The use of buccal fat pad in the management of osteoradionecrosis has not been described previously. A series of 10 consecutive cases of osteoradionecrosis treated with a combination of sequestrectomy and buccal fat pad is presented. The data were obtained by reviewing operative and medical records. The combination of sequestrectomy and buccal fat pad flap was successful in 86% of cases of stage II osteoradionecrosis and in 0% of cases of stage III. The overall success rate was 60%. Based on the result of this series, this treatment regime appeared to be beneficial in stage II osteoradionecrosis.
A case of marked penile skin loss following an adult circumcision is presented. The surgical requirement is to provide a soft and flexible cover for the penis to facilitate return of sensation and function. The two stage bilateral dartos musculocutaneous flaps offer an acceptable surgical alternative.
Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.
The pudendal thigh flap or the Singapore flap is a versatile flap that can be used in the repair of recto-vaginal fistulae. Apart from the potential problem of hair growth, this neurovascular flap proves to be surprisingly simple in technique, robust and has a high potential for normal or near-normal function.
Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient's age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flaps, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration. The infection rate was 16.4% and this had a strong correlation with the free flap failure in our study population. Postoperative anaemia could adversely affect the tissue oxygenation of the free flap and delay the re-exploration due to the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed. The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary both for the preoperative planning of free flap surgery as well as salvaging a failure.
Reverse abdominoplasty was originally described for epigastric lift. Since the work by Baroudi and Huger in the 1970s, it has become clear that reverse abdominoplasty application can be extended beyond just aesthetic procedure. Through the knowledge of anterior abdominal wall vascularity, its application had included reconstructive prospect in the coverage of various chest wall defects. To date, reverse abdominoplasty flap has been used to reconstruct unilateral anterior chest wall defect or for larger defect but only in combination with other reconstructive techniques. Here, we presented a case where it is used as a standalone flap to reconstruct bilateral anterior chest wall soft tissue defect post-bilateral mastectomies in oncological resection. In conclusion, reverse abdominoplasty flap provided us with a simple, faster, and satisfactory reconstructive outcome.
Presented here is a case of a pharyngocutaneous fistula which was closed primarily using a sternomastoid muscle flap, without skin coverage, thus obviating the need for a three-layered closure. Providing an intermediate cover was sufficient for the closure because the mucosal lining on the inside and the cutaneous covering on the outside grew using the muscle for support.
PURPOSE: When soft tissue flaps are reflected for implant placement, the blood supply from the periosteum to the bone is disrupted. The aim of this study was to compare the effects of the flapless (FL) and full-thickness flap (FT) techniques on implant stability. Methods : Nine patients received 22 implants. The implants were placed using the FL technique on the contralateral side of the jaw; the FT technique was used as the control technique. Resonance frequency analysis (RFA) was performed at the time of implant placement and at 6 and 12 weeks after implant placement. RFA values were compared between the FL and FT groups and between time intervals in the same group. Results : The median (interquartile range [IQR]) RFA values at the time of implant placement were 75.00 (15.00) for the FL technique and 75.00 (9.00) for the FT technique. At 6 weeks, the median (IQR) values were 79 (3.30) for the FL technique and 80 (12.70) for the FT technique. At 12 weeks, the median (IQR) values were 82.3 (3.30) for the FL technique and 82.6 (8.00) for the FT technique. There were no significant differences between the 2 techniques at the time of implant placement, after 6 weeks or after 12 weeks, with p values of 0.994, 0.789, and 0.959, respectively. There were significant differences between the RFA values at the time of implant placement and after 6 weeks for the FL technique (p=0.028) but not for the FT technique (p=0.091). There were also significant differences between the RFA values at 6 weeks and the RFA values at 12 weeks for the FL technique (p=0.007) and for the FT technique (p=0.003). Conclusion : Periosteum preservation during the FL procedure will speed up bone remodeling and result in early secondary implant stability as well as early loading.
Nail bed injuries were commonly found concomitantly with fingertip injuries. Reconstruction of fingertip including the nail bed should be attempted at acute stage. Aim of the surgery was to restore as much finger length and achieve normal nail growth. In chemical burns, the initial presentation might not reflect the exact extent of injury. Appropriate acute management must be initiated while waiting for demarcation. We report a case of young stewardess who presented with fingertip chemical burn injury. Surgical debridement was done on third day post-injury. A cross-finger flap to cover skin defect and split-thickness nail bed grafting from the remnant of injured finger were done. Excellent functional and cosmetic outcome was achieved in 6 months. Surgical treatment in a chemical burn was similar to traumatic injury. Nail bed graft was the best option for nail bed reconstruction. In cases of soft tissue loss, advancement or pedicle flaps are beneficial.
The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to reestablish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.
High failure rate for recurrent palatal fistulas closure pose a great challenge to plastic surgeons. Tongue and facial artery musculomucosal (FAMM) flaps are the more commonly used flaps for closure of these recurrent fistulas. We report a case of a formerly inset FAMM flap to effectively close a previously repaired oronasal fistula.
Gastrocnemius flap is the workhorse for wound coverage in the proximal
tibia. It can be perform by general orthopaedic surgeon because it is done without the
need of microscopic instrumentation. Its coverage can be extended to cover the knee
and midshaft of tibia when skin overlying it is included in the flap. (Copied from article).
IntraLASIK is a LASIK surgery that involved IntraLase femtosecond laser for the corneal flap creating. The objective of this research was to investigate and compare the changes in tear status at 1 and 3 months after undergoing conventional IntraLASIK with Bausch & Lomb PlanoScan (PS) algorithm, Bausch & Lomb Zyoptix Tissue Saving (ZTS) algorithm, and wavefront-guided (WG) IntraLASIK with VISX CustomVue.
For the management of a full-thickness scalp avulsion injury, thorough wound debridement and immediate primary revascularization or a split-thickness skin graft may be necessary. Graft failure may be common situation thereby predisposing the individuals to unnecessary multiple operations. In the recent times, the use of omental graft has gained much popularity. In the present study, we describe an interesting case of chronic non healing scalp ulcer in a young woman who eventually underwent a free omental flap reconstruction with split-thickness skin graft and had satisfactory outcome.
Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. We present here a method of penile reconstruction with a pre fabricated radial forearm free flap incorporating the segment of the radius for structural support.
Basal cell carcinoma (BCC) is an indolent, slow-growing malignant skin tumour. Approximately 70% of the tumours occur in the head and neck region. The nose is a common site for malignant skin tumours, such as basal cell carcinoma and squamous cell carcinoma because it is exposed to the sun. Excision of the BCC will leave the nose with a soft tissue defect which requires reconstruction. This report illustrates a case of BCC of nose whereby a wide excision and reconstruction was performed with a paramedian forehead flap.
We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted.
Soft tissue loss of the heel is difficult to treat as it may cause significant morbidity particularly recurrent ulceration and subsequent chronic osteomyelitis. Reconstruction of such defect with local flap can provide good result. We report our experience in treating four patients with heel defect using the in-step island flap. The flap, which is based on the medial plantar neurovascular pedicle, provides a sensate durable tissue required for weight-bearing and normal gait.