Clinical evaluation and comparison of three surgical procedures for treatment of root surface exposure after epulis resection / 中华口腔医学杂志

Objective@#To evaluate and compare the clinical effects of three surgical procedures for the periodontal treatment of root surface exposure after resection of epulis.@*Methods@#Thirty patients with epulis were selected in this study and the exposed root surfaces of the patients′ teeth were covered with laterally transposition flap, laterally pedicled transposition flap or coronally advanced flap combined with a connective tissue graft in the treatments of epulis. At the time of follow-up during the operation, 3 months after operation and 6 months after operation, respectively, the color, shape and quality of the gum in the operation area and the coordination of the diaphragm and diaphragm were observed, and the root surface exposure (recession depth, RD) and angle were recorded. Keratinized tissue height (KTH), root coverage rate (RC) and patients′ satisfaction with the surgery were also recorded.@*Results@#The flap widths in groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft were significantly wider than that in the group of laterally transposition flap at three-month and six-month follow-ups after the surgery. The width of keratoderma [(2.70±1.16) mm] in the group of laterally transposition flap was significantly lower at 6 months postoperatively than that in the other two groups [(4.80±1.14) and (4.90±1.66) mm, respectively] (P<0.01). At the 6th month after surgery, the root flap coverage was at the lowest level [(24±43)%] in the group of laterally transposition flap, and it was significantly lower than that in the other two groups [(80±23)% and (86±24)%, respectively] (P<0.01). There was no significant difference of the root flap coverage between groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft. At the time of follow-up, patients were satisfied with the aesthetic effects of the three surgical procedures.@*Conclusions@#After the resection of the gingival tumor, the defect of the gingiva is caused. The laterally pedicled flap and pedicled flap combined with connective tissue transplantations for soft tissue repairing can achieve satisfactory aesthetic effects which are superior to the effect of simple flap technique.

The Banner-type Transposition Flap with an Auricular Cartilage Graft for Lower Eyelid Reconstruction / 대한피부과학회지

No abstract available.

The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium

PURPOSE: In the present study, the effect of the inferior conjunctival transposition flap in patients with recurrent pterygium was evaluated. METHODS: This study included 60 patients (63 eyes) that received pterygium surgery with inferior conjunctival transposition flap and diagnosed with recurrent pterygium. The inferior conjunctival transposition flap obtained from lower bulbar conjunctiva was secured with 8-0 VICRYL® after removal of recurrent fibrovascular tissues. This study was retrospectively reviewed for recurrence and postoperative complications in patients with a minimum follow-up period over 6 months. RESULTS: The mean follow-up period was 5 years and 8 months (range; 6 months to 14 years). Corneal recurrence occurred in 4 eyes (6.3%) and conjunctival recurrence was observed in 2 eyes (3.1%) among a total of 63 eyes. Conjunctival recurrence was not the progressive type and limited to the limbus and suture site. One case of corneal recurrence required additional symblepharolysis and auto conjunctival graft. Although mild flap congestion, hemorrhage and granuloma were observed, these cases improved during the follow-up period. CONCLUSIONS: The inferior conjunctival transposition flap procedure can be regarded as an effective surgical treatment option for recurrent pterygium.

Surgical treating experience of lower eyelid longitudinal laceration combined with lower lacrimal canaliculi disruption / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To discuss the clinical applications of methods to localize nasal cut ends and the effects of Z-plasty in the surgeries for lower eyelid longitudinal laceration combined with lower lacrimal canaliculi disruption. METHODS: From September, 2010 to October, 2013, a total of 37 patients ( 37 eyes ) with lower eyelid longitudinal laceration combined with lower lacrimal canaliculi disruption were operated for anastomosis of lacrimal canaliculi disruption and suture of lower eyelid longitudinal. Different methods to search for the nasal cut ends of lacerated lacrimal canaliculi, such as “under a microscope directly”, “guided by probing needle” and“pigtail curved probe”. Then, to repair lower eyelid longitudinal laceration with Z-plasty transposition flaps. Follow up was 3mo~2a after operation. RESULTS: All nasal cut ends could be found successfully on 37 patients;Lacrimal duct unobstructed in 31 patients (83. 8%), improved in 5 patients (13. 5%), invalid in 1 patient (2. 7%),the overall successful rate was 97. 3%; the eyelids repair was satisfactory, small scars, the appearance and function was normal. CONCLUSION: The nasal cut ends can be found successfully by “directly under a microscope”, “guided by probing needle” and“pigtail curved probe”;the effect of silicone drainage tube used as lacrimal canaliculi bracket is satisfactory; most patients gained excellent recovery for both appearance and function after Z-plasty.

