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Int J Low Extrem Wounds 2021 May 5:15347346211015828. Epub 2021 May 5.

Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.).

The reconstruction of defects of the lateral malleolus involving the exposed fibular bone or tendon is challenging. This study aimed to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 15 patients (10 men, 5 women) between January 2007 and December 2018. Read More

Ann Plast Surg 2021 05;86(5):557-561

From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH.

Background: Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch. Read More

J Hand Surg Asian Pac Vol 2021 Jun;26(2):265-273

Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China.

Digital island flap remains among the most useful types of providing soft-tissues coverage for defect on the fingertip accompanied with underlying structures exposure. Nevertheless, its trends of functional and aesthetic issues such as the limited length of advancement and the limited flap size are the essential disadvantages. The main objective of the study was to assess the clinical effectiveness of dorsal branch skin flap of proper palmar digital artery with distal pedicle in repairing of fingertip soft tissue defect accompanied with underlying structures exposure. Read More

Dermatol Surg 2021 Apr 27. Epub 2021 Apr 27.

Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada; Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada; and Department of Dermatology, University of California Davis, Sacramento, California.

Background: Despite many options for upper lip reconstruction, each method's advantages and disadvantages are unclear.

Objective: To summarize complications and functional and aesthetic outcomes of localized skin flaps for oncological reconstruction of the upper cutaneous lip (PROSPERO CRD42020157244).

Methods: The search was conducted in Ovid MEDLINE, Ovid EMBASE, and CENTRAL on December 14, 2019. Read More

J Plast Reconstr Aesthet Surg 2021 Mar 30. Epub 2021 Mar 30.

Department of Urology, Dr. S.N. Medical College Jodhpur, Rajasthan 334003, India.

Introduction And Objective: The objective of the study was to evaluate the functional and cosmetic outcome of single-stage modified partial penile disassembly repair in isolated male epispadias.

Materials And Methods: A retrospective analysis of 15 cases of primary epispadias repair, from June 2015 to December 2018, was performed. Patients were classified by the type of epispadias, urinary incontinence, chordee, and rotation. Read More

J Craniofac Surg 2021 May;32(Suppl 3):1275-1280

Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami, Miami, FL.

Abstract: Soft tissue deficits of the scalp due to trauma, infection, or tumor resection present a unique challenge to the reconstructive surgeon whose goal is to achieve excellent cosmesis in a hair bearing area without compromising coverage. While extensive undermining for large rotation flaps or free tissue transfer can provide necessary coverage, the pericranial flap is an excellent alternative for less ideal surgical candidates who cannot tolerate more extensive interventions or for patients who require long-term cancer surveillance. Elevation of the pericranial flap limits the need for back cuts through the skin and uses blunt dissection to preserve overlying hair follicles. Read More

Zhonghua Shao Shang Za Zhi 2021 Apr;37(4):377-381

Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.

To explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture. A retrospective cohort study was conducted. From July 2016 to January 2020, 11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University, including 7 males and 4 females, aged 8 to 48 years. Read More

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Background:  Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Read More

J Craniofac Surg 2021 Mar 22. Epub 2021 Mar 22.

Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA Baylor College of Medicine, Houston, TX Division of Plastic and Reconstructive Surgery, Keck School of Medicine University of Southern California, Los Angeles Division of Plastic Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia Division of Plastic Surgery, Shriners Hospital for Children, Pasadena, CA.

Abstract: The understanding of cleft lip etiology and approaches for surgical repair have evolved over time, allowing for improved ability to restore form and function. The variability of cleft lip presentations has necessitated a nuanced surgical approach with multidisciplinary cleft care. The earliest documentation of unilateral cleft lip repair predates the 19th century, with crude outcomes observed before the advent of curved incisions and advancement flaps. Read More

Arch Plast Surg 2021 Mar 15;48(2):158-164. Epub 2021 Mar 15.

Department of Otorhinolaryngology, Corlu Private Reyap Hospital, Istanbul Rumeli University, Istanbul, Turkey.

Background: In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.

Methods: This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. Read More

J Mech Behav Biomed Mater 2021 Jun 9;118:104340. Epub 2021 Feb 9.

