Long-term comparison of two surgical flap designs for third molar surgery on the health of the periodontal tissue of the second molar tooth.
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Adolescent↗
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[Indications for 76 free surgical flaps for mandibular reconstruction].
Since 1985 76 revascularized osseous and osseocutaneous flaps collected from different donor sites were transferred. The overall rate of success amounted to 94.7%, 48.7% of the patients had previously undergone radiotherapy with tumor dose. Even though an elevated number of certain complications in cases of an irradiated recipient area occurred a critical analysis reveals the high value of the reanastomized flap in this situation. Proven indications are described in detail.
Bone Transplantation↗
[Use of surgical flaps in the treatment of ulcers in the region of the Achilles tendon].
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Achilles Tendon↗
Improved outcome of surgical flaps treated with topical dimethylsulfoxide.
OBJECTIVE: The objective of this study was to analyze the effect of dimethylsulfoxide (DMSO) on skin flap viability. BACKGROUND: Dimethylsulfoxide has been shown to decrease necrosis of random skin flaps in the rat model, but no human studies have been performed. The authors performed a randomized, prospective study on the effect of DMSO on skin flap viability in patients undergoing mastectomy and inguinal lymphadenectomy. METHODS: Twenty-four patients had topical 60% DMSO applied to their flaps every 4 hours x 10 days after operation and 27 patients had operation alone. The maximum area of flap ischemia was traced by a masked observer and measured by cut and weigh technique. Significance of differences between the treatment and control group was determined by Student's test. RESULTS: The mean area of ischemia for the DMSO group was 16.33 U versus 44.93 U for the control group. This difference was statistically significant (p = 0.01). CONCLUSIONS: The authors conclude that topical application of DMSO reduces skin flap ischemia in humans and recommend its use after operation in which skin flaps are created.
Administration, Topical↗
[Initial experiences with MR-mammography in after-care following surgical flap treatment of breast carcinoma].
PURPOSE: To demonstrate typical MR mammographic findings after plastic surgery of breast cancer. PATIENTS AND METHODS: Postoperative (7-38 months, median 13) MR mammographic examinations of 25 patients operated for breast cancer (11 latissimus dorsi-flaps (LAT), 14 rectus abdominis myocutaneous-flaps (TRAM)), were reevaluated. The examinations were performed with a breast coil at 1 T. The sequences applied were a fat-suppressed 2-D turbo IR-sequence proton-weighted and a T1-weighted FLASH 3-D sequence as dynamic series. RESULTS: Scars between the myocutaneous flap and the remaining breast tissue always appeared in form of a ligament or septum. Signal and perfusion characteristics of scar tissue and muscle stalk in this investigation were clearly different from those of tumour. One tumour recurrence and one fat necrosis was found and rectified by biopsy. CONCLUSION: MR mammography is a very valuable diagnostic method for postoperative evaluation of myocutaneous flap-based therapy of breast cancer.
Adult↗
[The V-Y surgical flap vascularized by the musculoaponeurotic layer for covering scalp defects].
The author describes a method for covering skin defects of the scalp combining the principles of V-Y plasty and vascularization by means of the musculoaponeurotic layer. It is a simple operation, using the hairy skin in the vicinity of the defect with direct closure of the defect after transposition of the flap. With regard to the satisfactory cosmetic results, the method is suitable not only for primary defects after excision of tumours but also for medium-sized alopecias.
Adolescent↗
[Use of surgical flaps for plastic surgery in posterior adduction cicatricial contracture of the thumb].
Methods of flap and combined plastics in dorsal adduction cicatricial contracture of the thumb are discussed. Different variants of plastics are substantiated on the basis of study of the anatomical features of the contracture. The formation of a commissure by a trapeziform flap of skin and fatty tissue of the palmar layer and palm is the foundation of the operation. Depending on the degree of deficiency of the cicatricial layer of the fold in the first interdigital space, the wounds to the sides of the main flap are closed with local tissues or by free dermatoplasty. The operative methods were approved in more than 200 patients and good functional and cosmetic results were produced in all of them.
Cicatrix↗
[Our experience with the cross-leg surgical flap].
Despite more recent operation methods the cross-leg flap technique is still of importance in covering defects at the lower leg and foot. Considering all contra-indications and certain technical particularities while operating with this method good results can be achieved.
Adolescent↗
Kinetics of E-selectin expression in surgical flaps.
