Clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures / 中华烧伤杂志

Objective@#To explore the clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures.@*Methods@#From December 2008 to December 2018, 21 patients with axillary burn scar contractures were admitted to our department. There were 12 male patients and 9 female patients, aged 2-48 years, with an average of 17.4 years. According to the characteristics of axillary scar contractures, the patients were divided into type Ⅰ of 5 patients, type Ⅱ of 2 patients, type Ⅲ of 5 patients, and type Ⅳ of 9 patients. The preoperative abduction ranges of shoulder joint were 20-150°, with an average of 68.33°. The wound areas after resection and release of scar contractures ranged from 12 cm×4 cm to 33 cm×11 cm, with an average of 18.13 cm×5.41 cm, and the wounds were repaired with scapular region flaps pedicled with circumflex scapular artery in the areas of 14 cm×5 cm-35 cm×14 cm, with an average of 20.19 cm×7.71 cm. The donor sites of 5 patients were expanded prior to flap repair operation, and the other 16 patients were repaired by direct transfer of flaps. The donor sites were closed directly. The type, number, and transfer way of scapular region flaps were calculated, and the improvement of abduction angle of shoulder joint and condition of the flaps were observed during follow-up after operation.@*Results@#There were 5 ascending scapular flaps, 13 scapular flaps, and 3 parascapular flaps. The flaps were transferred through open wounds in 18 cases, subcutaneous tunnel in 1 case, and trilateral foramia in the remaining 2 cases. All the flaps survived after operation. During follow-up of 3 months to 5 years, with an average of 19.4 months, the abduction angles of shoulder joints were 90-180°, with an average of 137.62°, which showed that the abduction function of shoulder joint improved obviously. The texture of flap was soft, and the color of the flap was close to the surrounding skin. The patients and/or their family members were satisfied with the operation results.@*Conclusions@#The scapular region flap pedicled with circumflex scapular artery has a lot of advantages, including a long vascular pedicle, simple technique for flap harvest, a hidden donor site, and flexible and diverse transfer mode of flap. It is an effective option for clinical reconstruction of severe axillary burn scar contracture.

Island scapular flap based on transverse branch of circumflex scapular artery for axillary burn scar contracture / 中华医学美学美容杂志

Objective Island scapular flap (ISF) based on transverse branch of circumflex scapular artery is less reported than ISF based on ascending or descending branch. This article presented authors' experiences in correction of severe axillary burn scar contracture with ISF based transverse branch of circumflex scapular artery. Methods ISFs based transverse branch was harvested in 12 patients with 15 severe axillary burn scar contracture, rotating an arc of about 180°. Flap size was between 12 cm× 5cm to 20 cm × 10 cm. The donor site was closed primarily. Results All 15 flaps survived completely and axillary burn scar contracture was corrected successfully. 8 patients were satisfied with both the functional and aesthetic results after 1-3 years' follow-up. Conclusion ISF based transverse branch of circumflex scapular artery is a good choice for reconstruction of severe axillary burn scar contracture, especially for female patients or ones whose ISF based on ascending or descending branch could not be harvested because of formation of hypertrophic scar in donor site.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Functional reconstruction of dento-palatal and maxillary defect using staged operation of prefabricated scapular free flap and dental implants

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

Free Vasularized Scapular and Parascapular Flap / 대한정형외과학회잡지

The trestment of extensive soft tissue injury of the extremities is known to be one difficulty in the field of Orthopedic Surgery. The authors present a study of 55 free vascularized scapular flaps, 12 free vascularized parascapular flaps and 9 combined scapular and latissimus dorsi flaps for extensive soft tissue injury of the extremities at the Department of Orthopedic Surgery, Severance Hospital from March 1983 to December 1988. The results of the study are as follows:1. The pedicles of the flap were consistent in length and diameter. 2. The flap was uniform and relatively thin in thickness in free scapular and psrascapular flaps 3. There was no limitation to motion of the shoulder despite excision of the scapular and parascapular flap. 4. Primary closure of the donor flap was feasible in almost all cases. 5. Reconstruction of a 1arge soft tissue defect was possible with scapular and parascapular flap in one stage. 6. The free vaseularized scapular flap and parascapular flap would be recommended of one-stage reconstructional surgery for extensive soft tissue defects.

