Application of slender narrow pedicle flap in facial skin cancer treatment / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the application of slender narrow pedicle flap in repairing facial tissue defects after skin carcinoma excision, and investigate its survival mechanism.</p><p><b>METHODS</b>The slender narrow pedicle iateral maxillocevical flap was designed with its pedicle including skin fascia or only the fascia located in front of auricle or behind of it, repaired 26 cases of facial defects, including 5 temporal skin basal cell carcinoma, 6 skin squamous cell carcinoma, and 1 facial skin malignant melanoma, 8 skin basal cell carcinoma, 5 skin squamous cell carcinoma, 1 skin mucinous carcinoma. In 26 cases, 24 cases their pedicles in front of the auricle, 2 cases behind of the auricle; 4 cases their pedicles only including fascia. The size of the flaps ranged from 3.0 cm x 2.5 cm to 10.0 cm x 8.0 cm. The width and length of the pedicle ranged 1.0-1.5 cm and 2-6 cm.</p><p><b>RESULTS</b>26 cases of the slender narrow pedicle flaps all survived and the results were satisfactory except 5 cases of distal congestion, then gradual recovery.</p><p><b>CONCLUSIONS</b>This slender narrow flap don't include any major blood vessel, without dissecting the blood vessels in operating. Due to its slender pedicle, the whole flap looks like "pingpang bat", the flap rotation is easy and its coverage area is very large, without cat ears. The postoperative appearance (color, texture, cosmetic aspect) is satisfactory. This slender narrow flap is an extraordinary new flap design and is ideal for the repair of the facial tissue defect after skin carcinoma excision.</p>

Experiment study of SDF-1 expression during the survival process of the narrow pedicle flap with hypoxia and ischemia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To detect the stromal cell derived factor 1 (SDF-1) expression during the survival process of the narrow pedicle flap with hypoxia and ischemia and to investigate the role of SDF-1/ CXCR4 axis in flap neovascularization.</p><p><b>METHODS</b>The narrow pedicle flaps were formed on the bilateral back of 5 pigs. The pedicle ratio of length to width was 4:2. The flap size was 2 cm x 2 cm (group A), 3 cm x 3 cm (group B), 4 cm x 4 cm (group C), 5 cm x 5 cm(group D), 6 cm x6 cm (group E). The flaps survival rate was observed and HE staining was performed. The SDF-1 expression at the distal end of flaps was detected by ELISA during the operation and 3, 5, 7, 14 days after operation.</p><p><b>RESULTS</b>(1) SDF-1 expression at the same group increased after operation until it reached the peak value at 5 days after operation; then it decreased to basic value. (2) SDF-1 expression in different groups was higher in bigger flaps until the flaps size reached 5 cm x 5 cm. Then partial necrosis happened at the distal end of flaps.</p><p><b>CONCLUSIONS</b>The SDF-1 expression may be related to the blood supply during the survival process of the narrow pedicle flap with hypoxia and ischemia.</p>

Experimental study of the effect of deferasirox on the micro-angiogenesis in narrow pedicle flap through epithelial-mesenchymal transition / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Deferasirox on the micro-angiogenesis in narrow pedicle flap through Epithelial-Mesenchymal Transition.</p><p><b>METHODS</b>32 male rats were randomly divided into group I and II which were subdivided into Ia and Ib, IIa and IIb, 8 rats in each group. The rats were administrated intragastrically for 7 days with Deferasirox 100 mg/kg in group Ia and IIa, with the same dose of N. S. in group Ib and IIb. After that, narrow pedicle flaps were formed on the rats back. In group I, the subcutaneous vascular network was observed intraoperatively. The flap survival rate was recorded. In group II , specimens were collected at the distal end of flaps 3 days after operation. IHC and Western Blot were done to examine the expression of CD34, E-cadherin, Vimentin. The microvessel density was also calculated.</p><p><b>RESULTS</b>The subcutaneous micro-angiogenesis in group Ia was more exuberant than that in group Ib. The narrow pedicle flaps in group Ia survived completely, while the survival rate was 62.5% in group Ib (P < 0.05). The percentage of flap survival area for Ia and Ib was (100 +/- 0.00) % and (84.06 +/- 4.42)% (P < 0.05). The expression of E-cadherin in IIa was lower than that in IIb, while the expression of Vimentin and CD34 were higher in IIa, showing statistically difference (P < 0.05).</p><p><b>CONCLUSION</b>Deferasirox can improve the flap micro-angiogenesis through inducing epithelial-mesenchymal transition, so as to improve the survival rate of narrow pedicle flap.</p>

