There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer...There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.展开更多
Free flap transplantation is the most important plastic surgery treatment.Although free flap is an important tissue repair tool for plastic surgery,it is easy to happen due to the anastomotic stenosis or thrombosis,as...Free flap transplantation is the most important plastic surgery treatment.Although free flap is an important tissue repair tool for plastic surgery,it is easy to happen due to the anastomotic stenosis or thrombosis,as well as the inflammatory reaction caused by ischemia-reperfusion injury of the flap and the inflammation caused by these inflammatory reactions.Microcirculation contracture or occlusion will lead to partial or complete flap necrosis,thus affecting the repair effect.Numerous studies show that neutrophils are closely involved in the process of ischemic injury of free flaps.The purpose of this experiment is to investigate the use of ulinastatin to inhibit the inflammatory infiltration of free flaps to improve the survival of the flap.展开更多
I was interested to read the article by Chakraborty et al.1 that referred to my article.2 On the basis of my published studies on ACE2 angiotensin-converting enzyme 2(angiotensin-converting enzyme 2)gene expression in...I was interested to read the article by Chakraborty et al.1 that referred to my article.2 On the basis of my published studies on ACE2 angiotensin-converting enzyme 2(angiotensin-converting enzyme 2)gene expression in both skin and subcutaneous tissue,one can elucidate whether skin and subcutaneous tissues of free flaps are directly susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.展开更多
Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating ...Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating early detection and timely intervention.Developing a monitoring approach that is highly sensitive,specific,noninvasive,continuous,and cost-effective is crucial for accurately assessing flap perfusion and informing clinical decisions.Methods:From April 2024 to December 2024,20 patients with oral tumors requiring flap transplantation were enrolled at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine.Continuous monitoring of various free flaps was performed utilizing a transcutaneous blood gas analyzer,both before and after surgery.This approach allowed for real-time measurement of transcutaneous partial pressure of oxygen(TcPO_(2))and transcutaneous partial pressure of carbon dioxide(TcPCO_(2)),facilitating the evaluation of perfusion dynamics across various free flap types.Results:After free flap transplantation,a reduction in blood supply resulted in a rapid decline in TcPO_(2)(to below 10 mmHg),accompanied by a gradual increase in TcPCO_(2),peaking at 135 mmHg.Following vascular anastomosis and blood flow restoration,TcPO_(2)and TcPCO_(2)exhibited opposite trends.Statistical analysis revealed no significant differences in TcPO_(2)and TcPCO_(2)measurements among the various flap types(P<0.05),indicating a consistent pattern of change across all flaps.Conclusion:The transcutaneous blood gas analyzer proves to be a reliable method for monitoring free flap perfusion.Dynamic changes in TcPO_(2)and TcPCO_(2)effectively reflect blood supply status,enabling early detection of vascular compromise and potentially enhancing flap preservation outcomes.展开更多
BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-fla...BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.展开更多
Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may b...Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may be challenging because of the radiation damage to regional tissues.As a result,distant free flaps may be an optimal choice.For instance,the gracilis muscular free flap(GMFF)has consistent vascular anatomy and can be used to reconstruct small defects.We report three cases of uncontrolled ORN-TB requiring an extensive temporal bone resection followed by vascularized obliteration with a GMFF.The patients reported complete control of the main otologic symptoms(otorrhea,otalgia,and aural fullness)and optimal functional and aesthetic outcomes.Finally,the patients reported significant improvement in quality of life despite early postoperative complications.To our knowledge,the GMFF had not been used to obliterate temporal bone defects in patients with ORN-TB.展开更多
The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The sur...The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The surnames and given names of these authors are reversed:Saro-Buendía Miguel,Andresen-Lorca Belén,Pérez-García Alberto,Llópez Carratala Nacho,Carreres Polo Joan,Armengot Carceller Miguel,Perolada Valmaña Jose María.It should be Miguel Saro-Buendía,Belén Andresen-Lorca,Alberto Pérez-García,Nacho Llópez Carratala,Joan Carreres Polo,Miguel Armengot Carceller,Jose María Perolada Valmaña.展开更多
The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step appro...The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. The"keystone"of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the"piece of a puzzle"into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative"sculpting"is employed both"in situ"at the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author's approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as the"palette"upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a"natural"facial appearance while preserving fluid motions of facial expression.展开更多
Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data ...Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.展开更多
Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage ...Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants respectively. The main reasons for failure of the dental proliferation. The fibula flap presents many advantages for implant-supported prosthetic rehabilitation difficult. placed into the fibula bone grafts were 95% and 87%, replants were infection, tumor recurrence and soft tissue implant placement, but its limited height sometimes makes Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.展开更多
Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rat...Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 vs.day 4)and weight bearing(day 5 vs.day 14)post lower limb free flap surgery.Methods:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database.Patient data were collected from the comprehensive lower limb free flap database,medical notes,and electronic records.Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded.Results:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for comparison.The mean age was 43(17-72)with a M:F of 3:1.There was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both groups.No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.展开更多
Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of ...Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14cm×6cm to 8cm×4cm. These flaps were exposed to 60Co radiation ranging 40-69 Gy. Results Observation during irradiation, no visible changes of skin flaps and oral mucous membrane were detected, when irradiation dose was within 40 Gy; some changes may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations were found in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation 2 years after irradiation, rib necrosis happened in 29 skin flaps. Hairs were found on 15 of 29 flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradiation at the dose of 60 Gy.展开更多
The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or fr...The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or free flap harvest is not feasible. This method was used for the reconstruction of post-ablative defect in a 36-year-old male with a T4 squamous cell carcinoma of the base of tongue with laryngeal involvement. The distal paddle was adapted to reconstruct a defect of the floor of the mouth and further sutured in two layers (muscle-basal mandible and skin paddle-oral mucosa) while the proximal skin paddle was used to close the cervical skin and the peri-tracheostomy defect.展开更多
The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruct...The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.展开更多
Tumor resection causes damage in the head and neck which creates problems in swallowing,chewing,articulation,and vision,all of which seriously affect patients'quality of life.In this work,we evaluated the applicat...Tumor resection causes damage in the head and neck which creates problems in swallowing,chewing,articulation,and vision,all of which seriously affect patients'quality of life.In this work,we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection.We discussed the anatomy,surgical technique,and the advantages and disadvantages of the flap.We found several benefits for the flap,such as,it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect;a two-team approach can be used because the donor site is far away from the head and neck;and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft.Thus,the medial tibial flap could replace the forearm flap for certain applications.展开更多
We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area o...We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area of penile skin. Then shear the shape of graft was sheared, sutured to hostage skin defect and enswathed with tension. The postoperative appearance and function of the penis were satisfactory. It is suggest the homologous free skin flap from lower limbs is suitable for penile skin repair and beneficial to patient resulting in satisfactory erection and shape.展开更多
BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irrever...BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.展开更多
Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（...Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.展开更多
The purpose of the experiment was to study the efficacy of edaravone in enhancing flap viability after ischemia/reperfusion（IR） and its mechanism. Forty-eight adult male SD rats were randomly divided into 3 groups：...The purpose of the experiment was to study the efficacy of edaravone in enhancing flap viability after ischemia/reperfusion（IR） and its mechanism. Forty-eight adult male SD rats were randomly divided into 3 groups： control group（n=16）, IR group（n=16）, and edaravone-treated IR group（n=16）. An island flap at left lower abdomen（6.0 cm×3.0 cm in size）, fed by the superficial epigastric artery and vein, was created in each rat of all the three groups. The arterial blood flow of flaps in IR group and edaravone-treated IR group was blocked for 10 h, and then the blood perfusion was restored. From 15 min before reperfusion, rats in the edaravone-treated IR group were intraperitoneally injected with edaravone（10 mg/kg）, once every 12 h, for 3 days. Rats in the IR group and control group were intraperitoneally injected with saline, with the same method and frequency as the rats in the edaravone-treated IR group. In IR group and edaravone-treated IR group, samples of flaps were harvested after reperfusion of the flaps for 24 h. In the control group, samples of flaps were harvested 34 h after creation of the flaps. The content of malondialdehyde（MDA） and activity of superoxide dismutase（SOD） were determined, and changes in organizational structure and infiltration of inflammatory cells were observed by hematoxylin-eosin（HE） staining, apoptotic cells of vascular wall were marked by terminal deoxynucleotidyl transferase-mediated d UTP nick-end labeling（TUNEL） assay, and the apoptotic rate of cells in vascular wall was calculated. The ultrastructural changes of vascular endothelial cells were observed by transmission electron microscopy（TEM）. Seven days after the operation, we calculated the flap viability of each group, and marked vessels of flaps by immunohistochemical staining for calculating the average number of subcutaneous vessels. The results showed that the content of MDA, the number of multicore inflammatory cells and apoptotic rate of cells in vascular wall in the edaravone-treated IR group were significantly lower than those in the IR group. The activity of SOD, flap viability and average number of subcutaneous vessels in the edaravone-treated IR group were significantly higher than those in the IR group. All the differences were statistically significant. The ultrastructure injury of vascular endothelial cells in the edaravone-treated IR group was slighter than that in IR group. It was concluded that edaravone can significantly enhance IR flap viability and protect flap vessels, which is related to scavenging oxygen free radicals, reducing the consumption of SOD, reducing the extent of lipid peroxidation and inflammation, and protecting functional structure of vessels in the early stages of reperfusion.展开更多
Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case pr...Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.展开更多
文摘There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.
