Search

This study aimed to investigate the clinical outcomes of local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures. This retrospective case series study included patients with Gustilo IIIB open tibiofibular fractures treated by local muscle or myocutaneous flap transfer in Weifang People's Hospital between May 2016 and April 2021. Fifteenpatients (11 males aged 19–72 years) were included. The follow-up ranged from 8 to 24 months. The ranges of bone healing time and wound healing time were 6–17 months and 1–3 weeks, respectively. The length of hospital stay was 26 days (11–50 days). All patients reported acceptable functional recovery and satisfactory leg appearance, with Johner-Wruhs scores of excellent, good, and fair in 10, four, and one patients, respectively. The excellent-good rate was 93.3%. The complications included one case of infection and one case of nonunion. In conclusion, local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures may be useful in providing adequate soft tissue coverage and fracture healing with low complication and infection rates. [ABSTRACT FROM AUTHOR]

Background: Anal fistula cancer is rare and definitive treatment has not yet been established. Laparoscopic abdominoperineal resection is generally the first choice of treatment if the cancer is determined to be resectable. However, complicated anal fistula cancer often requires extensive resection. Using a myocutaneous flap for reconstruction after resection in such cases, radical resection can be performed regardless of the size of the anal fistula cancer. Case presentation: We report two cases in which we performed laparoscopic abdominoperineal resection with extensive buttock resection and myocutaneous flap reconstruction for widespread anal fistula cancer. One of the cases was reconstruction with a posterior thigh flap, the other was with a bilateral expanded gluteus maximus flap. Both cases were anal fistula cancers that developed from complicated anal fistulas. Conclusions: If the size of anal fistula cancer is large and extended buttock resection is necessary, radical resection of anal fistula cancer is possible using myocutaneous flap for reconstruction after extended abdominoperineal resection. [ABSTRACT FROM AUTHOR]

We report the case of a 32‐year‐old man who developed a giant diaphragmatic hernia following the removal of a left ventricular assist device 4 years prior due to improved cardiac function. Chest radiography revealed an intrathoracic prolapse of the gastrointestinal tract. The patient was diagnosed with a diaphragmatic hernia and a laparoscopy‐assisted repair was performed. A 12 × 8 cm hernia was found intraoperatively on the left diaphragm, and a large portion of the gastrointestinal tract had prolapsed into the thoracic cavity. We attempted to repair the ventromedial defect using mesh; however, it was found to be insufficient. Therefore, we used a left rectus abdominis myocutaneous flap to fill the defect and sutured it to the mesh. A myocutaneous flap could be a useful strategy in cases where complete closure with mesh is difficult. [ABSTRACT FROM AUTHOR]

ObjectiveMaterials and MethodsResultsConclusionTo describe and evaluate a modified cochlear implant surgical procedure for patients with a thick musculocutaneous flap.A prospective study for cochlear implant surgery in selected patients with a musculocutaneous flap thicker than 7 mm.Fourteen patients with a thick scalp flap underwent cochlear implantation between July 2019 and December 2020. The patient age ranged between 17 and 53 years. The flap thickness was between 7 mm and 14 mm. The mean follow uptime post operatively was 16.5 months. The cochlear implant receiver coil was successfully implanted using the transmuscular technique without complications and with normal audiological function.The transmuscular pocket modified technique is a safe and effective method to overcome a thick musculocutaneous flap in cochlear implant surgery. [ABSTRACT FROM AUTHOR]

The article discusses a technique called "V-I penoscrotal reconfiguration" for the surgical treatment of congenital webbed penis (CWP). The authors propose using scrotal skin for penile shaft reconstruction due to its similar color, thickness, pliability, elasticity, and consistency. However, they caution that the creation of linear scars from this technique can lead to complications such as hypertrophic scars, unsuitable penile curvature, and pain. They suggest further studies with longer follow-ups to assess the risk of complications in younger patients. The authors also mention the use of transposition local flaps harvested from the scrotum as an alternative technique to avoid complications. [Extracted from the article]

This report describes two similar cases in which the distal forearm was compressed between the rib cage and floor for a prolonged period owing to immobility, resulting in severe compartment syndrome and extensive penetrating necrosis in the forearm. The cases were a 59-year-old man with cervical spondylolisthesis and a 65-year-old man suspected of having Parkinson's disease. A distinctive necrotic pattern characterized by necrosis in the volar and dorsal compartments, preservation of the lateral compartment, and retention of the radial artery was commonly observed in both cases. Despite the anticipated nonfunctional outcome of the salvaged limb, a two-lobed free latissimus dorsi musculocutaneous flap transfer with interposition of the thoracodorsal nerve in the median nerve defect was performed in both cases. Although the salvaged limbs were nonfunctional, the patients were able to use it for activities such as getting up and other daily tasks. [ABSTRACT FROM AUTHOR]

Postoperative infection is a devastating complication in limb salvage surgery for malignant soft tissue tumors. The low absolute case numbers of these rare cancers represent a bottleneck for data collection and analysis. The administration of nationwide registry data is a practical option for the accumulation of cases. Data on malignant soft tissue tumor resection were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The incidence of postoperative infection and its risk factors were analyzed. A total of 14,460 cases were included. The incidence of infection was 2.6%. Significant risks for infection were male sex, lower extremity or trunk location, tumor diameter of over 10 cm, trans -compartmental invasion, high grade, autologous bone graft, myocutaneous flap, vascular reconstruction, reconstruction by prosthesis, postoperative radiotherapy, and delayed wound healing. The incidence was lower than those in the previous studies, perhaps because of less frequent radiotherapy application. Some of the significant risk factors represented local invasiveness of the tumor, suggesting the importance of the preservation of soft tissue for infection prevention. The administration of nationwide registry data was informative for the analysis of infection in malignant soft tissue tumor resection. [ABSTRACT FROM AUTHOR]