Paraspinal Transposition Flap for Reconstruction of Sacral Soft Tissue Defects: A Series of 53 Cases from a Single Institute

STUDY DESIGN: Case series. PURPOSE: To describe paraspinal transposition flap for coverage of sacral soft tissue defects. OVERVIEW OF LITERATURE: Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature. METHODS: The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cmx5 cm) to extensive (21 cmx10 cm). The median age of the patients was 58 years (range, 16-78 years). RESULTS: There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores. CONCLUSIONS: The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

Rhombic Flap Reconstruction after Mohs Micrographic Surgery for Premalignant Lesions and Skin Cancer / 대한피부과학회지

BACKGROUND: Recently, increasing attention in the field of dermatological surgery has been paid to treating skin cancers, including both premalignant and malignant lesions. The rhombic flap, one of the transposition flaps, is an outstanding method for reconstructing small- to medium-sized defects after skin surgery. OBJECTIVE: The aim of this study was to evaluate our clinical results with the rhombic flap for reconstruction after Mohs micrographic surgery (MMS), including the cosmetic aspects, complete surgical excision, and recurrence. METHODS: Between June 2010 and September 2013, 37 patients who were diagnosed with premalignant and malignant lesions on the face and extremities were treated with rhombic flaps for the reconstruction of primary cutaneous defects following lesion excisions. We reviewed the medical records and evaluated the clinical aspects and surgical treatment outcomes, and the cosmetic results were scored as excellent, good, fair, or poor. In addition, we assessed the surgical treatment outcomes using the Vancouver Scar Scale (VSS). RESULTS: Thirty-seven patients received 37 rhombic flaps. The cosmetic results of the reconstructions were gratifying, and 28 of 37 patients (75.7%) showed good to excellent results. Specifically, the cosmetic results of the modified rhombic flaps were great, and 27 of 30 patients (90.0%) showed good to excellent results. The cosmetic results on the VSS showed a high mean score (2.9). CONCLUSION: Our study showed that the rhombic flap is a simple reconstruction method and provides aesthetically pleasing results. Therefore, it could be a useful option for reconstructing defects of the face and extremities.

Rhombic Transposition Flap: Its Modifications and Application in Skin Tumor Surgery / 대한피부과학회지

BACKGROUND: There is currently an increasing demand in the field of dermatology for surgical therapy for treating skin cancers, including premalignant and malignant lesions. The rhombic (often referred to as rhomboid) flap is a transposition flap that is an excellent option for reconstructing small to medium-sized defects after skin surgery. Objective: We analyzed our clinical results of using the rhombic flap for reconstruction after skin cancers, and especially in regard to the aspects of cosmesis, complete surgical excisions, recurrence and the scope of dermatosurgical care. METHODS: From July 2004 to May 2008, forty one patients who were diagnosed with non-melanoma skin cancer or benign tumor on the face, trunk and extremities were treated with a rhombic flap or its modified form for the reconstruction of primary cutaneous defects following the excision of tumor. The cases were divided into groups according to the cosmetic units and the clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair or poor. RESULTS: Forty-two rhombic transposition flaps were done in 41 patients. Among these patients, 16 were men and 25 were woman. There were 23 cases of malignant tumor and 19 cases of premalignant and benign tumors. Thirty two cases were located on the face (12 on the cheek, 7 on the nose, 5 on the forehead and periorbital area, 2 on the mouth and 1 on the ear) and 10 cases were located on the other sites (4 on the trunk, 2 on the buttock, 2 on the finger, 1 on the arm and 1 on the leg). There was tumor recurrence in one case. The cosmetic results of reconstructions were satisfactory, and 29 cases out of the 42 (69%) cases showed good to excellent results after 6 months. CONCLUSION: Rhombic transposition flap can be a simple and good choice for reconstructing cutaneous defects on the face, trunk and extremities after skin tumor surgery. It could also be applied to the defect with limited skin laxity without tension or distortion, and it especially showed excellent and good cosmetic results in most of the cases.