During the ischemia/reperfusion phenomenon, adhesion molecules seem to play a critical role in the recruitment of neutrophils to sites of eventual tissue injury. E-selectin is an endothelium-derived molecule that mediates adhesion of neutrophils to activated endothelial cells. In vitro expression of E-selectin, after exposure to stimuli such as endotoxin, interleukin 1, or tumor necrosis factor alpha is maximal at 4 to 6 h, followed by a decline toward basal levels at 24 to 48 h. Characterizing the temporal expression of E-selectin in an in vivo model of skin flap ischemia-reperfusion would help to determine the optimal approach to eventual pharmacologic blockade. This intervention may prove therapeutically beneficial in attenuating flap injury. This study, using the standard porcine buttock skin flap model, was designed to evaluate immunohistochemically the expression of E-selectin in flaps subjected to (1) arterial ischemia (8 h)-reperfusion (18 h), (2) venous ischemia (8 h)-reperfusion (18 h), and (3) distal ischemia (26 h). Four flaps were examined per group, with 8 biopsies being collected sequentially over the 26-h study period from each flap. Blinded, semi-quantitative histologic scoring revealed the following results: (1) E-selectin is absent in normal porcine skin; (2) with arterial ischemia/reperfusion, E-selectin expression in flaps was maximal at 1 h of reperfusion, declining thereafter; (3) with venous ischemia/reperfusion, E-selectin expression peaked during the first hour of ischemia, with subsequent decline; and (4) within a flap designed to sustain distal ischemia, E-selectin expression is relatively more intense in regions of the flap distant from the vascular pedicle, and maximal at 6 h after flap elevation. Our conclusion, therefore, is that the kinetics of E-selectin expression within the tissues of porcine skin flaps differs depending on the type of ischemic insult sustained. Interpretation of these findings, correlating possible pathophysiologic differences in the different models of ischemia, is offered.
Animals↗
[Evaluation of shoulder function after removal of the latissimus dorsi muscle for surgical flap].
The latissimus dorsi muscle is frequently used in reconstructive surgery. The present study was undertaken to determine the post-operative function of the shoulder girdle with respect to dominance in 26 patients following latissimus dorsi flap transplantation mainly for soft tissue coverage in the lower leg. The patients were interviewed and examined, with special attention being paid to shoulder mobility, dexterity and muscular strength. On interview, a considerable majority felt that very good results had been achieved. Raising the latissimus dorsi flap did however influence shoulder retroversion, particularly when surgery was performed on the non-dominant side. The influence of dominance was further noted as regards inward rotation of the shoulder and the ability to lead the hand backward over the shoulder. Dexterity was determined by a modified tapping test in the sagittal plane. Other than a minor correlation with age, post-operative function depended on whether the latissimus dorsi flap had been raised from the dominant or non-dominant shoulder. No effect of operation or dominance was observed in terms of isometric muscular strength, measured with an electronic device (Hottinger-Baldwin-Messtechnik). We believe that the function of the latissimus dorsi muscle can be compensated for by synergistic muscles. Yet, in rehabilitation, particular attention must be paid to the function of the non-dominant shoulder since it is used less in daily activity.
Adolescent↗
Shortening of rat teeth prevents autocannibalization of surgical flaps.
Self-biting in laboratory rats is an irritating problem that can impede progress and affect the credibility of experimental interventions. Autocannibalization frequently complicates the epigastric skin flap model that is often used to evaluate flaps. In one of the authors' studies, the autocannibalization rate of 55.6 percent in nine rats with unprotected skin flaps of the entire abdominal wall necessitated the application of previously reported plastic collars and protective vests to hinder self-biting. Because the use of these devices resulted in distress symptoms in nine of 11 rats with collars and flap congestion in five of five rats with vests, rat incisor teeth shortening was introduced as a stress-free method to prevent chewing. Careful teeth cutting obviated autocannibalization in 19 of 20 rats (p<0.01) during a 5-day follow-up. Rat incisor teeth shortening performed every 3 or 4 days is a simple, inexpensive, and reliable method to prevent autocannibalization in the rat, while maintaining the well-being of the animal.
Animals↗
[Osteo-bursal muscular pedicle surgical flap in aseptic femur head necrosis].
In 14 patients with aseptic necrosis of the whole or almost the whole support surface of the femoral head its affected part was dissected and the defect was replaced with osteo-bursal muscular pedicle graft, taken from the greater trochanter of the same name. Peculiarity of the technique resides in the fact that the bursa of the greater trochanter is used as an integrated block with the osteochondral graft of the greater trochanter and the musculotendinous pedicle, attached to its frontal edge, taken from the musculus gluteus medius. Clinico-roentgenologic observations of the operated patients during 4 years demonstrated that the anatomical structure of the femoral head and functions of the joint are restored.
Adult↗
Closure of palatal defects without a surgical flap: an experimental study in rabbits.
PURPOSE: This study evaluated the use of resorbable calcium sulfate with and without bone grafting in palatal defects in rabbits as a guide to regeneration of the mucoperiosteal tissue and bone. METHODS AND MATERIALS: Eighteen New Zealand rabbits were used in the experiment. A 1-cm wide region of mucoperiosteum, nasal mucosa, and bone between the incisor and premolar teeth was excised from the left side of the palate to create a defect. These gaps were left open and unfilled in 6 animals as a control (group 1). Defects in a second group of 6 animals were packed with calcium sulfate (group 2). The osseous defects in a third group of 6 animals were filled with bovine demineralized xenographic bone particles, and the soft tissue gaps were covered with calcium sulfate (group 3). The various sites were evaluated clinically at 1, 3, and 4 weeks, and then at 3 months after surgery. All animals were killed at the 3 months period, and the sites were evaluated histologically. RESULTS: The calcium sulfate had resorbed and the mucoperiosteal margins of the defects in both experimental groups had regenerated and the soft tissue gaps were closed at 4 weeks. Osseous defects in group 3 showed complete bone regeneration compared with osseous defects in group 2. Defects in the control group showed persistent oronasal fistulae and fibrous healing. CONCLUSION: Open mucoperiosteal wounds in rabbits packed with calcium sulfate can heal uneventfully, and the gaps can be closed successfully.