Background The versatile musculocutaneous latissimus dorsi flap and the thoracodorsal artery (TDA) perforator flap have developed into indispensable approaches in reconstructive surgery. While the anatomy of the TDA is consistent, the skin perforators vary in location and course. Dynamic infrared thermography (DIRT) recently gained popularity for perforator identification; however, its use and accuracy in thoracodorsal artery perforator (TDAP) mapping is yet to be determined. Methods TDAPs were visualized in 50 cases by DIRT. Based on the thermographic hotspots, the corresponding perforators were then identified by color duplex ultrasound (CDU) and handheld Doppler in a blinded fashion by two separate examiners. Results The midpoint of all perforator fascia passages was localized 99.7 mm caudal and 13.5 mm medial of the posterior axillary fold. The positive predictive value of perforator identification by dynamic infrared thermography was 86.5% and the correlating perforator fascia passage was 9.9 ± 5.8 mm from the hotspot midpoint, with a maximum of 29 mm. The positive predictive value of perforator identification by handheld Doppler was 95% and the signal was 7.2 ± 5.1 mm from the perforator fascia passage. Conclusion DIRT precisely localizes TDAPs. The fusion with CDU combines both modalities' advantages. The combination with handheld Doppler is a fast way of perforator imaging, decreasing the handheld Dopplers' high false positive rate. [ABSTRACT FROM AUTHOR]

Circular pharyngolaryngectomy for oncologic resection requires a tubular reconstruction. Different options can be proposed to the patient: digestive free flap, fasciocutaneous flap, or musculocutaneous flap. The jejunum free flap is a tubular flap commonly used in esophageal and pharyngeal reconstruction with good functional outcomes and an acceptable rate of complications. Reconstruction with a jejunum free flap is an ideal choice. Patients at Gustave Roussy Institute (Villejuif, France) were offered a jejunum flap free flap for all circular pharyngolaryngectomies. The surgical technique is explained with a step‐by‐step video. The jejunum flap free flap has many advantages in circular pharyngolaryngectomy. This video article explains surgical steps for other teams. [ABSTRACT FROM AUTHOR]

We describe a case of mandibular gingival carcinoma with hypercalcaemia and leukocytosis caused by tumour-derived parathyroid hormone-related protein (PTHrP) and granulocyte colony-stimulating factor (G-CSF). A 54-year-old man presented to our Department of Oral and Maxillofacial Surgery with a chief complaint of a left-sided mandibular gingival ulcer. A 42 mm × 20 mm sized ulcer was found on the left lower molar gingiva. Squamous cell carcinoma was pathologically diagnosed. The patient underwent a hemimandibulectomy, left-sided radical neck dissection, plate reconstruction, pectoralis major musculocutaneous flap reconstruction, and tracheostomy under general anaesthesia. Pathologically, two metastatic lymph nodes were identified. Residual tumour was suspected at the resection margins. Eight weeks after surgery, the patient started postoperative concurrent chemoradiotherapy (CCRT). Two weeks after CCRT, the patient developed hypercalcaemia. Serum levels of PTHrP and G-CSF increased in parallel with the progression of hypercalcaemia and leukocytosis. Immunohistochemical analysis of the surgical specimen showed positivity for G-CSF. Based on these clinical and pathological findings, the patient was diagnosed with hypercalcaemia and leukocytosis associated with malignancy and was treated with denosumab. Irradiation was terminated at 50 Gy because CT showed rapid disease progression. Chemotherapy was initiated, however, four weeks after the start of chemotherapy, a CT scan showed increased metastases and pleural dissemination. Therefore, chemotherapy was discontinued. One week after the chemotherapy was discontinued, the patient died of respiratory failure. [ABSTRACT FROM AUTHOR]

Objectives The lateral supraorbital (LSO) approach is a less-invasive alternative to the pterional craniotomy that provides rapid transsylvian access. Establishing familiarity with the LSO technique and its features as compared with other anterolateral approaches is an important component of advanced skull base training. We present a step-by-step demonstration of the LSO approach using cadaveric dissection in a manner that is digestible for trainees at various levels. Design This is anatomic step-by-step dissection and representative case series. Setting This study was carried out in the cadaveric dissection laboratory. Participants A formalin-fixed, latex-injected cadaveric head specimen was dissected under microscopic magnification by a neurosurgery resident under faculty supervision. Following dissection, representative case applications were reviewed. Main Outcome Measures Dissection and case illustration were the main outcome measures. Results A single-layer myocutaneous flap is developed, and a single-burr-hole technique is used, followed by extensive drilling of the sphenoid wing. The dura is opened in a C-shaped fashion centered on the Sylvian fissure, exposing the inferior frontal and superior temporal lobes. Labeled photographs of dissections with pertinent anatomical structures are presented. Three case examples illustrating the versatility of the LSO approach, including the resection of a large pituitary adenoma, an inferior frontal melanoma metastasis presenting to the Sylvian surface, and a frontoinsular low-grade glioma, are reviewed. Conclusion As compared with the pterional craniotomy, the LSO approach involves a shorter incision, smaller craniotomy, and faster exposure; it can be conveniently tailored to various indications. Understanding the step-by-step dissection and indications of the LSO approach is of paramount importance to neurosurgery trainees. [ABSTRACT FROM AUTHOR]

Background: Electrical burns are potentially devastating injuries. Scalp defects following electrical burns present as a reconstructive challenge. The factors influencing decision-making in the repair of scalp defects are their size, depth and location, and integrity of surroundings. A successful reconstruction must result in less morbidity, decreased hospitalization time, and good aesthetic appearance preserving the hairline. The rationale for the study is to study the epidemiology of post-electrical burns scalp defects and to propose an algorithm for their reconstruction. Methods: This retrospective study includes 95 patients with post-electrical burns scalp defects from Jan 2013 to Dec 2022. Patients admitted with scalp defects resulting from electrical injuries were initially resuscitated. Once deemed fit for surgery, they underwent wound debridement. Due to the progressive tissue necrosis associated with electrical burns, multiple debridements were necessary. Various methods were employed to reconstruct the scalp defects based on the specific nature of the defect, including primary closure, skin grafting, and the use of flaps. Follow-up visits were scheduled weekly for the first month and then monthly for the subsequent six months. Results: 52 patients had pericranium intact for which SSG was performed. 43 cases had loss of pericranium for which local flaps were given in 36 cases. In 2 patients skin traction by stainless steel wires was done. Sequestrectomy + Tensor fascia lata Graft with Bipedicle Advancement Flap cover was done for a patient with osteomyelitis of bone. Regional Vertically placed Trapezius Myocutaneous flap was done in 3 cases and for one case Free Anterolateral thigh flap was given. Conclusion: Reconstruction of post-electrical burn scalp defects should follow the reconstructive ladder. Reconstructive strategies are to be adapted based on defect size, depth, presence or absence of pericranium. If pericranium is intact - split-thickness skin grafting can be done. If pericranium is lost - a flap cover is to be given. Local flaps are the ideal choice for the reconstruction of scalp defects due to their easy availability, and minimal complications. [ABSTRACT FROM AUTHOR]

