Katsuyuki Urushibara

Paraumbilical perforator flap without deep inferior epigastric vessels.

&NA; With the introduction of supramicrosurgery, a new paraumbilical perforator flap without a deep inferior epigastric vessel and with very small perforator anastomoses was used for nine patients. The abdominal defects of two patients, the lower leg or foot defects of five patients, and the scalp defects of two patients were repaired with an island perforator flap. The advantages of the paraumbilical perforator flap are as follows: (1) there is a very short operating time for flap elevation; (2) there is no invasion or sacrifice of any rectus abdominis muscle; (3) for middle‐aged, obese patients, the donor site may be the best from the cosmetic point of view; (4) many small recipient vessels to anastomose the perforator exist throughout the body; (5) a thin skin flap with adequate thickness can be created easily with simultaneous removal of fatty tissue; (6) secondary defatting around the perforator can be done by minor surgery under local anesthesia; and (7) a vascularized adiposal flap with adequate thickness can be created easily. This flap seems to be indicated for female patients with defects in the abdominal wall and the lower leg. The island flap can easily resurface abdominal skin defects, such as intestinal fistula or radiation ulcers. The free flap is suitable for covering defects in the lower leg, foot, and scalp temporarily before administration of a tissue expander. (Plast. Reconstr. Surg. 102: 1052, 1998.)

Superficial circumflex iliac artery perforator flap for reconstruction of limb defects.

The superficial circumflex iliac artery perforator (SCIP) flap differs from the established groin flap in that it is nourished by only a perforator of the superficial circumflex iliac system and has a short segment (3 to 4 cm in length) of this vascular system. Three cases in which free superficial circumflex iliac artery perforator flaps were successfully transferred for coverage of soft-tissue defects in the limb are described in this article. The advantages of this flap are as follows: no need for deeper and longer dissection for the pedicle vessel, a shorter flap elevation time, possible thinning of the flap with primary defatting, the possibility of an adiposal flap with customized thickness for tissue augmentation, a concealed donor site, minimal donor-site morbidity, and the availability of a large cutaneous vein as a venous drainage system. The disadvantages are the need for dissection for a smaller perforator and an anastomosing technique for small-caliber vessels of less than 1.0 mm.

Fingertip reconstructions using partial-toe transfers.

&NA; Fifty‐six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo‐onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo‐onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes‐Weinstein test) and 6.3 mm (moving two‐point discrimination) at 2.6 years after the transfer; those of the thin osteo‐onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery. (Plast. Reconstr. Surg. 105: 1666, 2000.)

Free medial plantar perforator flaps for the resurfacing of finger and foot defects.

In this article, three cases in which free medial plantar perforator flaps were successfully transferred for coverage of soft‐tissue defects in the fingers and foot are described. This perforator flap has no fascial component and is nourished only by perforators of the medial plantar vessel and a cutaneous vein or with a small segment of the medial plantar vessel. The advantages of this flap are minimal donor‐site morbidity, minimal damage to both the posterior tibial and medial plantar systems, no need for deep dissection, the ability to thin the flap by primary removal of excess fatty tissue, the use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, short time for flap elevation, possible application as a flow‐through flap, and a concealed donor scar. (Plast. Reconstr. Surg. 107: 1753, 2001.)

Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities.

In the three cases presented in this study, free tensor fasciae latae perforator flaps were used successfully for the coverage of defects in the extremities. This flap has no muscle component and is nourished by muscle perforators of the transverse branch of the lateral circumflex femoral system. The area of skin that can by nourished by these perforators is larger than 15 × 12 cm. The advantages of this flap include minimal donor‐site morbidity, the preservation of motor function of the tensor fasciae latae muscle and fascia lata, the ability to thin the flap by removing excess fatty tissue, and a donor scar that can be concealed. In cases that involve transection of the perforator above the deep fascia, the operation can be completed in a very short period of time. This flap is especially suitable as a free flap for young women and children who have scars in the proximal region of the lateral thigh or groin region that were caused by split‐thickness skin grafting or full‐thickness skin grafting during previous operations. (Plast. Reconstr. Surg. 107: 1759, 2001.)

Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer

Dynamic reconstruction of the abdominal wall using a free reinnervated rectus femoris muscle and an island tensor fascia lata transfer was performed for a large herniation with loss of the bilateral rectus abdominis muscles of the abdominal wall. The tensor fascia lata transfer was used to close an inner side of the abdominal defect, and the rectus femoris muscle replaced the rectus abdominis muscle deficit. The motor nerve of the rectus femoris muscle was sutured to the motor branch of the intercostal nerve. Postoperatively, the transferred rectus femoris muscle was reinnervated via electromyography, and there was no abdominal protrusion and no hernia recurrence.