Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects.

The principle of the V-Y advancement flap has been used since its first description by Blasius (1848) for reconstruction of smaller defects. We wish to describe V-Y advancement flaps, the design of which includes distinct perforator or fascial feeder vessels, which may originate from periosteum, muscle, cutaneous nerve or from large tendon sheaths. These flaps are planned in an oblique manner when there is a defect over the anterior, antero-lateral or antero-medial aspect, and in a vertical manner when there is a defect over the posterior aspect of the leg. The main advantage of this design is the ability to close the secondary defect primarily, allowing adequate cover of the defect, particularly in the pre-tibial region, without the unsightly divot left by a split skin graft in this area. When the flap includes branches of the long saphenous nerve on the medial aspect, superficial peroneal nerve laterally or sural nerve posteriorly it results in a sensate flap, giving protection in this vulnerable area, which has previously not been possible. We describe 40 cases where perforator-based V-Y advancement flaps have been used to cover large defects of the lower leg following excision of malignant skin lesions and in selected trauma cases that do not involve degloving injuries. This technique allows adequate soft tissue cover in the pre-tibial area and around the ankle with excellent aesthetic results. The planning, operative technique and the results with case presentations have been described.

Use of type III venous flaps: single- and multistaged procedures.

Two cases are presented in which the principles of type III (arteriovenous) venous flaps were applied in single- and multistage procedures. In the first case, the flap was used for correction of a post-thermal burn adduction contracture of the first web space of the hand as a one-stage microvascular free flap and in the other for the resurfacing of a post-traumatic defect on the dorsum of the foot as a two-stage transfer. A brief review, along with the technique, advantages, mode of survival, and feasibility of using type III venous flaps, is presented. A simple classification of type III venous flaps is also suggested.

The tongue flap in the primary treatment of cleft palate: a report of 19 cases.

The conflict between the need to create an effective levator palati sling on the one hand, and the morbidity of raising oral mucoperiosteal flaps on the other, is highlighted in the treatment of clefts of the bony palate, with a limited review of the existing literature. A method in which an anteriorly based tongue flap is used to cover the raw areas resulting from displacement of the oral mucoperiosteal flaps to reconstruct and maintain the levator palati sling in its proper place is described in the primary treatment of cleft palates in 19 cases. One of these cases is presented in detail with the help of illustrations. Comments are added about the method employed. The future plan of action in regard to this method is mentioned.