Present study is a comparative evaluation of the financial impact on choice of flap, clinical results as well as post resection quality of life assessment of cancer patients reconstructed with anterolateral thigh(ALT) flap and pectoralis major myo-cutaneous(PMMC) flap. Ethical clearance was obtained from institutional ethical committee. In this non-randomised, prospective study design among 49 oral squamous cell carcinoma cases, 39 cases were reconstructed using PMMC flap and 10 using ALT flap from year 2020 to 2022. These 2 flaps were compared in terms of parameters like time utilised for reconstruction, hospital stay, overall survival and Washington University Quality of Life index(UW-QOL) for head and neck cancer. Patients were followed regularly for post-operative complications. The University of Washington Quality of Life score (UW-QOL) questionnaire, version 4, was completed at six months post-operatively. Obtained data was statistically analysed using IBM® SPSSⓇ. Washington University Quality of Life index scores and esthetics are better with Antero-lateral thigh flap, with less overall post-operative complications. On the other hand Pectoralis myocutaneous flap has less surgical time and more salvage potential. Despite of Antero-lateral thigh flap having Good Washington University Quality of Life index scores, lesser post-operative complications and better esthetics; scale of developing nations is still tipping towards economical, less time consuming and less technique sensitive Pectoralis major myocutaneous flap. [ABSTRACT FROM AUTHOR]

Patients who undergo surgery for breast cancer are at risk for venous thromboembolism (VTE) and bleeding, which can lead to significant consequences on outcomes. This study examined factors related to VTE and bleeding risk in breast cancer surgery, with and without reconstruction. We also investigated the relationship between operative time and resident involvement on bleeding and VTE risk. Using the ACS-NSQIP database, patients who underwent mastectomy, implant, pedicled, or free flap reconstruction from 2005 to 2021 were identified. Resident involvement was available from 2007 to 2010. We fitted two logistic regressions to model the log odds of bleeding occurrence and VTE as linear functions of procedure type, controlling for age, body mass index, and comorbidities. Implant reconstruction had significantly reduced 30-d incidence of bleeding, compared to those who underwent transverse rectus abdominus muscle flap (P < 0.001). Free flap was associated with a significant increase in bleeding but not VTE risk (P < 0.001; P = 0.132). Increase in operative time significantly increased the risk of bleeding and VTE (P < 0.001). For surgeries with resident involvement coded, there was no significantly increased risk of bleeding or VTE (P = 0.600; P = 0.766). Implant reconstruction remains the procedure with the lowest risk of both bleeding and VTE. Free flap reconstruction did not show a significantly increased risk of VTE, potentially expanding reconstruction options for patients previously excluded from autologous reconstruction. Surgeons should be mindful of operative time, with re-evaluation of risk factors with each additional hour of surgery, irrespective of reconstruction type. Resident involvement in surgeries should continue to be encouraged by faculty. [ABSTRACT FROM AUTHOR]

Transversus abdominis release (TAR) is increasingly being performed for reconstruction of complex incisional and recurrent ventral hernias, with complication rates ranging from 17.4% to 33.3% after open TAR (oTAR) or robotic TAR (rTAR). The purpose of this study was to describe the outcomes of patients undergoing TAR with macroporous polypropylene mesh (MPM) and to compare outcomes between oTAR and rTAR. A retrospective review of 183 consecutive patients undergoing TAR with MPM performed by a single surgeon at a single institution from 2015 to 2021 was performed. Patients with less than one year of follow-up were excluded. Univariate analysis was performed to compare outcomes between oTAR and rTAR patients. Average patient age was 59.4 y, median body mass index was 33.2 kg/m2, and median hernia width was 12.0 cm. Forty 2 (23%) patients underwent oTAR, 127 (69%) underwent rTAR, and 14 (8%) underwent laparoscopic TAR. Patients experienced 16.4%, 10.4%, 3.8%, and 6.0% rates of overall complications, surgical site occurrences, surgical site infections, and other complications, respectively. At average follow-up of 2.3 y, a 2.7% hernia recurrence rate was observed. In comparison to patients undergoing oTAR, rTAR patients required shorter operative times and length of stay, and were less likely to experience postoperative complications overall, and other complications. Recurrence rates were similar between oTAR and rTAR. Patients undergoing TAR with MPM experienced complication and recurrence rates in alignment with previously published results. In comparison to oTAR, rTAR was associated with more favorable perioperative outcomes and complication rates, but similar recurrence rates. [ABSTRACT FROM AUTHOR]

Objective: To present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction. Methods: We performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes. Results: Thirty‐three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti‐infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed. Conclusion: The SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

The research purpose is to review the surgical approach and evaluate the results in adult patients with head and neck sarcomas. The histopathology varied, including two leiomyosarcomas, six malignant fibrous histiocytomas, two malignant peripheral nerve sheath tumors, four dermatofibrosarcomas protuberans, three osteosarcomas, two angiosarcomas, one liposarcoma, one Ewing sarcoma, one synovial sarcoma, two unclassified/non-differentiated sarcomas and one solitary fibrous tumor. Surgical resection included maxillectomy, mandibulectomy, craniectomy, parotidectomy, scalp resection, face skin resection and laminectomy. The reconstruction was performed with one rectus abdominis flap, four radial forearm flaps, two latissimus dorsi flaps, two vascularized fibula flaps, two pectoralis major myocutaneous flaps, two trapezius flaps, two temporalis flaps, seven scalp flaps and two nasolabial flaps. The total patient number was 24. The hospitalization was uncomplicated, followed by postoperative radiotherapy in the majority of cases. In a mean 15-year follow-up period, 11 patients are still alive and disease-free. There were four recurrences treated with palliative radiotherapy. The surgical approach for head and neck sarcomas, including the achievement of a functionally acceptable result by organ sparing techniques, remains challenging. Wide resection combined with the appropriate reconstruction, particularly with microsurgical techniques, and followed by adjuvant radiotherapy or chemotherapy offer improved prognosis and quality of life. [ABSTRACT FROM AUTHOR]