Rhombic Transposition Flap: Its Modifications and Application in Skin Tumor Surgery / 대한피부과학회지

BACKGROUND: There is currently an increasing demand in the field of dermatology for surgical therapy for treating skin cancers, including premalignant and malignant lesions. The rhombic (often referred to as rhomboid) flap is a transposition flap that is an excellent option for reconstructing small to medium-sized defects after skin surgery. Objective: We analyzed our clinical results of using the rhombic flap for reconstruction after skin cancers, and especially in regard to the aspects of cosmesis, complete surgical excisions, recurrence and the scope of dermatosurgical care. METHODS: From July 2004 to May 2008, forty one patients who were diagnosed with non-melanoma skin cancer or benign tumor on the face, trunk and extremities were treated with a rhombic flap or its modified form for the reconstruction of primary cutaneous defects following the excision of tumor. The cases were divided into groups according to the cosmetic units and the clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair or poor. RESULTS: Forty-two rhombic transposition flaps were done in 41 patients. Among these patients, 16 were men and 25 were woman. There were 23 cases of malignant tumor and 19 cases of premalignant and benign tumors. Thirty two cases were located on the face (12 on the cheek, 7 on the nose, 5 on the forehead and periorbital area, 2 on the mouth and 1 on the ear) and 10 cases were located on the other sites (4 on the trunk, 2 on the buttock, 2 on the finger, 1 on the arm and 1 on the leg). There was tumor recurrence in one case. The cosmetic results of reconstructions were satisfactory, and 29 cases out of the 42 (69%) cases showed good to excellent results after 6 months. CONCLUSION: Rhombic transposition flap can be a simple and good choice for reconstructing cutaneous defects on the face, trunk and extremities after skin tumor surgery. It could also be applied to the defect with limited skin laxity without tension or distortion, and it especially showed excellent and good cosmetic results in most of the cases.

Effect of Inferior Conjunctival Transposition Flap Surgery for Primary Pterygium

PURPOSE: To evaluate the efficacy and safety of the inferior conjunctival transposition flap for primary pterygium surgery. METHODS: This study reviewed 59 eyes in 59 patients with primary pterygium who were treated with pterygium excision and an inferior conjunctival transposition flap. The inferior conjunctival flap was obtained from lower bulbar conjunctiva and was secured with 8-0 vicryl. Patients were followed-up on the third day after surgery and then at 1, 2, 4 and 12 weeks postoperatively. RESULTS: The mean patient age was 55.6 (ranging from 34 to 74) years. The mean follow-up period was 24.9 (ranging from 12 to 46) months. During the follow-up period, the pterygium recurred in one (1.7%) of the 59 eyes. There were no severe complications except for mild congestion and hemorrhage of the conjunctival flap. CONCLUSIONS: Inferior conjunctival transposition flap technique may be considered as a safe and effective method that reduces complications and recurrences after primary pterygium excision.

Repair of the Combined Defect of the Nasolabial Fold and Nose with Simple Primary Suture and Modified Transposition Flap / 대한피부과학회지

The performance of facial cutaneous reconstructive surgery requires understanding and application of many important principles. Facial surgical defects can be repaired by simple primary suture, secondary intention healing, skin graft or by cutaneous flap. Tissue reservoirs, mechanisms and effects of tissue movement, and favorable incision placement should be considered when planning a local flap repair for surgical defects. Surgical techniques that maximize the aesthetic and functional outcome should be conducted. Management of surgical defects of the nose is often challenging. Maintenance of an aesthetically and functionally normal nose requires careful preoperative planning and meticulous surgical technique. One of the challenges in nasal reconstruction is the lack of excess skin within the nasal cosmetic unit. We reconstructed the defect of the nasolabial fold and nose with simple primary suture and modified transposition flap and achieved a good cosmetic result.

A Case of Squamous Cell Carcinoma of the Ear Helix Successfully Treated with Rhombic Transposition Flap

Approximately 6% of all head and neck skin cancers arise from the external ear, of which squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common. Acquired helical rim defects can be caused by injury or after excision of a tumor. Since many patients feel that the auricle has a functional and cosmetic importance, it is crucial to consider the esthetics. In cases where the defect exposes bare cartilage, second-intention healing is usually not achieved. Therefore, full-thickness skin grafts have been adopted, but the healing time is long and in many cases, mismatch of color between the grafted skin and the surrounding ear has been observed. Alternatively, reconstruction with flaps may provide optimal coverage. Among the many possible flap designs, the rhombic transposition flap has become widely utilized in dermatologic surgery, due to its simplicity and versatility. Herein, we report a case of SCC on the superior helical rim (of which the cartilage was spared) successfully managed with a rhombic transposition flap. The surgical procedure had been relatively simple and the resultant ear helix was free from deformity. In future, we recommend that defects of the ear helix, which have an intact cartilage, should be treated with a rhombic transposition flap to give a successful cosmetic and functional outcome.

