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INTRODUCTION : Severe ballistic injuries to the face are common occurrence in South-Kivu province in the eastern Democratic Republic of the Congo (DRC) due to the 20 years’ unrest. High velocity ballistic injury creates large, complex and composite defects. Large soft tissue defects of the lower face actually rise concern as it is associated with cosmetic and functional deficits with that impact on patient's quality deeper than injuries in other areas of the body. [...]

Background: Coverage of soft tissue defects at the lower extremity may necessitate microsurgical tissue transfer, such as by fasciocutaneous anterolateral thigh (ALT) or myocutaneous musculus latissimus dorsi (MLD) flaps. Hitherto, these two flaps have not been compared systematically in terms of patient satisfaction and functional outcome. The purpose of this study was to compare patients' satisfaction and functional outcome following ALT vs. MLD transfer. Methods: Thirty-six patients were divided into an ALT group (n=22, mean age: 42.0 years) and a MLD group (n=14, mean age: 55.5 years). Both groups were compared concerning isokinetic analysis (Biodex System III), circumference measurement, flap volume, scar size, complication rates, patients' satisfaction, and functional outcome (SF-36 questionnaire, Foot and Ankle Outcome Score (FAOS)), hospital stay and duration of surgery.Results: Isokinetic force measurements showed a higher mean maximum force for dorsiflexion in the MLD group at an angular velocity of 60°/sec. (ALT 17.5±7.9 Nm, MLD 18.5±16.3 Nm; p<0.013) and higher strength endurance at 180°/sec (ALT 8.17±5.6 Nm, MLD 13.36±9.4 Nm; p<0.008), whereas no differences in all other measurements was found. The mean lower leg circumference was significantly larger in the MLD group (ALT 25.0±3.39 cm, MLD 30.36±2.14 cm; p<0.013). The mean difference in the circumference measurement between the covered and uninjured extremity within both groups differed significantly (ALT 2.55±1.71 cm, MLD 8.13±1.65 cm; p<0.001). The flap size in the ALT group was 148.77±6.58 cm² compared to 251.63±21.28 cm² in the MLD group (p<0.01). The scar size in the ALT group was 40.61±4.93 cm² compared to 93.40±22.65 cm² in the MLD group (p<0.01). Superficial necrosis occurred in both groups (ALT n=3, MLD n=5). Donor area seroma was only seen in the MLD group (n=2). A complete flap failure was recorded only in the ALT group (n=2). SF-36 and FAOS indicated no significant differences between group, Einleitung: Weichteildefekte können zur Defektdeckung einen mikrochirurgischen Gewebetransfer wie z.B. eine faszikutane Oberschenkellappenplastik (ALT) oder eine myokutane M. Latissimus dorsi Lappenplastik (MLD) benötigen. Bisher wurden diese beiden Lappenplastiken in Bezug auf Patientenzufriedenheit und alltägliche Funktionsfähigkeit weniger untersucht. Ziel dieser Studie ist es, die Patientenzufriedenheit sowie die Funktionsfähigkeit nach ALT- und MLD-Lappentransfer zu vergleichen.Methoden: 36 teilnehmende Patienten wurden in eine ALT-Gruppe (n=22, Durchschnittsalter 42,0 Jahre) und in eine MLD-Gruppe (n=14, Durchschnittsalter 55,5 Jahre) unterteilt. Beide Gruppen wurden hinsichtlich isokinetischer Kraftanalyse (Biodex System III), Umfangmessung, Lappengröße, Narbenlänge, Komplikationen, Patientenzufriedenheit und alltäglicher Funktionsfähigkeit ( SF-36-Fragebogen, Foot and Ankle Outcome Score (FAOS)), Krankenhausaufenthaltsdauer und Operationsdauer vergleichend untersucht.Ergebnisse: Isokinetische Kraftmessungen zeigten in der MLD-Gruppe bei einer Winkelgeschwindigkeit von 60°/sek. eine höhere mittlere Maximalkraft für die Dorsalflexion (ALT 17,5±7,9 NM, MLD 18,5±16,3 Nm; p<0,013) sowie eine höhere Kraftausdauer bei 180°/sek. (ALT 8,17±5,6 Nm, MLD 13,36±9,4 Nm; p<0,008), während in den anderen Messungen keine Unterschiede zwischen beiden Gruppen gefunden werden konnten. Der Unterschenkelumfang im Mittelwert zeigte sich in der MLD-Gruppe signifikant größer (ALT 25,0±3,39 cm, MLD 30,36±2,14 cm; p<0.013). Die mittlere Differenz in der Umfangmessung zwischen transplantierter und gesunder Extremität unterschied sich signifikant zwischen den beiden Gruppen (ALT 2,55±1,71 cm, MLD 8,13±1,65 cm; p<0,001). In der ALT-Gruppe zeigte sich eine Lappengröße von 148,77±6,68 cm² vergleichend zur MLD-Gruppe mit 251,63±21,28 cm² (p<0,01). Die Narbenlänge betrug in der ALT-Gruppe 40,61±4,93 cm² im Vergleich mit 93,40±22,65 cm² in der MLD-Gruppe. Oberflächliche Nekrosen traten in bei