Background: Partial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high‐risk patients with complex laryngopharyngeal ± cutaneous neck defects. Methods: Retrospective single‐surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck. Results: Twenty‐four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo‐esophageal peristomal fistulas. At last follow‐up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G‐tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post‐operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively. Conclusions: The LDMFF can be a robust reconstructive option, particularly for radiated high‐risk patients with complex pharyngeal defects, including skin. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life. [ABSTRACT FROM AUTHOR]

Reconstruction of chest wall defects after tumor resection is challenging. With the advancement of reconstructive surgery, more options are available for chest wall reconstruction. Workhorse flaps like the musculocutaneous latissimus dorsi flap are frequently employed. Its modification to the V-Y design of the latissimus dorsi myocutaneous flap allows huge chest wall defect closure with substantial benefits, especially for cancer patients. We describe our experience using this flap design in five patients and the difficulties we faced. All patients underwent immediate chest wall reconstruction with a modified V-Y latissimus dorsi myocutaneous flap with minimal complications and donor site morbidity. [ABSTRACT FROM AUTHOR]

Background: Venous insufficiency after flap surgery is an unpredictable complication that can lead to flap loss. Several approaches have been described to eliminate the venous problems after flap surgery, but it still remains unsolved. In this study, we aimed to demonstrate the application of the cupping method to treat the venous compromise in the flaps. Patients and Methods: Patients with flaps undergoing mechanical negative pressure drainage due to venous compromise were included in the study. Only procedures with pedicled island flaps were included to exclude cases of venous insufficiency due to thrombosis or anastomotic problems. Patients with free flaps, perforator flaps and skin-connected flaps were also excluded. Demographic data (age, sex), mean duration and frequency of application, complications were recorded. Results: Eight patients were included in the study with a mean age of 40.3 years. A parascapular flap was performed in four patients, a transverse rectus abdominis flap in three patients and a medial gastrocnemius musculocutaneous flap in one patient. The mean duration of mechanical negative pressure drainage was 2.8 days and the mean frequency of application was 4.6 times per day. The mean duration of the procedure was 2.25 minutes. Two patients underwent revision surgery on postoperative day 5 under local anaesthesia due to marginal necrosis of the flap. There were no complications in the other patients. Conclusion: Compared to other approaches described in the literature, the cupping method may provide a more practical and faster solution for venous congestion. Although the limited number of patients seems to be a limitation of the study, the main priority of the study was to demonstrate the applicability of the method. A large population study with a controlled randomised methodology will make a positive contribution to the literature. [ABSTRACT FROM AUTHOR]

Background: Obesity remains a high-level risk factor for various cancers. Yet, some research has shown that higher BMIs may improve survival outcomes, particularly for head and neck squamous cell carcinoma (HNSCC). While this is a clear deviation from the norm, it raises the question of what other effects obesity may have on head and neck cancer patients, including surgical outcomes. Choosing the most appropriate flap for patients can be difficult for even experienced surgeons. Head and neck reconstructive surgeries are no exception to this rule and can be especially challenging. To produce the most favorable outcomes, a physician must be able to combine all flap attributes including donor and recipient site location, flap thickness, as well as each patient's individual risk factors such as prior radiation. Purpose: The purpose of this study was to compare the outcomes of vertical rectus femoris myocutaneous (VRAM) and anterolateral thigh (ALT) flaps in overweight and obese individuals with varying head and neck cancers leaving large-sized defects to the outcomes in normal and underweight patients. Methods: A retrospective chart review was conducted of VRAM and ALT flaps performed over a period of 12 months at our university hospital for large head and neck reconstruction. Results: Of the 17 ALT patients, 80% (4/5) of the underweight patients, 57% (4/7) of the normal weight patients, 50% (1/2) of the overweight patients, and 33% (1/3) of the obese patients experienced complications. Of the 15 VRAM patients, 40% (2/5) of the underweight patients, 83% (5/6) of the overweight patients, and 50% (1/2) of the obese patients experienced complications. Conclusions: In our small sample size, a smaller percentage of obese patients with head and neck cancer who underwent flap reconstruction surgery had complications when undergoing ALT flaps than VRAM flaps, which contrasts with the normal and underweight patients, who had less complications with VRAM flaps than ALT flaps. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI)/periprosthetic joint infection (PJI) is a devastating complication in limb salvage surgery with endoprosthesis reconstruction for malignant bone tumors. The main bottleneck for data collection and analysis for the status of SSI/PJI in tumor endoprosthesis is the low absolute case numbers of this rare cancer. The accumulation of many cases is possible by administrating nationwide registry data. The data on malignant bone tumor resection with tumor endoprosthesis reconstruction were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The primary endpoint was defined as the need for additional surgical intervention for infection control. The incidence of postoperative infection and its risk factors were analyzed. A total of 1342 cases were included. The incidence of SSI/PJI was 8.2%. The incidence of SSI/PJI in the proximal femur, distal femur, proximal tibia, and pelvis were 4.9%, 7.4%, 12.6%, and 41.2%, respectively. Location in the pelvis or proximal tibia, tumor grade, indication of myocutaneous flaps, and delayed wound healing proved to be independent risks for SSI/PJI, whereas age, sex, previous surgery, tumor size, surgical margin, application of chemotherapy and radiotherapy were not significant. The incidence was equal to those in previous studies. The result reconfirmed the high incidence of SSI/PJI in pelvis and proximal tibia cases and cases with delayed wound healing. Novel risk factors such as tumor grade and application of myocutaneous flaps were marked. The administration of nationwide registry data was informative for the analysis of SSI/PJI in tumor endoprosthesis. [ABSTRACT FROM AUTHOR]

Background: Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent. Materials and Methods: This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer. Results: The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications. Conclusion: Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects. [ABSTRACT FROM AUTHOR]

