Reconstruction methods for and cosmetic evaluation of external nasal tumour resections: flap versus graft.

Nose reconstruction is challenging given the three-dimensional structure and free edge, and various methods have been reported. In general, local flaps provide cosmetic outcomes that are better than those following skin grafts, but there are no published comparative studies on Asians. To determine whether local flaps or skin grafts may optimally be used to reconstruct external nasal defects among Asians. We retrospectively collected data on patients who underwent external nasal tumour resection and reconstruction by 14 plastic surgeons in eight Japanese institutes from 2009 to 2021. The cosmetic results were scored by 14 surgeons using anonymized preoperative and six-month postoperative photographs. Scores for each reconstruction method were statistically evaluated. In total, 86 cases were enrolled; 57 received local flaps and 29 received skin grafts. Most local flaps showed better outcomes compared to skin grafts, but this was not the case for nasolabial and forehead flaps. Notably, local flaps placed in the nasal ala tended to be less successful than flaps placed elsewhere; only the bilobed flap scored better than skin grafts. The defect site did not affect the results of skin grafts. For Asians requiring nasal reconstruction, local flaps provide better cosmetic outcomes than skin grafts, except for those in the nasal ala. Skin grafts may be a good alternative when the bilobed flap is unavailable for the nasal ala.

Gustilo Type III Open and Comminuted Tibial Fractures Managed by Simultaneous Combination of a Free Latissimus Dorsi Muscle Flap and Ilizarov External Fixation: A Case Report.

CASE: A 70-year-old woman who sustained Gustilo type III open and comminuted tibial fractures presented with extensive soft-tissue defect. Definitive surgery was performed using a free latissimus dorsi muscle flap for the extensive soft-tissue defect and Ilizarov external fixation (IEF) to stabilize the fractures and arthrodese the ankle. Ankle arthrodesis was accomplished by the wires penetrating the implanted muscle flap. CONCLUSION: The combined free flap and IEF management protocol described in this report was effective in achieving early weight-bearing and prompt bone healing in an elderly patient with poor bone quality and extensive open and comminuted fractures.

Proximal nail fold flap for digital mucous cyst excision.

The skin covering a digital mucous cyst is often very thin and is often excised with the cyst. Thus, transfer of a skin flap is needed for the defect. We have developed a proximal nail fold flap technique by which the thin skin covering the cyst can be preserved. We conducted a retrospective study to assess the effectiveness and reliability of this technique for digital mucous cyst excision. The study group comprised 26 patients treated for 28 digital mucous cysts. The flap was elevated on the nail matrix to expose the distal interphalangeal joint capsule. To preserve the skin in cases in which the skin covering the cyst was exceptionally thin, we did not excise the upper part of the cyst wall. Excision of the cyst and stalk was successful in all cases. Additional excision of the joint capsule or osteophyte(s) was achieved in 20 cases and 5 cases, respectively. No flap necrosis, skin defect or nail deformity resulted. Three of the cysts recurred and were treated successfully by reoperation involving the same flap elevation technique. We conclude that the proximal nail fold flap is useful for excision and reliable for wound coverage after digital mucous cyst excision. J. Med. Invest. 63: 278-280, August, 2016.

Severe radiation-induced injury after cardiac catheter ablation: a case requiring free anterolateral thigh flap and vastus lateralis muscle flap reconstruction on the upper arm.

Although cases of radiation-induced skin injury after fluoroscopically-guided procedures have been reported since 1996, diagnosis and treatment of such injury remain difficult. We present the case of a patient who complained of two ulcers, one on his right arm and one on his back, and limited motion of the right elbow joint after repeated cardiac radiofrequency catheter ablations. After resection of the skin ulcer on the patient's arm and of degenerated tissue in the distal part of the triceps brachii muscle, a combined free flap incorporating an anterolateral thigh flap and vastus lateralis muscle flap was transplanted. In the present case, this combined flap was very useful for simultaneous reconstruction of the muscle and skin defects under and over the tendon because the muscle flap and skin flap could be arranged separately.

Flap monitoring by transcutaneous PO2 and PCO2: importance of transcutaneous PCO2 in determining follow-up treatment for compromised free flaps.

The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO (2)) and transcutaneous carbon dioxide pressure (TcPCO (2)) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO (2) and TcPCO (2) were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO (2) decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO (2) increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO (2) more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO (2) 80 mmHg or less, survived completely without further treatment. The TcPO (2) of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO (2) is more sensitive than TcPCO (2) to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO (2) alone. The authors believe that a congested flap with a TcPCO (2) more than 90 mmHg requires further treatment.

Sarpogrelate hydrochloride, an antagonist of 5-hydroxytryptamine receptor, improves skin flap survival and suppresses thrombus formation in injured microvessels of rabbits.

The authors carried out two studies to examine the effects of the 5-hydroxytryptamine receptor antagonist, sarpogrelate hydrochloride (SH), on flap necrosis. The first study measured survival rates and included histologic examination of random-pattern skin flaps in rabbits. The second study assessed the time to complete obstruction of blood flow with the artificial thrombus formation method, and the time for leukocytes to adhere to the endothelium of microvessels in a rabbit-ear chamber. The treatment groups were injected with SH. The survival rates of skin flaps in the SH-treated group were increased significantly. Histologic examination of vessels in the control group revealed that vessels in the deep dermis were obstructed completely by thrombi, whereas such vessels were not obstructed in the SH-treated group. Thrombus formation time and leukocyte adhesion time in the SH-treated group were prolonged and decreased, respectively. Thus, SH maintained flap circulation and promoted flap survival by preventing thrombus formation.