文摘Free flap transplantation is the most important plastic surgery treatment.Although free flap is an important tissue repair tool for plastic surgery,it is easy to happen due to the anastomotic stenosis or thrombosis,as well as the inflammatory reaction caused by ischemia-reperfusion injury of the flap and the inflammation caused by these inflammatory reactions.Microcirculation contracture or occlusion will lead to partial or complete flap necrosis,thus affecting the repair effect.Numerous studies show that neutrophils are closely involved in the process of ischemic injury of free flaps.The purpose of this experiment is to investigate the use of ulinastatin to inhibit the inflammatory infiltration of free flaps to improve the survival of the flap.
文摘I was interested to read the article by Chakraborty et al.1 that referred to my article.2 On the basis of my published studies on ACE2 angiotensin-converting enzyme 2(angiotensin-converting enzyme 2)gene expression in both skin and subcutaneous tissue,one can elucidate whether skin and subcutaneous tissues of free flaps are directly susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.
基金supported by the Fundamental Research Program(grant no.:JYZZ228)the Clinical Research Booster Program(grant no.JYLJ202311)of the Shanghai Ninth Peoples’Hospital of Shanghai Jiao Tong University School of Medicine.
文摘Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating early detection and timely intervention.Developing a monitoring approach that is highly sensitive,specific,noninvasive,continuous,and cost-effective is crucial for accurately assessing flap perfusion and informing clinical decisions.Methods:From April 2024 to December 2024,20 patients with oral tumors requiring flap transplantation were enrolled at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine.Continuous monitoring of various free flaps was performed utilizing a transcutaneous blood gas analyzer,both before and after surgery.This approach allowed for real-time measurement of transcutaneous partial pressure of oxygen(TcPO_(2))and transcutaneous partial pressure of carbon dioxide(TcPCO_(2)),facilitating the evaluation of perfusion dynamics across various free flap types.Results:After free flap transplantation,a reduction in blood supply resulted in a rapid decline in TcPO_(2)(to below 10 mmHg),accompanied by a gradual increase in TcPCO_(2),peaking at 135 mmHg.Following vascular anastomosis and blood flow restoration,TcPO_(2)and TcPCO_(2)exhibited opposite trends.Statistical analysis revealed no significant differences in TcPO_(2)and TcPCO_(2)measurements among the various flap types(P<0.05),indicating a consistent pattern of change across all flaps.Conclusion:The transcutaneous blood gas analyzer proves to be a reliable method for monitoring free flap perfusion.Dynamic changes in TcPO_(2)and TcPCO_(2)effectively reflect blood supply status,enabling early detection of vascular compromise and potentially enhancing flap preservation outcomes.
文摘BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.
文摘Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may be challenging because of the radiation damage to regional tissues.As a result,distant free flaps may be an optimal choice.For instance,the gracilis muscular free flap(GMFF)has consistent vascular anatomy and can be used to reconstruct small defects.We report three cases of uncontrolled ORN-TB requiring an extensive temporal bone resection followed by vascularized obliteration with a GMFF.The patients reported complete control of the main otologic symptoms(otorrhea,otalgia,and aural fullness)and optimal functional and aesthetic outcomes.Finally,the patients reported significant improvement in quality of life despite early postoperative complications.To our knowledge,the GMFF had not been used to obliterate temporal bone defects in patients with ORN-TB.
文摘The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The surnames and given names of these authors are reversed:Saro-Buendía Miguel,Andresen-Lorca Belén,Pérez-García Alberto,Llópez Carratala Nacho,Carreres Polo Joan,Armengot Carceller Miguel,Perolada Valmaña Jose María.It should be Miguel Saro-Buendía,Belén Andresen-Lorca,Alberto Pérez-García,Nacho Llópez Carratala,Joan Carreres Polo,Miguel Armengot Carceller,Jose María Perolada Valmaña.
文摘The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. The"keystone"of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the"piece of a puzzle"into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative"sculpting"is employed both"in situ"at the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author's approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as the"palette"upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a"natural"facial appearance while preserving fluid motions of facial expression.
基金Beijing Jishuitan Hospital Nova Program Funding[XKXX201617]。
文摘Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.
文摘Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants respectively. The main reasons for failure of the dental proliferation. The fibula flap presents many advantages for implant-supported prosthetic rehabilitation difficult. placed into the fibula bone grafts were 95% and 87%, replants were infection, tumor recurrence and soft tissue implant placement, but its limited height sometimes makes Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.