A Case of Lentigo Maligna Melanoma Treated with Mohs Surgery Adopting Lateral Based Transposition Flap / 대한피부과학회지

Lentigo maligna melanoma (LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM located on the left lower eyelid of an 86-year-old woman. This female patient presented with a longstanding irregular brownish patch containing black macules consistent with LMM. There are several treatment modalities for removing the LMM lesion. However, considering the functional and the aesthetic aspect of the lower eyelid, we performed Mohs micrographic surgery to remove the lesion, and lateral based transposition flap was employed to reconstruct the resultant defect on the left lower eyelid.

Reconstruction of Ischial Pressure Sore by Using Posterior Thigh Transposition Flap

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.

Omental Transposition Flap and Pectoralis Major Muscle Flap for Reconstruction of Wide Sternal Defect

Infected median sternotomy wounds represents one of major complication of cardiothoracic surgery. Although the incidence is less than 1%, its associated morbidity, mortality, and "cost" remain unacceptably high. For the treatment of this recalcitrant wound infections, most patient underwent radical debridement with sternectomy and reconstructed by muscle flaps. The most common combination of flaps being the omentum and bilateral pectoralis major musculocutaneous flaps. In our case, 2 patients who had extensive mediastinal infection at sternotomy wound underwent omental transposition flap pedicled on the right gastroepiploic artery and pectoralis major muscle flap. Omentum has rich lymphatics and high vascularity enough to revascularize the ischemic tissues. Using the greater omentum for infected median sternotomy wound combined with other muscle flap is an useful method for reconstruction of large defects invading lower 1/3 of sternum or retrosternal dead space.

A Case of Recurrent Preauricular Cyst Treated with Retroauricular Transposition Flap Using Superior Auricular Artery / 대한이비인후과학회지

The retroauricular flap has been known as a useful material for reconstruction of nose, auricle, and other facial area. A key point of success using a retroauricular flap in the reconstruction surgery is the preservation of feeding artery. This method also has advantages of co-transplantation of hair, a good color match for the face, and of not having to leave a conspicuous donor site. Two main blood vessels of retroauricular flap are posterior auricular and superior auricular artery. Although the former has been widely used, the retroauricular transposition flap using the latter is easier and time-saving than other techniques in the reconstruction of anterosuperior defect of auricle. Recently, we experienced a case of recurrent preauricular cyst, reconstructed with retroauricular transposition flap using superior auricular artery and report this case with literature review.

Recurrent Basal Cell Carcinomas Treated by Rhombic Transposition Flap / 대한피부과학회지

We report two cases of recurrent BCC in a 51- year-old woman and a 39-year-old woman which had been misdiagnosed aind treated as pigrnented nevi. Complete surgical resections were done followed by reconstruction using local rhombic transposition flaps. Final cosmetic results were excellent and no local recurrence was noticed during one year follow-up.

Variations of the Transposition Flap for Facial Reconstruction after Mohs Micrographic Surgery of the Basal Cell Carcinoma

BACKGROUND: The transposition flap is one of the most useful methods of facial reconstruction after Mohs micrographic surgery of the basal cell carcinoma, but occasionally some variations are needed. OBJECTIVE: We present our experience with several variations of the transposition flap to overcome the disadvantages of classic rhomboid flaps. METHODS: We performed the Webster 30-degree angle flap on the lower eyelid, the double 30-degree angle flap on the temple area and the nasolabial flap on the ala nasi. RESULTS: These variations of the transposition flap gave no complications such as ectropion, tissue distortion, protrusion, or trapdoor deformity. CONCLUSION: The variations of the transposition flap in our cases might be of help in selecting the ideal method in facial reconstruction.

Reconstruction of a Skin Defect Following Excision of Basal Cell Carcinoma in the Nose by Labial - alar Transposition Flap / 대한피부과학회지

We report a case of nasal BCC in which the skin defect is reconstructed by a local labial-alar transposition flap. In nasal reconstruction, the local flap is the preferred methods. This flap has the advantage of a more acceptable scar, is easy to make, and less edematous than a superiorly based flap. However, for defects larger than 1cm, this flap is not advisable and the defect has to be located adjacent to th nsolabial fold.