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Since time, immemorial soft-tissue injuries to the face have been documented in literature and even depicted in sculptures, reflecting the image of society. In a polytrauma the face may be involved or there may be isolated injury to the face. The face consists of several organs and aesthetic units. The final outcome depends on initial wound care and primary repair. So one should know the "do's and don'ts". Disfigurement following trauma, becomes a social stigma and has the gross detrimental effect on the personality and future of the victim. Therefore, such cases are most appropriately managed by Plastic Surgeons who have a thorough knowledge of applied anatomy, an aesthetic sense and meticulous atraumatic tissue handling expertise, coupled with surgical skill to repair all the composite structures simultaneously. [ABSTRACT FROM AUTHOR]

Defects following excision of lesions in and around the oral commissure extending on either lip are not infrequent. A majority of them are malignant. Various local flaps have been described to correct these defects, but sometimes they may not be feasible. However, the advantage of single-stage reconstruction can still be achieved by using an island forehead flap based on the anterior branch of the superficial temporal artery. This is a versatile flap with a reliable blood supply. It is relatively less popular as it involves time-consuming dissection. Aims: We have modified the island forehead flap based on the anterior branch of the superficial temporal artery by designing the flap on the frontoparietal region based on the terminal course of the anterior branch of the superficial temporal artery. Materials and Methods: This flap was used in five cases of perioral defects involving both the upper and lower lips including the angle of the mouth. Conclusions: Small to moderate dimension full thickness perioral defects can thus be reconstructed effectively with this modified flap in a single stage. The functional and aesthetic results are gratifying with minimal donor site morbidity. [ABSTRACT FROM AUTHOR]

Background: The viability of any pedicled flap depends upon its vascularity. When a flap is dissected it becomes relatively ischaemic. Ultimately, the viability of the flap depends on the vessels incorporated in the pedicle and their perfusion capacity. There are different techniques to evaluate the blood supply of a flap. Aims: This study deals with experimental and clinical efficiency of fluorescein dye technique to evaluate the vascularity of flaps of various compositions. Materials and Methods: The experimental study was conducted on rats to standardize the technique. Thereafter clinical evaluation was conducted for different flaps namely fasciocutaneous, skeletonized perforator based fasciocutaneous, adipofascial, fasciocutaneous flap with adipofascial extension, fasciocutaneous flap with fascial extension and fasciocutaneous flap with split fascial extension. Conclusions: The paper deals in detail with the technique and method of documentation of a fluorescein study on flaps both experimentally and clinically. The appearance of fluorescein on both the surfaces and distal margin of the flap confirmed the adequacy of vascularity soon after dissection of the flaps. It was found to be an easy, safe and reliable objective method. [ABSTRACT FROM AUTHOR]

The cross leg fasciocutaneous flaps are less frequently indicated for distal leg and foot defects due to the availability of other alternative options. However they still remain one of the more realistic options for the surgeon in situations like unsuccessful attempt of free flaps, non-availability of ipsilateral proximal calf tissue, damaged distal perforators following trauma, burns, radiation etc., and inadequate reach beyond mid sole. In the present article we share our experience emphasizing the significance and use, with redefined indications and surgical technique of cross leg retrograde fasciocutaneous flaps for various distal leg and foot defects. We are of the opinion that these flaps are still useful as they continue to prove to be the flap of choice in demanding situations. [ABSTRACT FROM AUTHOR]

The article presents a response by V. Bhattacharya to a letter to the editor about his article "Distal Perforator Based Cross Leg Flaps for Leg and Foot Defects" in the December 2005 issue.