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Shimada K, Komiya T, Ito N, Sato M, Ida Y, Shibata D, Matsumura H. Surgical treatment of tracheocutaneous fistula and tracheostomy scars using a hinged flap and local myocutaneous flap. Int Wound J 2023; 20:2499-2504. [PMID: 36727609 PMCID: PMC10410321 DOI: 10.1111/iwj.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023] Open
Abstract
Tracheocutaneous fistula and tracheostomy scar are complications associated with the prolonged use of tracheostomy tubes. They have functional and cosmetic problems owing to tracheal tugging during swallowing and easily visible scars. Although many procedures exist to correct this issue, there is no consensus on the optimal surgical technique. Therefore, an ideal surgical procedure was devised. The study was performed on 12 patients between September 2016 and May 2021. All patients had persistent tracheocutaneous fistulas or hypertrophic scars on the neck after tracheostomy. All procedures were performed using a hinged flap and two myocutaneous local flaps. All patients had no complications, and their aesthetics were excellent in postoperative photographs. The scar was better on the straight scar when the flap's skin is denuded than on the VY advancement flap. It should be noted, however, that this procedure can cause the flap to become congested in a short period after head and neck surgery. This procedure is safe, reliable and simple for surgical closure. This was found to produce excellent cosmetic results with no major complications.
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Affiliation(s)
- Kazuki Shimada
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Takako Komiya
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Norihito Ito
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Munenori Sato
- Trauma and Reconstruction CenterShinyurigaoka General HospitalKanagawaJapan
| | - Yukiko Ida
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Dai Shibata
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
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Azuma R, Horiguchi A, Ojima K, Shinchi M, Aizawa T, Tsuchiya M, Nakayama E, Nagano H, Ito K, Asano T, Kiyosawa T. Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty. Int J Urol 2021; 28:806-811. [PMID: 33960024 DOI: 10.1111/iju.14582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/04/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis. METHODS A total of 23 patients (triangular extension group) were studied in 2013-2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17-Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second-stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group). RESULTS In total, 20 patients from each group underwent second-stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first-stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second-stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027). CONCLUSIONS The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis.
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Affiliation(s)
- Ryuichi Azuma
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akio Horiguchi
- Department of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Department of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, Nishisaitama-chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Tetsushi Aizawa
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Tsuchiya
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Eiko Nakayama
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hisato Nagano
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Ito
- Department of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Tomohiko Asano
- Department of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Tomoharu Kiyosawa
- Departments of, Department of, Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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Portilla N, Cerci FB, Tolkachjov SN. Hinge flaps with Burow grafts for reconstruction of deep facial defects. J Am Acad Dermatol 2020; 86:e7-e9. [PMID: 32344072 DOI: 10.1016/j.jaad.2020.04.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Nataly Portilla
- Department of Dermatology, Clínica Erasmo, Valledupar, Colombia
| | - Felipe B Cerci
- Department of Dermatology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Clínica Cepelle, Curitiba, Brazil
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Alagirisamy RB. Conchal defect correction by hinge flap and transposition flap. J Cutan Aesthet Surg 2011; 4:138-40. [PMID: 21976908 PMCID: PMC3183721 DOI: 10.4103/0974-2077.85042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Reconstruction of old full-thickness conchal defects is rarely described in the literature. This article describes a simple technique for reconstruction of old through-and-through small defects of the concha. The anterior part of the defect is covered with hinge flap taken from the posterior surface of the ear. The resultant final posterior defect is covered with local transposition flap from the adjacent skin.
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Affiliation(s)
- Ramesh Bellam Alagirisamy
- Department of Plastic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur, Tamil Nadu, India
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