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Background/Aim: Since their introduction in 1991, propeller flaps are increasingly used as a surgical approach to loss of substance. The aim of this study was to evaluate the indications and to verify the outcomes and the complica...
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Background/Aim: Since their introduction in 1991, propeller flaps are increasingly used as a surgical approach to loss of substance. The aim of this study was to evaluate the indications and to verify the outcomes and the complication rates using this reconstructing technique through a literature review. Materials and Methods: A search on PubMed was performed using "propeller flap", "fasciocutaneous flap", "local flap" or "pedicled flap" as key words. We selected clinical studies using propeller flaps as a reconstructing technique. Results: We found 119 studies from 1991 to 2015. Overall, 1,315 propeller flaps were reported in 1,242 patients. Most frequent indications included loss of substance following tumor excision, repair of trauma-induced injuries, burn scar contractures, pressure sores and chronic infections. Complications were observed in 281/1242 patients (22.6%) occurring more frequently in the lower limbs (31.8%). Partial flap necrosis and venous congestion were the most frequent complications. The complications' rate was significantly higher in infants (<10 years old) and in the older population (>70 years old) but there was not a significant difference between the sexes. Trend of complication rate has not improved during the last years. Conclusion: Propeller flaps showed a great success rate with low morbidity, quick recovery, good aesthetic outcomes and reduced cost. The quality and volume of the transferred soft tissue, the scar orientation and the possibility of direct donor site closure should be considered in order to avoid complications. Indications for propeller flaps are small-or medium-sized defects located in a well-vascularized area with healthy surrounding tissues.
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Basic flap design utilization for reconstruction of head and neck defects requires creativity from the surgeon. Ultimately, the surgeon must closely restore the basic functions and properties of the surgical flap and adjacent tiss...
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Basic flap design utilization for reconstruction of head and neck defects requires creativity from the surgeon. Ultimately, the surgeon must closely restore the basic functions and properties of the surgical flap and adjacent tissue. All options within the reconstructive ladder should be considered. When possible, like should be replaced with like (similar tissue) within an esthetic zone. When considering a flap design, the surgeon must remember that the donor site must be closed in an esthetic and functional manner. Finally, knowledge of normal anatomy, the extent of the defect, and the patient is vital for successful outcomes.
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A chimeric flap consists of multiple discrete tissues or flaps connected only by a common source vessel. Each component must have an independent source of circulation. Rotation of any included part only about its specific vascular...
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A chimeric flap consists of multiple discrete tissues or flaps connected only by a common source vessel. Each component must have an independent source of circulation. Rotation of any included part only about its specific vascular supply, such as done with a propeller flap, would be possible. These characteristics, whereby the chimeric flap concept and propeller flap concept are combined, would result in a chimeric propeller flap. Such a choice will enhance overall flap insetting capabilities and versatility, while often limiting the reconstructive need to but a single donor site!
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Purpose To introduce modified submental platysmal adipomyofascial flap as a new and viable hairless locoregional option for reconstruction of small- to mid-sized defects after ablative surgery in oral/oropharyngeal cancer patients...
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Purpose To introduce modified submental platysmal adipomyofascial flap as a new and viable hairless locoregional option for reconstruction of small- to mid-sized defects after ablative surgery in oral/oropharyngeal cancer patients keeping in mind the present pandemic situation. Methods An observational retrospective study was conducted using modified submental platysmal adipomyofascial flap as a locoregional reconstructive option for both intraoral and oropharyngeal defects in early-stage oral/oropharyngeal cancer patients, from Jan 2016 to May 2020 in a tertiary care hospital. All patients in this study were male and the overall flap outcome was evaluated with post-operative follow-up. Results Out of 18 patients, in 4 patients modified submental platysmal adipomyofascial flap was used as a combination of flaps for reconstruction. Six patients (33.33%) underwent adjuvant radiation therapy/radiation chemotherapy. The long-term functions (speech and swallowing) and cosmetic outcomes were good in the majority of the patients. One patient (5.55%) had pinhole oroantral fistula. No patient had any major flap failure. Conclusion Modified submental platysmal adipomyofascial flap can be considered as a good alternative in male patients for reconstruction of small- to mid-sized oral cavity/oropharyngeal defects post-resection, especially during the prevailing pandemic crisis. It is an oncologically safe procedure with the major advantage of providing a hairless flap for oral cavity, tonsillar and BOT resection defects with lesser donor site morbidity.
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Background?Elevation in different layers achieving thin flaps are becoming relatively common practice for perforator flaps. Although postreconstruction debulking achieves pleasing aesthetic results and is widely practiced, customi...
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Background?Elevation in different layers achieving thin flaps are becoming relatively common practice for perforator flaps. Although postreconstruction debulking achieves pleasing aesthetic results and is widely practiced, customized approach during elevation to achieve the ideal thickness will increase efficiency while achieving the best possible aesthetic outcome. Multiple planes for elevation have been reported along with different techniques but it is quite confusing and may lack correspondence to the innate anatomy of the skin and subcutaneous tissue. Methods?This article reviews the different planes of elevation and aims to clarify the definition and classification in accordance to anatomy and present the pros and cons of elevation based on the different layers and provide technical tips for elevation. Results?Five different planes of elevation for perforator flaps are identified: subfascial, suprafacial, superthin, ultrathin, and subdermal (pure skin) layers based on experience, literature, and anatomy. Conclusion?These planes all have their unique properties and challenges. Understanding the benefits and limits along with the technical aspect will allow the surgeon to better apply the perforator flaps.
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Abstract Purpose We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. Methods Free flaps were identified using the 2005–2010 NSQIP database. ...
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Abstract Purpose We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. Methods Free flaps were identified using the 2005–2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap failure. Results There were 1,187 microvascular free tissue transfers identified. The overall flap failure rate was 5.1%. Head and neck flaps had the highest rate of free flap failure at 7.7%. Prolonged operative time is an independent predictor of flap failure for all free flaps (OR: 2.383, P ?=?0.0013). When examining predictors of failure by flap site, free flaps to the breast with prolonged operative time are independently associated with flap failure (OR: 2.288, P ?=?0.0152). When examining predictors of flap failure by flap type, muscle based free flaps with an ASA classification ≥3 are associated with flap failure ( P ?=?0.0441). Conclusions Risk factors for free flap failure differ based upon flap site and flap type. Prolonged operative time is an independent risk factor for the failure of free flaps used for breast reconstruction. An ASA classification ≥3 is associated with the failure of free muscle based flaps. Our findings identify actionable areas that may help to improve free flap success.
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The versatile application of local perforator flaps for coverage throughout the lower extremity has already been well proven. Often a free-style approach has been used to design these flaps, as conventional imaging devices for per...
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The versatile application of local perforator flaps for coverage throughout the lower extremity has already been well proven. Often a free-style approach has been used to design these flaps, as conventional imaging devices for perforator identification may be too expensive or unavailable. The recent adaptation of Smartphone thermal digital imaging may now prove to be a cheaper and more readily available means for identifying the requisite perforators that will sustain these local flaps.
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