The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors. The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap. A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period. Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the authors' experience in head and neck reconstruction with the tensor fascia lata perforator flap (TFLPF). Between April 2009 and August 2020, 16 patients underwent head and neck reconstruction with a TFLPF. The flaps were designed in a vertical or transverse fashion based on perforators traveling along the medial or lateral aspect of the posterior edge of the tensor fascia lata muscle. Clinical details and postoperative results were recorded and analyzed. The size of the flap ranged from 7 × 5 cm2 to 25 × 9 cm2. The perforators were mostly septocutaneous (11 patients), allowing a simple and straightforward dissection of the perforator and TFLPF in most patients. There were either one or two perforators in all cases. The overall flap survival rate was 100%. All of the flaps healed uneventfully with no delayed wound healing or donor site dysfunction. Follow-up ranged from 18 to 120 months, during which all patients experienced satisfactory functional and aesthetic results, without serious complications at either the recipient or donor site. The TFLPF is a pliable and reliable flap that could be a first choice in selected head and neck reconstruction cases. [ABSTRACT FROM AUTHOR]

Purpose: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) presents significant challenges, especially in elderly and comorbid patients, often necessitating revision surgeries. We report on a series of patients with confirmed PJI of the knee and concomitant soft‐tissue/extensor apparatus defects, treated by using pedicled myocutaneous medial or lateral sural artery perforator (MSAP/LSAP) gastrocnemius flaps. Methods: Our retrospective study at the Center for Musculoskeletal Infections, included patients with knee PJI undergoing pedicled myocutaneous MSAP/LSAP gastrocnemius flap reconstruction for combined soft tissue and extensor apparatus defects. The tendinous back of the gastrocnemius muscle was used and, if required, the Achilles tendon for extensor apparatus reconstruction, with the skin island addressing the cutaneous defect. Perioperative complications and postoperative outcomes after 1 year were evaluated, including functional and clinical assessments with the American Knee Society Score (AKSS). Results: Eight patients (mean age 73 years; five female) were included, predominantly with Staphylococcus aureus infections. Six patients involved isolated MSAP flaps, two were extended with the Achilles tendon. The median time for wound healing was 9 days. Short‐term follow‐up showed successful reconstruction in seven patients, with minor wound dehiscence in one patient. One patient required flap revision for a perigenicular haemato‐seroma and two patients were diagnosed with new haematogenous PJI infection. Significant improvement in AKSS scores after surgery was observed (functional AKSS: median 33–85; clinical AKSS: median 64–91, p = 0.001). Conclusion: Pedicled myocutaneous MSAP/LSAP gastrocnemius flaps offer a safe, reliable and versatile option for reconstructing combined soft tissue and extensor apparatus defects in PJI after TKA. This approach yields excellent functional outcomes with minimal peri‐ and postoperative complications, which is particularly beneficial in elderly and comorbid patients and feasible in settings without microsurgical availability. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Four patients with rectal cancer required reconstruction of a defect of the posterior vaginal wall. All patients received neoadjuvant (chemo)radiotherapy, followed by an en bloc (abdomino)perineal resection of the rectum and posterior vaginal wall. The extent of the vaginal defect necessitated closure using a tissue flap with skin island. The gluteal turnover flap was used for this purpose as an alternative to conventional more invasive myocutaneous flaps (gracilis, gluteus, or rectus abdominis). The gluteal turnover flap was created through a curved incision at a maximum width of 2.5 cm from the edge of the perineal wound, thereby creating a half-moon shape skin island. The subcutaneous fat was dissected toward the gluteal muscle, and the gluteal fascia was incised. Thereafter, the flap was rotated into the defect and the skin island was sutured into the vaginal wall defect. The contralateral subcutaneous fat was mobilized for perineal closure in the midline, after which no donor site was visible.The duration of surgery varied from 77 to 392 min, and the hospital stay ranged between 3 and 16 days. A perineal wound dehiscence occurred in two patients, requiring an additional VY gluteal plasty in one patient. Complete vaginal and perineal wound healing was achieved in all patients. The gluteal turnover flap is a promising least invasive technique to reconstruct posterior vaginal wall defects after abdominoperineal resection for rectal cancer. [ABSTRACT FROM AUTHOR]

Background: Carcinoma of the floor of the mouth (FOM) can be difficult to treat surgically. Reconstruction is often necessary to close defects and restore function. In countries with limited resources, the pedicled pectoralis major myocutaneous (PMMC) flap can be considered as an alternative for FOM reconstruction, especially in the era of microvascular techniques. Methods: In this study, we assess the effectiveness of using the PMMC flap to treat defects caused by carcinomas in the floor of the mouth (FOM). We have analyzed 28 patients and examined the surgical techniques, postoperative results, and complications related to the use of the PMMC flap. We have compared this approach to other reconstruction methods, with a focus on restoring function and ensuring patient satisfaction. Results: In our research, we studied 28 patients who had the floor of mouth cancer. Out of them, 15 patients underwent PMMC flap reconstruction. The reconstruction results were encouraging as patients reported high satisfaction levels with improved speech and swallowing abilities. Although some complications were observed, such as two cases of orocutaneous fistula formation and one case of partial flap necrosis, the functional outcomes of PMMC flap reconstruction were better than other flap reconstructions. Conclusions: In modern times, reconstructive surgery has advanced significantly, and the PMMC flap has proven its enduring worth. Although it may not always be the first choice, this time-tested technique has emerged as a viable option in the armamentarium for FOM carcinoma reconstruction. By balancing tradition and innovation, surgeons are able to offer optimal outcomes, functional restoration, and patient satisfaction in this challenging clinical scenario. Therefore, the PMMC flap deserves consideration as a valuable adjunct in the modern era of microvascular reconstruction for floor-of-mouth carcinoma. Further research and case studies are necessary to refine its indications and techniques in contemporary practice. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Enhancing aerodynamic efficiency is vital for optimizing aircraft performance and operational effectiveness. It enables greater speeds and reduced fuel consumption, leading to lower operating costs. Hence, the implementation of Gurney flaps represents a promising avenue for improving airfoil aerodynamics. The optimization of Gurney flaps holds considerable ramifications for improving the lift and stall characteristics of airfoils in aircraft and wind turbine blade designs. The efficacy of implementing Gurney flaps hinges significantly on its design parameters, namely, flap height and mounting angle. This study attempts to optimize these parameters using a design optimization framework, which incorporates training a Radial Basis Function surrogate model based on computational fluid dynamics (CFD) data from two-dimensional (2D) Reynolds-Averaged Navier–Stokes (RANS) simulations. The Cuckoo search algorithm is then employed to obtain the optimal design parameters and compared with other competing optimization algorithms. The optimized Gurney flap configuration shows a notable improvement of 10.28% in C l / C d , with a flap height of 1.9%c and a flap mounting angle of −58 ∘ . The study highlights the effectiveness of the proposed design optimization framework and furnishes valuable insights into optimizing Gurney flap parameters. The comparison of metaheuristic algorithms serves to enhance the study's contribution to Gurney flap design optimization. [ABSTRACT FROM AUTHOR]

