Subgaleal-subperiosteal flap for forehead and scalp reconstruction.

Forehead soft tissue defects are most usually associated with motor vehicle accident and less commonly with physically assault, trauma resulting from falls, malignant tumor resection, and burn injury. These kinds of defects incorporate only the soft tissue in general but sometimes there are accompanying bone defects. Different reconstruction alternatives can be preferred depending on the defect type and the amount of tissue loss. In this report, a patient who underwent surgery for tumor excision is presented. After surgical excision, denuded frontal bones were covered with subgaleal-subperiosteal flap. Split thickness skin graft harvested from the medial upper arm was used for skin resurfacing. Optimal healing and cosmetic outcome were obtained using 1-step surgical procedure.

Comparison of clinical outcomes between single- and multiple-perforator-based free thoracodorsal artery perforator flaps: clinical experience in 87 patients.

BACKGROUND: Although thoracodorsal artery perforator flaps have not gained popularity in the reconstructive era, the results of recent studies regarding the vascularity of thoracodorsal artery perforator flaps are promising. In the present study, the authors aimed to determine the clinical outcomes of free multiple-perforator versus single-perforator thoracodorsal artery perforator flaps. METHODS: Eighty-seven patients with various defects underwent reconstruction with free thoracodorsal artery perforator flaps. The flap was used for upper extremity reconstruction in 43 patients (49.4 percent), for head and neck reconstruction in 16 patients (18.4 percent), and for lower extremity reconstruction in 28 patients (32.2 percent). Of the 87 flaps, 48 (55.2 percent) were based on a single perforator, whereas 39 flaps (44.8 percent) were based on multiple perforators. The single- and multiple-perforator-based thoracodorsal artery perforator flaps were compared regarding clinical outcomes and morbidity. RESULTS: The morbidity rate was found to be significantly higher in the single-perforator-based group. Of the patients in the single-perforator group, seven patients had transient venous congestion, five were heparinized and treated with leeches for permanent venous congestion, six had partial necrosis, and one had total necrosis. In the multiple-perforator-based group, two patients had transient venous congestion, and no partial or total necrosis was observed. CONCLUSION: Despite the fact that dominant perforators may often be absent, this study showed that a multiple-perforator-based thoracodorsal artery perforator flap may be more reliable with safe vascularity compared with a single-perforator-based flap.

Pre-auricular and ascending helical free composite flap in reconstructing an alar defect resulting from a human bite: a case report.

Full-thickness defects of the nose result in severe aesthetic and functional problems. Nasal alar defects are frequently caused by trauma, surgical resection or congenital deformities, yet an alar defect due to a human bite is quite rarely seen. For a successful alar reconstruction, selected tissue must be similar to nasal structures in texture, color and thickness. The structural similarities between the nasal alae and auricular helices have allowed the use of free helical composite flaps for the repair of nasal defects. In this article, we report a 36-year-old male patient who had a right alar defect caused by a human bite. The defect was successfully reconstructed with a reverse flow superficial temporal vessel based pre-auricular and ascending helical free composite flap. Since the color and the texture of the flap was compatible with the nose integuments, this flap enjoyed of an optimal integration in the central facial area.

The bipedicled latissimus dorsi myocutaneous free flap: clinical experience with 53 patients.

The Latissimus dorsi musculocutaneous flap is a valuable workhorse of the microsurgeon, especially in closing large body defects. One of the pitfalls in harvesting the flap, is particularly in its inferior aspect which may be unreliable. Here we report a series of 53 patients who were undergone bipedicled free latissimus dorsi musculocutaneous free flaps for extensive tissue defects. The age of patients were between 5 and 64 and all of them were males. The wound sizes in these patients ranged between 31-35 x 10-12 cm and flap dimensions were between 38-48 x 6-8 cm. Perforator branches of the 10th intercostal vessels were dissected and supercharged to the flaps to reduce the risk of ischemia of the inferior cutaneous extensions. The secondary pedicles were anastomosed to recipient vessels other than the primary pedicles. Recipient areas were consisted of lower extremities. Four patients suffered of early arterial failure in the major pedicle and all revisions were successfully attempted. Neither sign of venous congestion nor arterial insufficiency were observed at the inferior cutaneous extensions of the flaps, and all defects were reconstructed successfully. All donor sites were primarily closed, only two patients suffered from a minor area of superficial epidermal loss at the donor site, without suffering any adjunct complications. In conclusion coverage of large defects can be safely performed with extending the skin paddle of latissimus dorsi flap as a bipedicled free flap.

Bifid mandibular condyle: a rare disorder.

Bifid mandibular condyle is a rare disorder and little is known about the etiology and pathogenesis. We reported a patient with left bifid mandibular condyle with a history of trauma. There was no limitation of mouth opening but the patient was complaining of pain while chewing. Underdeveloped lateral head of the bifid condyle was excised at the level of condylar neck under general anesthesia. The patient healed without any problem. Microscopic evaluation of the excised condyle supported a congenital etiology. Although most cases of the bifid condyle discovered by chance it should be recognized and treated by plastic surgeons interested in craniomaxillofacial surgery.