Absorbable Implants↗
[Reconstruction of the anterior mouth floor by surgical flap microanastomosis: oncologic and functional results].
INTRODUCTION: The purpose of this retrospective study was to evaluate oncological and functional results after reconstruction of the anterior floor of the mouth using free flaps. METHODS: From 1992 to 1998, 30 patients with squamous cell carcinoma of the anterior floor of the mouth underwent surgical excision and primary reconstruction with either free forearm- or bone-composed flaps. Functional assessment included evaluation by the Karnofsky scale, Performance Status Scale for Head and Neck Cancer (PSS-HNC), articulation test and videofluoroscopic examination. RESULTS: 16 patients underwent reconstruction with a free forearm flap, 13 with an iliac crest flap and 1 with a fibula flap. The most serious local complication was partial flap necrosis in two cases. Local control was 90% at 24 months and the specific survival rate was 92% at five years. Functional evaluation was performed on 19 patients: PSS-HNC median score for diet was 70 (range 50-100), the score for speech was 70 (range 50-100) and the score for "eating in public" was 65 (range 25-100). Patients with a major mobile tongue resection had a lower score compared to patients with minor or no mobile tongue resection. Videofluoroscopy showed swallowing alterations following large resections of soft tissues. DISCUSSION: Our study confirms that wide resection of mobile tongue is associated decreased rehabilitation quality. Mandibulectomy does not influence rehabilitation.
Adult↗
[Combined surgical flaps for simultaneous reconstruction of the tongue, mouth floor and pharynx in expanded glossectomy within the scope of multi-modal treatment of squamous epithelial cancers of UICC stage IV].
Multimodal approach and improved surgical techniques enable the head and neck surgeon to operate even far advanced tumours of the head and neck under curative intention. Microanastomosed distant flaps and intestinal grafts expanded the operative spectrum while having the disadvantages of being time-consuming and in most cases the necessity to call for the specialist (e.g. the abdominal, vascular surgeon). In 6 cases of total glossectomy combined with hemipharyngectomy and hemimandibulectomy the possibilities of closing large defects by combined regional and pedicled flaps in the head and neck area are shown. In all of our cases surgical therapy had been placed at the end of therapeutic interventions in a multimodal treatment protocol. Treatment started with induction chemotherapy with a regimen including cisplatin, bleomycin and vindesin sulfate and was followed by a subsequent radiotherapy reaching a total reference dose of 60 to 70 Gy. After radiotherapy 5 patients received adjuvant chemotherapy of 1-4 cycles. Despite the aggressive presurgical treatment, the postoperative complications were minor. In a median survival of 37.5 months there were 3 recurrences, 2 patients died of tumour progression. All of our patients benefited from of the "salvage-operation" especially with regard to tumour pain. Quality of the patients' life could be improved upon by percutaneous endoscopic gatrostomy (PEG) and as well good functional and cosmetic results of the surgical reconstructions. The results justify the discussion about a palliative indication of extended surgical procedures and reconstructive surgery in far advanced head and neck cancer in the course of a multimodal treatment regimen.
Adult↗
[Evaluation of surgical flaps used for creation of an artificial penis in female-male type transsexuals].
In the years 1983-1997, 252 female to male transsexuals were treated in the Department of Plastic Surgery of University Medical School in Łódź. In 209 patients surgical penis construction was performed. The paper presents operative techniques and results of penis construction with the use of four kinds of flaps: a bipedicled abdominal tube flap, a single pedicled infraumblical flap, a pedicled myocutaneous flap with gracilis muscle and a pedicled lateral groin flap. Overall estimation of early results of penis construction with the use of the four methods applied in the Department showed that we obtained good results in 69.8% of operated transsexuals, satisfactory effects in 24.4% of patients and poor outcome in 5.8% of cases. The best results were achieved with the technique involving a lateral groin flap.
Adult↗
Imaging of the postoperative neck with emphasis on surgical flaps and their complications.
Radiologists are playing an increasingly important role in the management of patients with head and neck cancer. Imaging is often essential in preoperative planning. It is therefore imperative for the radiologist to be familiar with the wide variety of surgical procedures used as well as the normal CT and MR imaging appearance after such procedures. In addition, familiarity with the appearance of tumor recurrence and postoperative complications is essential. This pictorial essay illustrates the appearance of the normal and abnormal postoperative neck on CT scans and MR images, with an emphasis on reconstructive flaps. Postoperative complications evident on imaging studies are depicted, as is the appearance of tumor recurrence. One lymph node classification system is briefly reviewed as a basis for discussion of neck dissection and other surgical procedures.
Aged↗
[Infrared thermometry in surgical flaps].
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Animals↗