULTS: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. CONCLUSION: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

Standardization of Flap Design for Oropharyngeal Reconstruction after Cancer Ablation Surgery

A variety of residual defects containing many sulci and fossae in the oropharyngeal cavity make it extremely difficult to achieve an adequate flap design as well as the functional reconstruction of the complex defects after ablation surgery for oropharyngeal tumors. This study attempted to standardize flap design for the different types of defects in order to produce a better functional reconstruction of intra-oral defects. The oropharyngeal defects were classified into 6 Zones. When the defect involves only the mouth floor, it was classified as Zone 1. A hemi tongue was classified as Zone 2. A defect involving the mouth floor and a part of the tongue was classified as Zone 3. A defect involving the mouth floor, a part of the tongue and the tonsil was classified as Zone 4. A defect involving the mouth floor, a part of the tongue, tonsil and soft palate was classified as Zone 5. A defect involving the pharyngeal wall was classified as Zone 6. The following four types of forearm free flap designs were applied to each defective Zone accordingly: Type I flap design - an unilobed design for reconstructing Zone 1, 2 and 6 defects, Type II design - bilobed design for reconstructing Zone 3 defects, Type III design - trilobed design for reconstructing Zone 4 defects and Type IV design for reconstructing Zone 5 defects. During 1999 to 2002, 91 patients with oropharyngeal defects underwent a reconstruction using these standardized forearm free flap designs. The Type I design was used in 41 cases, the Type II design in 18 cases, the Type III design in 10 cases and the Type IV design in 22 cases. In all patients, the decannulation was successful, and the swallowing and deglutination functions were within the normal parameters. There was less nasal escape of the voice and the regurgitation of food than that observed using the conventional flap design method. Effective and functional reconstructions with minimal morbidities are possible with the application of the standardized forearm free flap design in oropharyngeal defects.