Purpose: Skull base reconstruction is one of the most difficult reconstructive surgical procedures. Due to its complexity, most surgeons have modified the reconstruction methods to minimize the postoperative complications and mortality rate. In the past, flap surgery was not usually performed, but it has recently become more common due to advances in medicine. In this study, we analyzed successful flap surgery methods in skull base reconstruction for large cranial-nasal communications. Methods: Patients who underwent skull base reconstruction from April 2015 to January 2024 were eligible for this study. Of these patients, we included those who underwent reconstruction using a volumetric flap. Reconstructions that only used the conventional galeal flap, allograft skin, or bone substitute were excluded. The reconstruction methods used local flaps and free flaps. Results: In total, 22 patients underwent skull base reconstruction. The most frequently used local flap was the bilateral reverse temporalis muscle flap (seven of 11 cases), and the most frequent free flap was the anterior lateral thigh flap (10 of 11 cases). Other local flap operations used the modified temporalis muscle flap and scalp flap. A rectus myocutaneous flap was also used. There were no cases of flap necrosis. Conclusion: Flap surgery is needed for skull base reconstruction in patients with large cranial-nasal communications. As long as the flap volume is large enough to block and fill the defect, either a local flap or a free flap can be used for reconstruction. [ABSTRACT FROM AUTHOR]

A 47-year-old male patient presented with multiple squamous and basal cell carcinomas on the anterior chest, back, and left cheek. The patient experienced odorous discharge from the tumors. Surgical excision was planned, beginning with the anterior chest squamous cell carcinoma. An extensive 32×30 cm cutaneous defect was created, which was covered by a bilateral deep inferior epigastric perforator and pedicled latissimus dorsi myocutaneous flaps. The basal cell carcinomas on the back and squamous cell carcinoma on the left cheek were serially excised, after which the left cheek wound required flap coverage. Postoperative complications such as venous thrombosis and infection led to several reoperations, yet the extensive defect was successfully reconstructed. No local recurrence developed during 31 months of follow-up. We report this case to demonstrate that although the wide excision of very large skin cancers may result in extensive and challenging defects as large as 5.8% of the total body surface area, coverage with appropriate flaps may lead to successful oncologic outcomes and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The open Rives–Stoppa retrorectus and transversus abdominis release (TAR) techniques are well established in open ventral and incisional hernia repair. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate our initial results of transperitoneal laparoscopic TAR for ventral incisional hernia repair (laparoscopic TAR). Methods: Over a 20-month period, 23 consecutive patients with incisional hernias underwent surgery. Laparoscopic TAR was performed transperitoneally with adhesiolysis from the anterior abdominal wall, development of the retrorectus space and TAR, midline reconstruction and extraperitoneal mesh reinforcement. Results: There were 23 incisional hernias, of which 70% were M2–M4 and 60% were W3. Median patient age was 68 years and the median BMI was 31. Median operating time was 313 min, and hospital stay was 4 days. Morbidity was 26% (Clavien–Dindo 1: n = 4 and 2 + 3b: n = 2). Conclusion: With the laparoscopic TAR, it was possible to treat a series of patients with ventral incisional hernias. The operating times were long. However, with a low rate of perioperative complications the hospital stay was short As feasibility is demonstrated, the clinical relevance of the method has to be further evaluated. [ABSTRACT FROM AUTHOR]

Background Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast reconstruction has been poorly characterized. Methods A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction was conducted over 15 years. Patient operative characteristics were recorded and outcomes were analyzed. PROs were assessed using the BREAST-Q abdominal survey. Results In total, 75 women (108 flaps) with the mean body mass index (BMI) of 33.2 were included. Flaps included deep inferior epigastric artery perforator (24%), muscle-sparing (43%), and free transverse rectus abdominis myocutaneous flaps (f-TRAM; 33%). World Health Organization (WHO) obesity class, BMI, and flap type did not affect flap failure (1%) or complication rates. Hernia developed in 7%; all necessitated repair. Eight percent developed abdominal bulge; one was repaired. Hernia formation was associated with increased patient age (p < 0.05). Bulge formation occurred more often in f-TRAM donor sites (p = 0.005). BMI, WHO class, flap type, and mesh use were not related to hernia or bulge occurrence in either univariate or multivariate analysis. The survey response rate was 63%. Abdominal Physical Well-Being (proxy for abdominal wall function) and Satisfaction with Abdomen (patient-perceived cosmesis) were similar across flap types, age, and WHO classification groups. Patients with postoperative bulge reported higher abdominal physical well-being scores, regardless of flap type (p < 0.01). Bulge was correlated with lower satisfaction (p < 0.05). Conclusion The incidence of abdominal wall morbidity following abdominal free-tissue transfer for breast reconstruction was acceptably low in our population of obese patients. Hernia was a clinically significant complication, warranting surgical repair. Bulge was primarily a cosmetic concern and did not detract from patient-reported abdominal wall function. Age may represent an independent risk factor for hernia formation in this population. [ABSTRACT FROM AUTHOR]

Background Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. Methods This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. Results Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). Conclusion Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis. [ABSTRACT FROM AUTHOR]

Background: The pedicle pectoralis major muscle flap is the primary workhorse flap used in head, neck, and large axillary reconstruction; however, traditional harvesting techniques may leave significant donor site scarring. Case Report: Endoscopy-assisted harvesting of a pedicled pectoralis major muscle flap, or muscle flap and musculocutaneous flap, was performed in two patients, after which axillary defects were closed with a 4 cm incision at the 5th intercostal space using the harvested flap matching the size of the defect. The harvesting process took 40 and 32 minutes, respectively, and patients were able to return home at 5 to 7 days post-surgery. No postoperative complications were observed in either patient. Conclusion: Endoscopic harvesting of the pedicled pectoralis major flap helps to reduce the extent of skin incisions because it gathers the pedicle vessel under the skin. Furthermore, it minimizes postoperative complications such as long hypertrophic scars. [ABSTRACT FROM AUTHOR]

