Re: V-Y advancement flaps for tumor excision defects of the eyelids.
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Biomedical subjects
Publications and source records attributed to L M Field.
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The nasolabial flap has been a mainstay in reconstructing nasal defects. Errors in design and construction of this flap have caused many to condemn it and move away from its use. This article reaffirms its extensive applicability and seeks to forestall unaesthetic reconstructions by consideration of preventive steps.
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Coverage of surgical defects of the external auditory meatus and surrounding areas can be singularly challenging. Partial detachment of the lower pinna may facilitate surgical exposure and the movement of tissue from periauricular locations. A high level of esthetic reconstruction can be accomplished.
One may accomplish certain closures without tension or distortion using blunt liposuction cannula dissection with or without suction-assisted lipectomy. If closure cannot be accomplished with adequate undermining and an appropriate flap design, the surgeon may first aspirate fat to allow use of the focally expanded skin over the fat. If still unsuccessful, fibrous neurovascular septae are progressively sacrificed as necessary to allow adequate movement and closure. Preservation of the maximal number of blood vessels and nerves within the flap is a given fact. These techniques provide more rapid and safe methods for elevating flaps with significantly less morbidity than sharp dissection methods alone.
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Tubed pedicle flaps find limited application for the cutaneous surgeon, but the preauricular area offers particular advantages in reconstructing certain congenital or acquired defects on the pinnae. These flaps are two-staged procedures, the utmost care being required in presurgical assessment and careful handling of the transposing pedicles. The attached vascular pedicle virtually guarantees success in transferring thicker portions of preauricular tissue into deep defects on the auricle. The reconstructive surgeon will find the challenges rewarding in achievement of aesthetic results with difficult problems. To date we have performed 36 two-staged pedicled auricular reconstructive procedures with no untoward complications or sequelae.
cDNA clones for the esterase (E4) responsible for broad insecticide resistance in peach-potato aphids (Myzus persicae Sulz.) were isolated and used to study the molecular basis of resistance. Increased esterase synthesis by resistant aphids was found to be associated with amplification of the structural gene for the esterase (E4 or its closely related variant, FE4), the degree of amplification being correlated with the activity of the esterase and the level of resistance. Hybridization of the cDNA clones to genomic Southern blots showed that only some of the esterase-related restriction fragments are amplified. Qualitative differences between restriction patterns in different clones of resistant aphids correlated with the presence or absence of a specific chromosome translocation and with production of E4 or FE4.
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The single-pedicle retroauricular advancement flap is very useful for defects of the posterior ear surface and along the helical rim. Design elements are simple, vascular support excellent, and the aesthetic reconstruction of involved areas highly acceptable. Several cases are demonstrated photographically along with appropriate commentary.
The frontoglabellar skin has long served in reconstruction of certain nasal and canthal defects. The glabellar transposition "banner" flap is relatively simple and efficient. It can be designed either on a curved glabellar line or as a vertical midline closure, depending upon requirements and aesthetic variables.
Efforts continue to expand the role of blunt liposuction cannulae in flap elevation and reconstructive surgery. Suction-assisted lipectomy to reduce the actual volume of fat tissue present may allow the further reach and compressibility of mobilized flaps. These instruments find the safest possible plane for continued undermining dissection even at great distances. Applications yet unknown await discovery.
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