Naci Kostakoglu

The "Gent" consensus on perforator flap terminology: preliminary definitions.

Due to its increasing popularity, more and more articles on the use of perforator flaps have been reported in the literature during the past few years. Because the area of perforator flaps is new and rapidly evolving, there are no definitions and standard rules on terminology and nomenclature, which creates confusion when surgeons try to communicate and compare surgical techniques. This article attempts to represent the opinion of a group of pioneers in the field of perforator flap surgery. This consensus was reached after a terminology consensus meeting held during the Fifth International Course on Perforator Flaps in Gent, Belgium, on September 29, 2001. It stipulates not only the definitions of perforator vessels and perforator flaps but also the correct nomenclature for different perforator flaps. The authors believe that this consensus is a foundation that will stimulate further discussion and encourage further refinements in the future.

Orbicularis oculi myocutaneous flap in reconstruction of postburn lower eyelid ectropion

The management of postburn lower eyelid ectropion is difficult, since the contraction of the skin graft may give rise to secondary deformities especially around the lateral 1/3 of the lower eyelid. In this paper, the results of reconstruction in lower eyelid ectropion with a laterally based orbicularis oculi myocutaneous flap from the upper eyelid in 7 young patients are presented. Satisfactory function and cosmesis were obtained in the evaluation of the patients up to 40 months follow-up. The method proved versatile as the donor scar was well-hidden in the supratarsal fold and the temporally based myocutaneous flap provided additional support to the lower eyelid by exerting an upward pull against the gravity. It is concluded that usage of this flap in postburn ectropion cases is worthwhile to avoid any recurrences. reserved.

Upper limb reconstruction with reverse flaps : A review of 52 patients with emphasis on flap selection

Reverse flaps lend themselves to transposition from proximal to distal locations in the extremities. This series comprised 18 radial forearm flaps, 17 digital artery flaps, 13 posterior interosseous flaps, 3 lateral arm flaps, 2 dorsal digital flaps, and 1 dorsal metacarpal flap, all of which were utilized in a reverse pattern. The radial forearm, flap was mainly chosen for defects involving part of the palm and the palmar aspect of the first web space. The posterior interosseous flap was more commonly utilized for resurfacing the dorsum, dorsal aspect of the first web space, and especially the hypothenar aspect of the hand. The lateral arm flap was used to reconstruct antecubital fossa and proximal forearm defects. All posterior interosseous and lateral arm donor areas were closed primarily. Sensate digital artery flaps yielded 5 mm on average static two-point discrimination in 6 to 18 months of follow-up. Functional and cosmetic results concerning the recipient and donor areas were found to be satisfactory. It was concluded that reverse flaps are versatile tools in the coverage of all kind of defects in the upper limb and should be thought of in the first place.Kostakoglu N, Keçik A. Upper limb reconstruction with reverse flaps: a review of 52 patients with emphasis on flap selection.

Reverse superior labial artery flap in reconstruction of nose and medial cheek defects.

BackgroundAngular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap. Patients and MethodsReverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients. ResultsAll flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory. ConclusionsReverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery–based nasolabial flaps where these arteries could also be used as pedicle.

Scapular Bone Grafts: Good Options for Craniofacial Defects?

Introduction There is still no consensus on the ideal material to be used in craniofacial defects. Autogenous bone grafts are mostly preferred owing to their use with fewer complications. The aim of this study was to evaluate whether the scapular bone graft can be used with equal or more advantages to other bone graft resources in orbital, maxillary sinus front wall, and frontal bone defects. Patients and Methods Twenty-four orbital, maxillary sinus front wall, and frontal bone defects were reconstructed with scapular bone grafts. Sixteen patients presented with complicated orbital fractures, 5 patients presented with isolated orbital floor fractures, and 3 patients presented with frontal bone fractures. The grafts were radiologically evaluated 1 day, 6 months, and 12 months postoperatively by 3-dimensional computed tomography scan. Results All orbital, maxillary sinus front wall, and frontal bone defects were reconstructed successfully with scapular bone grafts. Clinical evaluation of the patients at 6 to 24 months of follow-up was considered satisfactory. Minimal donor site morbidity was observed. Scapular bone grafts adapted nicely to the recipient area, and bony union was complete as demonstrated by 3-dimensional computed tomography scans. Conclusions Reconstruction of orbital, maxillary sinus front wall, and frontal bone defects with scapular bone grafts is an easy and safe procedure with minimal donor site morbidity. Scapular bone graft is a good reconstructive option for orbital, maxillary sinus front wall, and frontal bone defects.

The Effect of Autologous Fat Graft with Different Surgical Repair Methods on Nerve Regeneration in a Rat Sciatic Nerve Defect Model.