We present a complex case of a patient diagnosed with bilateral breast cancer. The patient initially underwent bilateral skin-sparing mastectomy and immediate subpectoral implant-base breast reconstruction. She had an uncomplicated postoperative recovery. However, three months later, she developed a severe and persistent local infection during adjuvant chemotherapy, resulting in the loss of the breast implants and the formation of massive deforming scars in the chest area. To address this, the patient underwent a series of reconstructive procedures. Lipofilling was used on the chest wall to improve skin quality, followed by a late bilateral transverse rectus abdominis myocutaneous flap for breast reconstruction. Additionally, the final aesthetic result was enhanced by applying a 3-D tattoo. This case highlights the use of a sequence of reconstructive procedures as a feasible alternative to manage complex and extensive scars after failure of primary breast reconstruction. [ABSTRACT FROM AUTHOR]

Background: Preserving laryngeal function and reconstructing the hypopharynx in advanced hypopharyngeal cancer pose significant challenges for head and neck surgeons. Methods: A 48‐year‐old male patient was diagnosed with advanced hypopharyngeal cancer originating from the left pyriform sinus. The tumor extended into the hypopharynx, left vocal cord, ventricular fold, partial aryepiglottic fold, and a segment of the cervical esophagus. A curative tumor resection was performed, and a well‐thought‐out strategy was employed for hypopharyngeal repair and laryngeal reconstruction. Results: Following the surgery, the patient demonstrated exceptional flap survival, and the tracheostomy tube was removed at the 6‐month mark. No surgery‐related complications were observed, and both swallowing and vocal functions exhibited a robust recovery. Conclusion: Our reconstruction strategy proves effective in preserving laryngeal function among patients with advanced hypopharyngeal cancer. [ABSTRACT FROM AUTHOR]

Vascularized composite allografts (VCA) face ischemic challenges due to their limited availability. Reperfusion following ischemia triggers oxidative stress and immune reactions, and scavenger molecules could mitigate ischemia–reperfusion injuries and, therefore, immune rejection. We compared two scavengers in a myocutaneous flap VCA model. In total, 18 myocutaneous flap transplants were performed in Major histocompatibility complex (MHC)-defined miniature swine. In the MATCH group (n = 9), donors and recipients had minor antigen mismatch, while the animals were fully mismatched in the MISMATCH group (n = 9). Grafts were pretreated with saline, sodium iodide (NaI), or hydrogen sulfide (H2S), stored at 4 °C for 3 h, and then transplanted. Flaps were monitored until clinical rejection without immunosuppression. In the MATCH group, flap survival did not significantly differ between the saline and hydrogen sulfide treatments (p = 0.483) but was reduced with the sodium iodide treatment (p = 0.007). In the MISMATCH group, survival was similar between the saline and hydrogen sulfide treatments (p = 0.483) but decreased with the sodium iodide treatment (p = 0.007). Rhabdomyolysis markers showed lower but non-significant levels in the experimental subgroups for both the MATCH and MISMATCH animals. This study provides insightful data for the field of antioxidant-based approaches in VCA and transplantation. [ABSTRACT FROM AUTHOR]

Background: There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery. Methods: Four patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center. Results: All patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up. Conclusions: We recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry. [ABSTRACT FROM AUTHOR]

Auricle is the outward visible part of ear and composed of skin and cartilage. Auricle due to its standout and projected position is more vulnerable to get injured and cause distortion of the facial aesthetics. Reconstruction of the ear defect should be individualized depending on the defect size, location, nearby skin, patient requirement and surgeon experience. To present the results of various reconstructive options for partial ear defect which will aid in decision making among reconstructive options available. Reconstruction was individualized considering the defect size, depth, location, surrounding skin. In upper 1/3 defect reconstructive options include Antia–Buch chondrocutaneous advancement flap, autogenous cartilage with temporoparietal fascial flap, for middle 1/3 defect options include retroauricular soft tissue tube flap, diefenbach procedure, Autogenous cartilage graft and temporoparietal fascial flap, for lower 1/3 defect reconstructive options include pre auricular flap, triangular repair method, Zenteno Alanis technique. Reconstruction with various techniques results in aesthetically good outcomes. There is no major complication seen in any patient. Reconstruction of ear defect with various options available has good outcome. Planning is important part in reconstruction process. Reconstructive option chosen for a ear defect should be individualized depending on patient characteristics, surgeon experience. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SSc) is an autoimmune disease characterized by systemic inflammation, endothelial dysfunction, generalized fibrosis and high cardiovascular mortality. The evaluation of cardiovascular risk through the visceral adiposity index (VAI) has been helpful due to its direct relationship to the body and visceral fat percentage. We evaluated the influence of body composition and anthropometrics on cardiovascular risk as measured by VAI in healthy controls (HC) and SSc. An analytical cross-sectional study of 66 participants (33 SSc and 33 HC), mean age 52.7 ± 10, 95% women, was conducted from August 2020 to January 2021. Inclusion criteria in cases were consecutive patients with SSc (ACR/EULAR 2013), 63.6% were diffuse cutaneous (dcSS) subtype, and 36.4 were limited cutaneous (lcSS) subtype. HC was matched by age and gender. Serum lipid profiles and InBody anthropometrics were analyzed and compared. We performed descriptive statistics, bivariate analysis with Student's t, or Mann–Whitney U, correlation and chi-square according to the variable type and distribution. Total cholesterol was significantly higher in SSc than HC (345 vs 194, p = < 0.001). The BMI was higher in HC (26.2 vs 28.9, p < 0.001). Kilograms of muscle (19.8 vs 28.9, p < 0.001) and total fat (23.4 vs 28.9, p < 0.001) were lower in SSc patients compared to HC. VAI was similar when BMI < 25, but significantly higher when BMI > 25 in SSc than in HC (3 vs 1.9, p = 0.030). The increase in BMI at overweight or obese in SSc is associated with a significant increase in cardiovascular risk. [ABSTRACT FROM AUTHOR]

The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15–31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular. [ABSTRACT FROM AUTHOR]