School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA. Electronic address:

To produce functional, aesthetically natural results, reconstructive surgeries must be planned to minimize stress as excessive loads near wounds have been shown to produce pathological scarring and other complications (Gurtner et al., 2011). Presently, stress cannot easily be measured in the operating room. Read More

Zhonghua Shao Shang Za Zhi 2021 Mar 18;37(3):1-6. Epub 2021 Mar 18.

Department of Burns & Plastic Surgery, Institute of Burns, the Fourth Medical Center, PLA General Hospital, Beijing 100048, China.

To explore the method and clinical effect of repairing extensive facial and cervical scar with pre-expanded anterior perforator flap of transverse cervical artery and repairing donor site with contralateral pre-expanded thoracic random flap in relay. A retrospective cohort study was conducted. From May 2008 to December 2018, 10 patients with extensive facial and cervical scar after burns were treated in the Fourth Medical Center of PLA General Hospital, including 8 males and 2 females, aged 10-55 years. Read More

BMC Surg 2021 Mar 8;21(1):120. Epub 2021 Mar 8.

Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H-8, Islamabad, Pakistan.

Background: Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. Read More

Clin Plast Surg 2021 Apr 22;48(2):183-192. Epub 2021 Jan 22.

Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, University of California at Davis, 2335 Stockton Boulevard, Room 6008, Sacramento, CA 95817, USA. Electronic address:

The perforator-plus flap is a new concept for lower extremity reconstruction. It combines a perforator flap with a traditional skin rotation flap. It can be another option for lower extremity soft tissue defects since the flap has an augmented blood supply. Read More

J Insect Physiol 2021 Mar 2;131:104212. Epub 2021 Mar 2.

Functional Morphology and Biomechanics, Zoological Institute, Kiel University, Kiel 24118, Germany.

The small white cabbage butterfly (Pieris rapae) flaps its fore- and hindwings in synchrony as the wings are coupled using a wing "coupling mechanism". The coupling mechanism of butterflies includes an enlarged humeral area located at the anterior of the hindwing base and a corresponding basal posterior part of the forewing, of which the former component dorsally contacts the ventral side of the latter one. The coupling mechanism allows for the fore- and hindwings sliding in contact along the span and chord. Read More

Facial Plast Surg Aesthet Med 2021 Mar 1. Epub 2021 Mar 1.

Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Reconstruction of nasal skin defects can be challenging due to limited skin laxity and underlying cartilage and, therefore, often require a complex repair. The aim of this review is to systematically analyze the literature on nasal skin reconstructions with specific detail to flap reconstructions. A systematic literature review of nasal skin reconstruction was performed and focused on flap reconstructions. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Feb;35(2):200-205

Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P.R.China.

Objective: To explore the feasibility of using indocyanine green (ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller (BAPP) flaps to repair soft tissue defects of the trunk and upper limbs.

Methods: Between August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and 7 females, with an average age of 28. Read More

JPRAS Open 2021 Jun 26;28:10-18. Epub 2021 Jan 26.

Department of Hand & Reconstructive Microsurgery, Singapore General Hospital Singapore.

Though the thenar flap has been described since 1926, its use has not been widespread. The main criticisms are donor site morbidity and proximal interphalangeal joint (PIPJ) stiffness. In this paper, we describe a standard design technique for flap design and division to address these two issues. Read More

J Surg Res 2021 Jun 16;262:190-196. Epub 2021 Feb 16.

Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany.

Background: The safe execution of local flaps tends to be challenging for surgical residents. Thus, the purpose of the study was to evaluate a training model of local flaps based on fresh human skin excised from body contouring procedures.

Materials And Methods: A questionnaire and surgical skills evaluation-analyzing the theoretical and procedural knowledge about local flaps-were held both before and after the surgical skills training. Read More

Plast Reconstr Surg Glob Open 2021 Jan 26;9(1):e3376. Epub 2021 Jan 26.

Faculty of Medicine, Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer. Read More

Ann Transl Med 2021 Jan;9(1):61

Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Background: Total auricular reconstruction is a challenge for plastic surgeons. Expanded flap method and Nagata's method with autologous costal cartilage are two leading techniques for ear reconstruction. And a two-stage strategy of expanded flap method received attention. Read More

J Plast Surg Hand Surg 2021 Feb 3:1-9. Epub 2021 Feb 3.

Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Japan.

The local flap method is a minimally invasive, quick, and common technique of closing skin defects. Several methods using multiple local flaps are employed for the purpose of closing relatively large defects, and minimizing the resultant scar and deformity. We present a combined local flap method using a banner flap with an adjacent rotation flap (B-R flap) with the potential for closing circular defects. Read More

Wounds 2020 12;32(12):E62-E66

Department of Surgery, University Hospital Regensburg, Regensburg, Germany.

Introduction: Open abdominal wounds with intestinal fistula formation are challenging complications in abdominal surgery. Special fistula devices (SFD) used along with negative pressure wound therapy with instillation and dwell time (NPWTi-d), may improve management of these wounds, increasing NPWT dressing durability and helping decrease dressing leakage.

Case Report: A 57-year-old, obese (body mass index: 55 kg/m²) female with a long history of Crohn disease and multiple intestinal resections, presented with an incarcerated parastomal hernia, abscess formation, and septic shock. Read More

Childs Nerv Syst 2021 Apr 16;37(4):1323-1326. Epub 2021 Jan 16.

Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain.

Purpose: Myelomeningocele (MMC) is the most prevalent form of spina bifida aperta. Here we present the surgical repair technique of a dorsolumbar myelomeningocele with a large associated soft tissue defect.

Methods: Data concerning the anamnesis and complementary studies were obtained from the clinical history. Read More

Facial Plast Surg 2021 Jan 14. Epub 2021 Jan 14.

Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, Essen, Germany.

The objective of this study was to examine the role of cheek rotation flaps in the reconstruction of orbital defects after exenteration. From January 2000 to August 2018, patients undergoing orbital exenteration and reconstruction with cheek rotation flaps were enrolled in this retrospective study. All patients were evaluated for wound complications, orbital rehabilitation, tumor relapse, and survival. Read More

Plast Reconstr Surg Glob Open 2020 Dec 17;8(12):e3325. Epub 2020 Dec 17.

Plastic and Maxillofacial Surgery Department, Royal Children's Hospital, Melbourne, Australia.

Repair of a bilateral cleft lip and nose deformity remains a challenge. The nose remains the main persisting stigma for patients, deserving an equal amount of attention as the lip during the repair. We share 3 technical principles to help achieve the optimal nasolabial result and minimize cleft nose deformity after bilateral cleft lip repair. Read More

J Gastric Cancer 2020 Dec 28;20(4):454-460. Epub 2020 Dec 28.

Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Tracheo-gastric conduit fistula is an extremely rare but severe complication that is difficult to manage. Conservative care, esophageal or tracheal stent placement, or cutaneomuscular flaps have been suggested; however, no definite treatment has been proven. We report a case of tracheo-gastric conduit fistula that occurred after a minimally invasive radical three-field esophagectomy. Read More

J Surg Res 2021 May 7;261:85-94. Epub 2021 Jan 7.

Department of Plastic Surgery, Ege University Faculty of Medicine, Izmir, Turkey.

Background: The use of perforator propeller flaps in lower limb reconstruction has increased recently. Many pharmacological agents are used to increase flap viability. Botulinum toxin has been used in various types of flaps in the literature. Read More

Laryngoscope Investig Otolaryngol 2020 Dec 15;5(6):1029-1038. Epub 2020 Oct 15.

Department of Otolaryngology-Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA.

Objective: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation.

Methods: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Read More

Foot Ankle Surg 2020 Dec 1. Epub 2020 Dec 1.

Ankara University Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Hand Surgery, Talatpasa Blv No:82 Altindag, Ankara, Turkey.

Background: Covering soft tissue defects of the distal one-third of the leg and the Achilles tendon region and is a challenging problem for an orthopedic surgeon. With recent advancements in the anatomical knowledge of perforating vessels, perforator-pedicled propeller flaps have become increasingly popular in recent decades. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects in the distal leg were reconstructed with propeller flaps and assessed association of complications with age, gender, flap size and arc of rotation. Read More