Alan G. Leonard

Reconstruction of major abdominal wall defects using the sensor fasciae latae myocutaneous flap

Five cases of abdominal wall reconstruction using the tensor fasciae latae myocutaneous flap are described. This flap provides a deep layer of tissue of sufficient strength to prevent herniation and external cover in a single stage repair. We regard it as the method of choice in the reconstruction of major defects of the abdominal wall.

Tissue expansion in the treatment of alopecia

During the period December, 1983 to August, 1984, 14 patients were treated for alopecia of the scalp using tissue expansion in the Northern Ireland Plastic and Maxillo-Facial Service. Nine of the defects were due to burns. Representative case reports are presented and the planning of advancement and rotation flaps described. The management and prevention of complications are discussed, and the conclusion drawn that tissue expansion is a valuable technique in the treatment of alopecia, allowing reconstruction of defects previously beyond adequate surgical repair.

The posterior auricular flap: anatomical studies

The aim of this study was to investigate the blood supply of the auriculomastoid skin and to prove the reliability of the posterior auricular vessels for supply of a skin flap in this region. This was done by means of studies of arteriograms, cadaver dissections, India ink perfusion, lead oxide injection and contact radiographs. Information from operative dissections performed in the course of superficial parotidectomies and neck dissections was included, as was information from 11 clinical flap transfers. The conclusion was drawn that the auriculomastoid skin could safely be transferred on the posterior auricular vessels, either as an island flap or as a free flap.

The posterior auricular flap: intra-oral reconstruction

During 1986, the posterior auricular flap was used, in the Northern Ireland Plastic and Maxillo-Facial Service, for the reconstruction of a variety of post-excisional defects in the head and neck. In this paper, we present the results of its use in intra-oral defects. The operative technique is described in detail and representative case reports are presented. The posterior auricular flap would appear to have a role to play in the reconstruction of defects in the oral cavity as the skin quality equals that of the radial forearm flap, and in many cases it may be transferred as an island pedicle flap without the need for microvascular anastomosis.

The use of continuous temperature monitoring in the post-operative management of microvascular cases

Continuous temperature measurement and recording has been carried out on all microvascular cases performed in the Northern Ireland Plastic and Maxillo-facial Service since 1976. The method is described and illustrative temperature graphs are presented. It is felt to be a simple technique which allows early detection of vascular complications and enhances the safety of microvascular tissue transfer.

Experience with the tensor fasciae latae free flap

Six cases of reconstruction using the tensor fasciae latae myocutaneous free flap are described and in three of these a neuro-sensory flap was used. Four cases involved a lower limb reconstruction, one an upper limb reconstruction and one an abdominal wall reconstruction. Reduction of the bulk of the flap by transection of the muscle between the superior and inferior branches of the vascular pedicle was performed in four cases. One case of partial failure occurred in the lower limb group.

Reconstruction of the chest wall using a de-epithelialised “turn over” deltopectoral flap

The use of a deltopectoral flap, de-epithelialised and turned over into the defect in the reconstruction of the chest wall damaged by radiation necrosis is described. The advantages of the technique are discussed.

Nasal reconstruction using the Washio retroauricular temporal flap

Reconstruction of an external nasal defect presents a challenge to the reconstructive surgeon. Transferring retroauricular tissue on a temporal pedicle was first described by Washio as a means to repair the central portion of the face. This paper describes our experience with the Washio retroauricular temporal flap for nasal reconstruction in twelve patients, together with our modifications to simplify the planning and raising of the flap. There was one patient with a stitch abscess, one case of hair loss from the pedicle which recovered within one month and one elderly patient who developed thromboembolic complications. There was no instance of flap necrosis. Our results confirm that the Washio retroauricular flap is an excellent technique for difficult nasal reconstruction in young patients.

Complications associated with suction drains after microvascular anastomeses

Two head and neck cases in which free flaps were used for reconstruction are presented. The circulation of the flaps was compromised due to problems directly associated with suction drains. The methods of drain fixation are discussed.

Posterior superficial temporal artery island flap for intra-oral reconstruction: a case report

A case is presented in which a scalp island flap in an elderly bald male was used for intraoral reconstruction following tumour excision. The flap was based on the posterior branch of the superficial temporal vessels as its arteriovenous system. This flap when available has advantages over other flaps described for intra-oral reconstruction.