Background: The aim of this study was to evaluate the efficacy of autologous fat graft with different surgical repair methods on reconstruction of a 10-mm-long rat sciatic nerve defect model. Methods: One hundred forty-four sciatic nerves were operated on in 72 Wistar rats. The right limbs were assigned as group A (n = 72) and the left limbs as group B (n = 72). In group B, autologous fat graft was added to the surgical area so as to stay in contact with the coaptation site. Nerve regeneration was evaluated by walking track analysis, Sciatic Functional Index, pin-prick, and electrophysiologic and histologic tests at commencement and at 4 and 12 weeks after the operation. Results: The rats receiving fat graft showed better regeneration, but the difference was only significant according to Sciatic Functional Index and pin-prick test (p < 0.05). Primary repair, autogenous nerve graft, acellularized nerve graft, vein filled with fresh and denatured muscle graft subgroups in group B showed significantly better regeneration than those in group A according to the Sciatic Functional Index (p < 0.05). In terms of latency and amplitude, all subgroups in groups A and B were found significantly different from the commencement of the study, but there was no difference between groups A and B (p < 0.05). Conclusions: Although there was no significant difference between the groups, rats receiving autologous fat graft showed better regeneration. Combined use of autologous fat graft with surgical repair methods induced significantly better regeneration. It was concluded that autologous fat grafting may have a beneficial effect on nerve regeneration when it is present in the coaptation site during healing.

X-linked recessive inheritance of radial ray deficiencies in a family with four affected males.

Radial ray deficiencies are frequently associated with additional clinical anomalies and have a heterogeneous aetiology. X-linked forms are extremely rare. We report a family in which four male relatives show bilateral absence of the radius with presence of the thumbs and associated anomalies. The segregation of the phenotype is suggestive for X-linked recessive inheritance. This is confirmed by performing linkage analysis using 24 markers spanning the X chromosome in which a maximum lod score of 1.93 for DXS8067 and DXS1001 is obtained. We defined a critical region of maximal 16.2 cM on the X chromosome with haplotype analysis.

Hair transplantation using a freely transferred nonhair-bearing skin flap.

Cicatricial alopecia is a common sequela of burns involving the head region. The authors present a case of an extensive form of cicatricial alopecia in an 18-year-old female patient who sustained a burn to the head at 2 years of age. The patient was treated with combined scalp reduction with the aid of tissue expanders and micrografting of the freely transferred, preexpanded deep inferior epigastric artery nonhair-bearing skin flap. The aim of this article is to show that hair transplantation on the freely transferred nonhair-bearing skin flap may be associated with infection and fat necrosis, and the end result is not satisfactory, as in the cases of hair transplantation on a normal bald scalp.

Reverse Superior Labial Artery Flap in Reconstruction of Nose and Medial Cheek Large Defects: Reply.

FIGURE 1. Left: defect in the right nasal sidewall after squamous cell carcinoma excision; reconstruction with a V-Y advancement angular artery perforator based flap was planned. Middle: intraoperative view of the perforator vessels dissected (artery and vein are clearly identifiable); the flap was islanded on the dissected pedicle with preservation of the underlying mimic musculature and advanced without tension to the recipient site. Right: no vascular complications were registered and the patient was satisfied of the aesthetic result as shown in the 12-month postoperative follow-up. W e read with great interest the article by Turan and colleagues in which they describe the use of the reverse superior labial artery flap for reconstruction of nasal and medial cheek defects.We congratulate the authors for the introduction of such an interesting surgical technique and for the aesthetically pleasant results provided; nevertheless, we believe that some additional considerations on this topic should be made. The authors describe the use of an axial flap harvested around the corner of the mouth and based on the reverse flow from the ipsilateral super labial artery. In the surgical technique, they explain that the facial artery, the inferior labial artery, and the lateral nasal artery are progressively ligated and that risorius, zygomaticus major, and orbicularis oris muscles are divided to include the pedicle in the flap and achieve the desired arc of rotation. Even if the authors do not report functional sequelae associated with the procedure, as a matter of fact, a significant local morbidity is created to reconstruct small to moderate size defects in the nasal and perinasal subunits. In the last decade, the introduction of free style perforator flaps has revolutionized the approach to soft tissues reconstruction allowing us to harvest pure adipocutaneous flaps with preservation of the underlying muscles, nerves and source vessels, thus resulting in superior aesthetic and functional results with minimal morbidity for the patients. The same concept has been subsequently applied to facial reconstruction, and the use of free style perforator flaps of the facial angiosome, based on known perforator vessels originating from facial and angular arteries, has been popularized for reconstruction of perioral, perinasal, and nasal defects. Unfortunately, the authors do not make mention of this alternative and less morbid approach when reviewing the current avalaible reconstructive options in the discussion paragraph. The free style concept is particularly useful in nasal and perinasal reconstruction because of the significant soft tissue laxity observed in the nasolabial and perioral regions and the abundant vascularization of the facial integument. Starting from 1 side of the defect, preferably using an easier lateral approach, it