Akiteru Hayashi

Reverse first dorsal metatarsal artery flap for reconstruction of the distal foot

A method for reconstruction of soft tissue defects of the distal foot, web spaces, and toes using the reverse first dorsal metatarsal artery flap is presented. This flap is supplied by minute cutaneous branches of the first dorsal metatarsal artery and can be extended to the territory of the dorsalis pedis artery. We have applied this flap to 11 patients since 1987. Superficial tip necrosis occurred in 3 flaps among 8 extended ones, however, they healed spontaneously and satisfactory results were obtained in all patients. Two other reverse flow flaps based on the second, and the third and fourth dorsal metatarsal arteries, respectively, have also been applied. The versatility and pitfalls of reverse dorsal metatarsal artery flaps are discussed.

Bilateral latissimus dorsi V-Y musculocutaneous flap for closure of a large meningomyelocele

Reconstruction of a large meningomyelocele defect with bilateral latissimus dorsi V-Y musculocutaneous flaps is reported. This procedure provides a reliable, well-vascularized soft-tissue coverage over the neural repair with minimum donor-site morbidity.

The lateral genicular artery flap.

A method for reconstruction of skin defects around the knee using the lateral genicular artery flap is presented. This flap is supplied mainly by the cutaneous perforator of the superior lateral genicular artery. On the basis of ten cadaver dissections, we found that the nutrient artery is reliable, penetrates the deep fascia at a small triangular area surrounded by the lateral femoral condyle, the vastus lateralis, and the short head of the biceps femoris, and anastomoses predominantly with the lateral perforators of the profunda femoris artery in the midlayer of the subcutaneous fatty tissue. This flap can be safely extended to the midpoint between the lateral femoral condyle and the greater trochanter.

The use of the anteromedial thigh fasciocutaneous flap in the reconstruction of the lower abdomen and inguinal region; a report of two cases

The use of the anteromedial thigh fasciocutaneous flap in the reconstruction of the lower abdomen and inguinal region is described. If there is a dominant vessel supplying the anteromedial thigh flap, it can be raised as an island or a free flap. When there are only slender vessels in this area, a random pattern fasciocutaneous flap can safely be created with a fasciosubcutaneous pedicle.

Lateral calcaneal V-Y advancement flap for repair of posterior heel defects

We obtained favorable results in reconstruction of the posterior heel with a lateral calcaneal V-Y advancement flap. This technique simplifies the operative procedure and eliminates the disadvantages of the original lateral calcaneal flap and its island version while retaining the advantages of these methods.

The medial genicular artery flap

The anatomical basis and clinical applications of the medial genicular artery flap, which is supplied mainly by the cutaneous perforator of the superior medial genicular artery, are herein described. Based on 10 cadaver dissections, the nutrient artery was found to be consistent and was seen to penetrate the deep fascia within a small triangular area bordered by the medial femoral condyle, the vastus medialis, and the adductor magnus tendon. The distal end of the flap must cover the skin over the medial femoral condyle, and the axis of the flap is along the lower half of the sartorius. The proximal end of the flap can be extended safely beyond the midpoint of the thigh. The medial genicular artery flap is thin and can nicely recontour defects around the knee, with an inconspicuous donor site on the medial aspect of the thigh.

Vascularized iliac bone graft based on a pedicle of upper lumbar vessels for anterior fusion of the thoraco-lumbar spine

A new option for the use of a vascularized iliac bone graft, based on the upper (first or second) lumbar vessels, has been developed. As a pedicled graft, this supero-posteriorly-based vascularized iliac bone graft can reach the vertebrae from T8 to the sacrum, and the lower sternum and thoracic cage. In this report, the vascular anatomy of the flap and clinical experience using it for anterior spinal fusion are described.

Stepladder V-Y advancement flap for repair of postero-plantar heel ulcers

Random fasciocutaneous flaps with bilateral adipofascial pedicles were elevated from the posterior heel and transferred distally to defects of the postero-plantar heel in 4 patients, using a stepped incision technique, in combination with the V-Y advancement principle. In all cases the flap was successfully transferred without any linear scar or scar contracture in the posterior heel. The absence of recurrence of ulcers during the postoperative follow-up between 1.5 and 4 years indicated the reliability and durability of the flaps. Application of this procedure permits rapid resurfacing and excellent recontouring of small to moderate-sized defects of the heel with minimal donor site morbidity.

Lateral intermuscular septum of the thigh and short head of the biceps femoris muscle : an anatomic investigation with new clinical applications

&NA; An anatomic study was performed to reappraise the vasculature of the lateral intermuscular septum of the thigh and muscles associated with it using 12 preserved cadaver legs. Several possible new clinical applications of the lateral intermuscular septum and the short head of the biceps femoris were identified as follows: (1) short head of biceps femoris muscle or musculoseptal flap based on the second and/or third profunda perforating vessels, or based on the superior lateral genicular vessels, with or without the iliotibial tract and the deep fascia, and with or without the motor nerve of the short head; (2) transverse extension of the fascial portion of the tensor fasciae latae muscle or musculocutaneous flap to include the lateral intermuscular septum; (3) combination use of items 1 and 2, above; and (4) free septofascial graft using the lateral intermuscular septum and iliotibial tract. It is anticipated that the distally based short head of the biceps femoris muscle flap will be an additional option for repairing defects around the knee, and that a free short head of the biceps femoris muscle flap based on the profunda femoris perforating vessels will be useful in functional reconstruction such as reanimation of the paralyzed face. The lateral intermuscular septum can be incorporated into the short head of biceps femoris muscle flap or into the tensor fasciae latae flap, and it also can be used as a free fascial graft. Functional deficit resulting from harvesting the short head of the biceps femoris and the lateral intermuscular septum is minimal, and donor wound at the lateral lower thigh seems to be acceptable. (Plast. Reconstr. Surg. 108: 1646, 2001.)

Vascularized rib strut technique for repair of pectus excavatum

A vascularized rib strut based on the anterior intercostal branch of the internal mammary artery was applied to provide rigid internal fixation of the chest wall after correction of pectus excavatum. The procedure is simple and has substantial advantages when compared with techniques using metallic struts or nonvascularized free rib grafts.