Experimental study on the relationship between the ratio of length to width of slender narrow pedicle and random flap survival area in pig / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between the ratio of length to width of slender narrow pedicle and random flap survival area, and to provide a theoretical basis for the clinical application of slender narrow pedicle flaps.</p><p><b>METHODS</b>25 pigs were randomly divided into 5 groups, 5 pigs in each group. The ratio of length to width of slender narrow pedicle in 5 groups respectively was: 0:2, 1:2, 2:2, 3:2, 4:2. Every ratio' s slender narrow pedicle was carrying five different size of random flaps, which were 2 cm x 2 cm(A), 3 cm x 3 cm(B),4 cm x 4 cm(C), 5 cm x 5 cm(D), 6 cm x 6 cm(E), respectively. Flap A was control flap. In each group, flap A, B, C, D and E were created in each pigs' bilateral back. The order in both sides back is contrary. The flaps were evaluated with the general observation, fluorescence examination, blood flow ECT test, pathological expression and computerized analysis of survival area.</p><p><b>RESULTS</b>(1) The living process and pathologic process of traditional flap and slender narrow pedicle flap were consistent. It could not postpone the flap living process when the flap pedicle became long and narrow. (2) When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area , the distal flap would necrosis,the flap survival area would not reduce. (3) When the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would necrosis, the flap survival area would reduce.</p><p><b>CONCLUSIONS</b>(1) Pedicle width of random flap can be much smaller than flap width. The ratio of pedicle width to flap length is far less than traditional ratio. (2) The pedicle of random flap can be designed as slender shape, so that the whole flap looks like "pingpang bat", which makes the narrow pedicle flap rotate easily. (3) A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flap size or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.</p>

Island sternocleidomastoid myocutaneous flap for repairing the buccal composite tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the application of island sternocleidomastoid myocutaneous flap in repairing the buccal composite tissue defect especially penetrated tissue defect.</p><p><b>METHODS</b>The flap pedicle included upper part OF sternocleidomastoid muscle and occipital artery. The rotation point was located at 2 cm below the mastoid. The distance between the pivot point and distal border of the defect was the length of the muscular flap. The width of the flap was slightly larger than the defect, but should not be more than 7 cm. The lower border of the flap should not exceed 2 cm below the collar bone. The flap was elevated from the starting point of the sternocleidomastoid muscle and beneath it. The pedicle only contained muscle. The flap was transferred to the defect through the tunnel between the pedicle and defect. The wounds at donor sites were closed directly or with skin graft or local flaps.</p><p><b>RESULTS</b>12 cases were treated, including 10 cases of buccal soft tissue tumors and 2 cases of buccal penetrated defects. All the musculocutaneous flaps survived with good texture, color and thickness.</p><p><b>CONCLUSIONS</b>The island sternocleidomastoid myocutaneous flap is an ideal flap for large buccal composite tissue defect with reliable blood supply. It is easily performed and very practical.</p>

Clinic application of compound flap pedicled with arterial arch of palpebral margin / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the clinic application of compound flap pedicled with arterial arch of palpebral margin in repairing severe full defect of eyelid.</p><p><b>METHODS</b>According to eyelid structure and the defect size, the two compound flaps were designed beside the defect based on the arterial arch of the palpebral margin. If the defective area was too large, the lateral compound flap may be extended to lower or upper eyelid 0.5 cm away from the outer canthus, then cut and propelled the two compound flaps to repair the full eyelid defect.</p><p><b>RESULTS</b>20 cases had been cured with this method since 1998. In this cases, 4 cases were basal cell carcinoma of eyelid, 2 cases were squamous carcinoma, 3 angiomas, 6 chromatophore nexuses, 3 traumatic defects, 2 congenital defects. The largest length of eyelid full defect was 1.7 cm and the smallest was 0.8 cm. 6 cases were upper eyelid defect and 14 cases were lower eyelid defect. All the compound flaps survived completely without any complications. All cases obtained satisfactory results functionally and esthetically.</p><p><b>CONCLUSIONS</b>Repairing full eyelid defect with the compound eyelid flap is the same kind tissue repairing. It can not only provide enough tissues to primary repair large full defect of the upper or lower eyelid to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities. The arterial arch of the palpebral margin is constant and the blood supply of the compound flap is reliable. It is an ideal method of repairing the eyelid defect.</p>

Experience of vaginal reconstruction by using a pudendal-thigh island flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate a pudendal-thigh island flap for vaginal reconstruction.</p><p><b>METHODS</b>Forty-seven patients with congenital absence of vagina were undergoing the treatment. Based on the pedicle including the posterior labial neurovascular bundle, a pudendal-thigh island flap was designed and raised in the groin crease just lateral to the labia majora under the deep fascia. It was then transferred to the tunnel between the urethra and the anus for reconstruction of the vagina.</p><p><b>RESULTS</b>From May of 1993 to July of 2001, 47 patients were successfully treated for the vaginal reconstruction with the flap. The results were satisfactory without complications.</p><p><b>CONCLUSION</b>The above mentioned technique could be a safe and effect method for vaginal reconstruction with the advantages of reliable blood supply, good sensation and few complications. The areaes with the bilateral pudendal-thigh could be large enongh for the vaginal reconstruction without problem of the donor closure.</p>