Objective: Ablative surgery for vulvar cancer can involve the resection of perineum, vagina, urethra, groins, mons pubis, and abdominal wall creating complex defects. In our opinion, ALT flap is an ideal flap for reconstruction, because of low incidence of complications, long pedicle outside the radiotherapy field, capability of carrying fascia and muscle, possibility of sensate reconstruction, and low donor site morbidity. The purpose of this report is to describe our experience with ALT flap for reconstruction after vulvar cancer extirpative surgery, discussing our indications for complex defects and focusing on its versatility. Patients and Methods: We performed a retrospective review of 15 cases of complex postoncologic gynecological wounds, reconstructed with 16 pedicled ALT flap, after vulvar cancer ablative surgery between 2014 and 2016. Age of the patients ranged from 44 to 77, with mean age of 62.6. Postoperative outcomes were evaluated. Results: The flap size ranged from 12 × 8 cm to 22 × 15 cm., in two cases we harvested vastus lateralis to fill the dead space after pelvic exenteration. In nine flaps, we could include only 1 perforator, in 7 we could use two, 5 were septocutaneous and 18 myocutaneous with a pedicle length ranging from9cm.to15cm.We had no flap necrosis.3 flaps showed dehiscence of a part of the wound that healed by dressings. In one case of obese patient the donor site showed partial wound edge necrosis, and required secondary grafting. During follow-up that ranged from 1 month to 2 years, cancer relapsed locally in 5 patients. Global performance and specific pain improved after surgery. Conclusion: ALT flap should be included in the first line options for reconstructions of complex defects resulting from vulvar cancer surgery because of its reliability and versatility. © 2016 Wiley Periodicals, Inc. Microsurgery 37:516–524, 2017.

PURPOSE: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery.METHODS: This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft.RESULTS: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort.CONCLUSION: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.

Multiple variations of the musculocutaneous trapezius flap have been described, each of which use a single composite musculocutaneous unit in their designs. The limitation of such designs is the ability to use the components in a 3-dimensional manner, with only 1 vector existing in the geometry of the musculocutaneous unit. A review of the literature was undertaken with regard to designs of the musculocutaneous trapezius flap, and we present a new technique for flap design. With identification of individual perforators to each of the muscle and fasciocutaneous portions of the trapezius flap, the 2 components can act in a chimeric fashion, able to fill both a deep and complex 3-dimensional space while covering the wound with robust skin. A range of flap designs have been described, including transverse, oblique, and vertical skin paddles accompanying the trapezius muscle. We describe a technique with which a propeller-style skin paddle based on a cutaneous perforator can be raised in any orientation with respect to the underlying muscle. In a presented case, separation of the muscular and fasciocutaneous components of the trapezius flap was able to obliterate dead space around exposed cervicothoracic spinal metalwork and obtain robust wound closure in a patient with previous radiotherapy. This concomitant use of a muscle and fasciocutaneous perforator flap based on a single perforator, a so-called chimeric perforator flap, is a useful modification to trapezius musculocutaneous flap design.

Multiple variations of the musculocutaneous trapezius flap have been described, each of which use a single composite musculocutaneous unit in their designs. The limitation of such designs is the ability to use the components in a 3-dimensional manner, with only 1 vector existing in the geometry of the musculocutaneous unit. A review of the literature was undertaken with regard to designs of the musculocutaneous trapezius flap, and we present a new technique for flap design. With identification of individual perforators to each of the muscle and fasciocutaneous portions of the trapezius flap, the 2 components can act in a chimeric fashion, able to fill both a deep and complex 3-dimensional space while covering the wound with robust skin. A range of flap designs have been described, including transverse, oblique, and vertical skin paddles accompanying the trapezius muscle. We describe a technique with which a propeller-style skin paddle based on a cutaneous perforator can be raised in any orientation with respect to the underlying muscle. In a presented case, separation of the muscular and fasciocutaneous components of the trapezius flap was able to obliterate dead space around exposed cervicothoracic spinal metalwork and obtain robust wound closure in a patient with previous radiotherapy. This concomitant use of a muscle and fasciocutaneous perforator flap based on a single perforator, a so-called chimeric perforator flap, is a useful modification to trapezius musculocutaneous flap design.