A Combined Scapular Flap and Latissimus Dorsi Flap / 대한정형외과학회잡지

The treatment of extensive soft tissue injury of lower extremities is known to be one difficulty in the field of orthopedic surgery. At present, reconstructive surgery with free flap is being employed under the microscopy actively. But the size of defect is found larger than the maximum size of one free flap frequently. The authors present 6 cases of a combined scapular flap and latissimus dorsi flap for extensive soft tissue injury of the lower extremities at the department of orthopedic surgery of Severance hospital, during years period from 1983 to 1985. The results of the study are as follow: l. A one stage reconstruction of extensive soft tissue injury was done with a combined scapular flap and latissimus dorsi flap. 2. In spite ofa few complications of donor and recipient sites, the advantage of combined scapular flap and latissimus dorsi flap exceed the any methods that have been employed in functional and plastic aspects. 3. There was no limitation of motion of the shoulder in spite of the excision of the large combined scapular flap and latissimus dorsi flap around the axillary area. 4. The primary closure of the donor sites was feasible. 5. The reconstructive surgery of the extensive soft tissue injury using the above combined scapular flap and latissimus dorsi flap can be used without restriction as to the age of the patient.

A Combined Scapular Flap and Latissimus Dorsi Flap / 대한정형외과학회잡지

The treatment of extensive soft tissue injury of the lower extremities is known to be one difficulty in the field of orthopedic surgery. At present, reconstructive surgery with large cutaneous flaps is being employed, and the authors present 2 cases of a combination of flaps for extensive soft tissue injury of the lower extremity at the Department of Orthopedic Surgery of Severance Hospital during a 5 months period from June, 1983 to November, 1983. The results of the study are as follows: 1. A one-stage reconstruction of extensive soft tissue injury was done with a combination of a scapular and a latissimus dorsi flap. 2. There was no limitation of motion of the shoulder in spite of the excision of the scapular and the latissimus dorsi flaps around the axillary area. 3. The primary closure of the donor flap sites was feasible. 4. The reconstructive surgery of the extensive soft tissue injury using the above combination of the scapular and latissimus dorsi flaps can be used without restriction as to the age of the patient.

The Free Scapular Flap / 대한정형외과학회잡지

The simple cutaneous flap and myocutaneous flap are presently being employed in skin defects since Daniel and Taylor first tried the free flap in 1973. But the simple cutaneous flap which is being employed at present has problem in the flap size, the variation and complexity of the anatomical structure and postoperative complication of the donor site. On the other hand, the myocutaneous flap has partially solved the problem of a simple cutaneous flap, but the myocutaneous flap remains inadequate when thin flap reconstruction only is required. The scapular flap was first suggested by Saijo in 1978 and Santos described the anatomical aspects of the scapular flap in 1980. Since Gilbert first clinically utilized the scapular flap, it was seen to be much more suitable for relatively thin cutaneous flaps, The authors present 10 cases of free scapular flap performed at the Department of Orthopedic Surgery of Severance Hospital during the period of one year and 2 months from April, 1983 until June, 1984. The results of the study are as follows: 1. The scapular flap was of medium size in 9 cases and large in one case. 2. The pedicles of the scapular flaps were constant in length and diameter. 3. The flap was uniform and relatively thin in thickness. 4. The reconstruction of a large soft tissue defect was possible with a combination of scapular flap and latissimus dorsi myocutaneous flap done in one stage. 5. The donor site of a scapular flap can be primarily closed. 6. The free scapular flap is an excellent choice when intermediate-sized or large-sized uninnervated flap coverage is necessary for soft tissue damage.