文摘Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 vs.day 4)and weight bearing(day 5 vs.day 14)post lower limb free flap surgery.Methods:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database.Patient data were collected from the comprehensive lower limb free flap database,medical notes,and electronic records.Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded.Results:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for comparison.The mean age was 43(17-72)with a M:F of 3:1.There was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both groups.No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.
基金Supported by the Scientific Develop-ment Foundation of Jiangsu Health(9717)
文摘Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14cm×6cm to 8cm×4cm. These flaps were exposed to 60Co radiation ranging 40-69 Gy. Results Observation during irradiation, no visible changes of skin flaps and oral mucous membrane were detected, when irradiation dose was within 40 Gy; some changes may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations were found in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation 2 years after irradiation, rib necrosis happened in 29 skin flaps. Hairs were found on 15 of 29 flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradiation at the dose of 60 Gy.
文摘The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or free flap harvest is not feasible. This method was used for the reconstruction of post-ablative defect in a 36-year-old male with a T4 squamous cell carcinoma of the base of tongue with laryngeal involvement. The distal paddle was adapted to reconstruct a defect of the floor of the mouth and further sutured in two layers (muscle-basal mandible and skin paddle-oral mucosa) while the proximal skin paddle was used to close the cervical skin and the peri-tracheostomy defect.
文摘The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.
文摘Tumor resection causes damage in the head and neck which creates problems in swallowing,chewing,articulation,and vision,all of which seriously affect patients'quality of life.In this work,we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection.We discussed the anatomy,surgical technique,and the advantages and disadvantages of the flap.We found several benefits for the flap,such as,it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect;a two-team approach can be used because the donor site is far away from the head and neck;and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft.Thus,the medial tibial flap could replace the forearm flap for certain applications.
文摘We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area of penile skin. Then shear the shape of graft was sheared, sutured to hostage skin defect and enswathed with tension. The postoperative appearance and function of the penis were satisfactory. It is suggest the homologous free skin flap from lower limbs is suitable for penile skin repair and beneficial to patient resulting in satisfactory erection and shape.
文摘BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
基金Science Fund of Department of Public Health of Jiangsu Province(ZK200209)
文摘Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.
基金supported by Henan Provincial Key Scientific and Technological Project of China(No.132102310088)
文摘The purpose of the experiment was to study the efficacy of edaravone in enhancing flap viability after ischemia/reperfusion（IR） and its mechanism. Forty-eight adult male SD rats were randomly divided into 3 groups： control group（n=16）, IR group（n=16）, and edaravone-treated IR group（n=16）. An island flap at left lower abdomen（6.0 cm×3.0 cm in size）, fed by the superficial epigastric artery and vein, was created in each rat of all the three groups. The arterial blood flow of flaps in IR group and edaravone-treated IR group was blocked for 10 h, and then the blood perfusion was restored. From 15 min before reperfusion, rats in the edaravone-treated IR group were intraperitoneally injected with edaravone（10 mg/kg）, once every 12 h, for 3 days. Rats in the IR group and control group were intraperitoneally injected with saline, with the same method and frequency as the rats in the edaravone-treated IR group. In IR group and edaravone-treated IR group, samples of flaps were harvested after reperfusion of the flaps for 24 h. In the control group, samples of flaps were harvested 34 h after creation of the flaps. The content of malondialdehyde（MDA） and activity of superoxide dismutase（SOD） were determined, and changes in organizational structure and infiltration of inflammatory cells were observed by hematoxylin-eosin（HE） staining, apoptotic cells of vascular wall were marked by terminal deoxynucleotidyl transferase-mediated d UTP nick-end labeling（TUNEL） assay, and the apoptotic rate of cells in vascular wall was calculated. The ultrastructural changes of vascular endothelial cells were observed by transmission electron microscopy（TEM）. Seven days after the operation, we calculated the flap viability of each group, and marked vessels of flaps by immunohistochemical staining for calculating the average number of subcutaneous vessels. The results showed that the content of MDA, the number of multicore inflammatory cells and apoptotic rate of cells in vascular wall in the edaravone-treated IR group were significantly lower than those in the IR group. The activity of SOD, flap viability and average number of subcutaneous vessels in the edaravone-treated IR group were significantly higher than those in the IR group. All the differences were statistically significant. The ultrastructure injury of vascular endothelial cells in the edaravone-treated IR group was slighter than that in IR group. It was concluded that edaravone can significantly enhance IR flap viability and protect flap vessels, which is related to scavenging oxygen free radicals, reducing the consumption of SOD, reducing the extent of lipid peroxidation and inflammation, and protecting functional structure of vessels in the early stages of reperfusion.
文摘Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.
