Complex nasal and periorbital reconstruction using locoregional flaps: a case report

Facial reconstruction is one of the most challenging problems faced by a reconstructive surgeon. We present a case of complex facial reconstruction with a composite trauma to the nose resulting in near total loss of skin and lining along with complete loss of left eyebrow with exposed frontal bone and partial loss of the left eyelid. We combined a temporoparietal fascial flap for reconstruction of the eyebrows and covering the exposed frontal bone and prefabricated forehead flap with skin graft for nasal reconstruction. Proper planning and staging of the surgical procedures and use of local flaps gave us good aesthetic and functional outcome with a satisfied patient.

Flap outcome using "c" shaped and "new" incisions in pediatric cochlear implantation

BACKGROUND

Skin flap failure is a significant, though relatively uncommon complication of cochlear implant surgery. To achieve a good surgical result, a proper plan to locate the prospective implant is required. Thus, a new design of flap was evaluated in this regard.

METHODS

Two hundred and eleven consecutive children undergoing cochlear implantation in Baqiyatallah Cochlear Implant Center were compared with 75 cases who were operated through the classic "C shaped" fashion from Jul/14/2007 to Feb/14/2009.

RESULTS

There was one case of flap necrosis in the classic approach but there were no major flap complications in "new" design, also keloid formation as a minor complication was rare in the "new" method.

CONCLUSION

The "new" design is easier to apply with fewer complications, so it can be recommended in children undergoing cochlear implantation.

Versatility of pectoralis major myocutaneous flap in oncosurgery and its role in developing countries

The objective of this study was to assess the versatility of pectoralis major myocutaneous (PMMC) flap in the reconstruction of diverse surgical defects following resection of various head and neck malignancies. We performed retrospective analysis of patients in whom PMMC was used to reconstruct head and neck surgical defects during May 2006 to December 2010. The study was carried out at KLES Dr. Prabhakar kore Hospital & M.R.C, Belgaum and involved 95 patients. The patients were grouped depending on the site of defect reconstructed and were analyzed in detail. Of the 95 patients, between the age group 38 and 62 years, 69 patients were males while 26 patients were females. PMMC was used to reconstruct 59 cases of oral mucosal defect, ten cases of skin defect and 18 cases of simultaneous oral mucosal and outer skin defect. PMMC was also used in two cases of laryngopharyngeal defects and six cases with floor of mouth and tongue defects. No failures were noted in the study during the follow up period. Despite worldwide emphasis on free flaps as gold standard in the reconstruction of tissue defects, institutions in developing countries where financial constraints are encountered or as salvage procedure for free flap failure, PMMC due to its versatility is still considered the workhorse for reconstruction of moderate to large sized head and neck defects.

New workhorse flaps in hand reconstruction

With the passage of time, certain hand surgery procedures are anecdotally dubbed "workhorse" techniques. These are procedures that are extremely reliable and have repeatedly demonstrated good results. However, with time, paradigms undergo shifts, and this is as true for hand surgery as any other field. In this article, we will describe the use of three new "workhorse" flaps that we have found to have reliable results in complex hand reconstruction: the pedicled radial forearm fascia flap for dorsal hand reconstruction, the free anterolateral thigh flap for mangled hand reconstruction, and the medial femoral condyle vascularized bone graft for scaphoid fracture nonunion reconstruction.

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects

Reconstruction of small defects in the distal portion of the foot has always been a difficult problem. A case involving a young man with a deep electric burn of the distal lateral side of the big toe, successfully treated with a distally based dorsalis pedis fasciocutaneous flap, is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed three weeks later. Advantages, limits and anatomical consideration regarding the viability of the flap are also discussed.

Repair of Large Lip Vermilion defects with Mutual Cross Lip Musculomucosal Flaps

BACKGROUND

Vermilion irregularities are common secondary deformities after cleft lip repair, regressed or resected hemangiomas, trauma and tumor surgeries. Vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion defects can be corrected with upper lip advancement, rotation flaps, tongue flaps or grafts. Major defects defy correction with local flaps. A technique is described for correction of large absolute tissue defects of the vermilion using Mutual Cross-Lip Musculomucosal Flaps (MCLMF) Or Ahmad-Ali's flaps.

METHODS

This technique was applied in eight patients with major vermilion defects secondary to hemangioma regression, neoplasia, and trauma. Reconstruction with MCLMF led to create a balanced donor and recipient lips appearance and function.

RESULTS

There were no postoperative complications. Surgical results were satisfactory in all patients, and sufficient lip mobility with adequate bulk was maintained. One patient demonstrated minimal transient lip tightening.

CONCLUSION

Use of Ahmad-Ali's flaps in selected patients resulted in successful reconstruction of severe vermilion defects.

Reconstruction of the upper eyelid with flaps and free grafts after excision of Basal cell carcinoma

Purpose: To describe a reconstructive technique of the superior eyelid with flaps and free grafts after excision of a basal cell carcinoma. Methods: Single case report of a 79-year-old woman who presented to our hospital with a basal cell carcinoma of the upper eyelid margin with initial erosion. Results: A large and full-thickness excision of the carcinoma was performed. The reconstruction technique should be customized to the individual patient. In this case, the use of a full-thickness tarsal graft from the contralateral upper eyelid, followed by an ipsilateral bipedicled flap and finally by a skin graft, was an effective surgical procedure, performed in one stage, without complications, and with good functional and esthetic results. Conclusions: Malignant neoplasms represent the leading cause of plastic reconstruction in the orbital region. Surgical techniques must be individualized for each patient and for each type of carcinoma. Reconstructive techniques with free grafts and flaps yield excellent results in the orbital region, particularly when some advice and a few fundamental rules are followed, namely accurate hemostasis of the receiving graft bed by moderate use of diathermy, careful suturing of the edges, and application of a compressive dressing for at least 4 days. Postoperative complications are very rare.

Reconstructive options for the medial canthus and eyelids following tumor excision

General principles provide the framework for eyelid and periorbital reconstruction following tumor excision. Eyelid tumors involving the medial canthus region and/or lacrimal system add to the complexity of reconstructive planning. The nature of the tumor, patient and tissue factors, and surgeon preference guide repair design choices. Reconstructive considerations and options following medial canthal tumor resection are described.

Cervicopectoral rotation flap for primary closure of lateral face and neck defects

OBJECTIVE

To recount our experience with the cervicopecloral flap (clavipfcmral flap, herein after referred to as CVF) fur reconstruction of large lateral cervicofacial defects in fifteen patients, which has been underutilized and has not received due recognition in world literature pertaining to reconstructive surgery.

STUDY DESIGN

Retrospective case review

SETTING

Tertiary care regional cancer referral center.

PATIENTS

Those with lateral cervicofacial defects resulting from extirpative cancer surgical resection.

RESULTS

A 100% ‘take rate’ was observed at the primary defect. In 7% there was full thickness, distal loss that was successfully managed by split thickness skin grafting. Three cases (20%) shaved superficial epidermolysis, which healed by full epithelization within three weeks.

CONCLUSION

This flap provides satisfactory primary closure of surface defects that do not extend beyond an arbitrary line extending from the angle of mouth to tragus and posteriorly beyond the mastoid.