The management of extensive perineal defects resulting from aggressive tumor resections, such as abdominoperineal resections for advanced pelvic malignancies, can be a complex and demanding process during treatment. The primary options for reconstructing perineal defects are vertical rectus abdominis myocutaneous (VRAM) and anterolateral thigh (ALT) flaps. While both flaps are commonly used in reconstructive surgery, VRAM is often preferred due to several advantages. These include the ability to provide ample tissue to fill large perineal defects, as well as the convenience of harvesting this type of flap through a midline incision. This approach allows for a more cosmetically favorable scar location compared to other techniques. Overall, VRAM is a superior choice for perineal reconstruction due to its versatility and effectiveness in addressing complex defects. In this article, we describe our experience with utilizing a VRAM flap to close a 20x10 cm perineal defect that arose after an abdominoperineal resection performed due to extensive rectal melanoma in a 46-year-old man. We found that the vertical VRAM flap was an exceptional choice for covering this substantial defect in our patient. INSET: 6. [ABSTRACT FROM AUTHOR]

The clinical findings associated with nasal, cutaneous and systemic fusariosis in a 3‐year‐old billy Boer goat are summarised. The clinical features, treatment, postmortem findings and laboratory diagnostics are reported and discussed in the context of existing knowledge on mycoses of small ruminants. The goat presented primarily for respiratory signs (inspiratory dyspnoea) with unilateral left‐sided mucopurulent nasal discharge, and multifocal variably ulcerative and necrotic cutaneous nodules. Histopathology of nasal and cutaneous biopsies revealed necrotising pyogranulomatous inflammation with intralesional septate hyphal elements that correlated with culture of Fusarium oxysporum. The patient continued to deteriorate clinically during treatment with oxytetracycline and meloxicam, with the addition of sodium iodide and potassium iodide, and was humanely euthanased. Postmortem examination revealed multifocal nodular lesions throughout the kidneys, abdominal lymph nodes and lungs. These lesions were consistent with those identified antemortem from which F. oxysporum was cultured. Although treatment was unsuccessful, to the author's knowledge, no instance of rhinofacial or systemic caprine infection with Fusarium spp. has been documented in the veterinary literature, making this the first recognised instance of this form of infection in small ruminant species. [ABSTRACT FROM AUTHOR]

Introduction: Chest wall neoplasms encompass primary, locally invasive, and metastatic tumours. Malignant chest wall tumours are typically uncommon, comprising roughly 5% of all thoracic neoplasms and 1 to 2% of all primary tumours. This systematic review addresses the imperative need for a comprehensive analysis of chest wall resection, focusing on indications, reconstruction techniques, and outcomes, to provide clinicians with evidence-based guidelines for optimal patient management. Aim: To comprehensively review indications for chest wall resection, explore reconstruction techniques, and analyse complications and outcomes associated with the procedure. Materials and Methods: A thorough electronic database search was performed on PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED utilising the search terms "Chest wall," "Chest wall Resection," and "Chest wall Reconstruction." Fulltext articles published in English within a 20-year period (from 1999 to 2020) were selected based on pre-defined inclusion and exclusion criteria and subjected to analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: In total, 24 full-text records met the inclusion and exclusion criteria and underwent critical analysis for this systematic review. Chest wall sarcomas emerged as the primary indication for chest wall resection in the present study, with recurrent or locally advanced breast carcinoma also noted as significant causes. Various artificial soft meshes, notably Marlex or Goretex, were commonly employed for reconstruction, while soft-tissue coverage was achieved through various myocutaneous flaps, both pedicled and free. Respiratory complications predominated among the observed complications, with wound-related issues also documented. Conclusion: Patient selection is paramount in chest wall reconstruction, with the ideal method still under debate. However, prioritising minimal patient morbidity during reconstruction is crucial. Adherence to these principles can lead to better outcomes in terms of complications, survival, and quality of life, especially in appropriately selected patients. [ABSTRACT FROM AUTHOR]

Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017–2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005–2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life. [ABSTRACT FROM AUTHOR]

Periodic fasting (PF) as a form of dietary restriction has been shown to induce tissue-protective effects against ischemic injury in several different tissues. Accordingly, in this study we analyzed whether a short-term 24 h fast is suitable to prevent necrosis of musculocutaneous flap tissue undergoing acute persistent ischemia. C57BL/6N mice were randomly divided into a PF group (n = 8) and a control group that was given unrestricted access to standard chow (n = 8). The PF animals underwent a 24 h fast immediately before flap elevation and had unrestricted access to food for the rest of the 10 day observation period. Musculocutaneous flaps with a random pattern design were dissected on the animals' backs and mounted into dorsal skinfold chambers. On days 1, 3, 5, 7 and 10 after surgery, nutritive tissue perfusion, angiogenesis and flap necrosis were evaluated using intravital fluorescence microscopy. Thereafter, the flap tissue was excised and fixed for histological and immunohistochemical analyses. The flaps of PF-treated animals exhibited a higher functional capillary density and more newly formed microvessels, resulting in a significantly increased flap survival rate. Moreover, they contained a lower number of myeloperoxidase (MPO)-positive neutrophilic granulocytes and cleaved caspase-3-positive apoptotic cells in the transition zone between vital and necrotic flap tissue. These findings indicate that short-term PF improves tissue survival in ischemically challenged musculocutaneous flaps by maintaining nutritive blood perfusion and dampening ischemia-induced inflammation. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 67-year-old man with a complex nasal alar defect resulting from the removal of a basal cell carcinoma. The defect extended into multiple cosmetic subunits, including the nasal ala, upper cutaneous lip, and medial cheek. The authors explore various reconstructive approaches to address this challenging defect, considering the unique contours and convexity of the area. They ultimately used a combination of repair techniques, including a "flipped island pedicle" flap, to reconstruct the nasal ala and repair defects in adjacent cosmetic subunits. The patient had a successful outcome with no complications. [Extracted from the article]

This article discusses the reconstruction of a full-thickness lower lip defect after Mohs micrographic surgery. The case involves a 54-year-old man with squamous cell carcinoma on his lower lip. The authors explore different options for repairing the defect, ultimately deciding on a buccal myomucosal flap combined with skin advancement. The technique provides vermillion coverage and muscular bulk without the need for large incisions, resulting in optimal aesthetic and functional outcomes. [Extracted from the article]