iao Q

Perineum reconstruction with pedicled anterolateral thigh fasciocutaneous flap

Eighteen pedicled anterolateral thigh perforator island flaps were used for complex perineal reconstructions between May 2003 and May 2005. The patients’ average age was 48.6 years (range, 32 to 64 years), and the average follow-up period was 8 months (range, 2 to 13). In 7 cases, the perforator was septocutaneous and in 11 it was intramuscular. The application of the pedicled anterolateral thigh fasciocutaneous flap is described perineum reconstruction. The size of the perineum defects ranged from 6 × 9 cm to 16 × 17 cm, and the size of the transferred flap ranged from 8 × 11 cm to 18 × 20 cm. All flaps survived. One patient developed minor wound dehiscence in the posterior aspect of the perineal wound because of fecal contamination and skin maceration. The esthetic appearance of the reconstructed perineum was good. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the flap, the authors conclude that this is a safe and reliable flap for perineal reconstruction.

Management for Postoperative Complications of Breast Augmentation by Injected Polyacrylamide Hydrogel

Polyacrylamide hydrogel, a new biomaterial, has been used for injected breast augmentation in China since 1997. A series of 30 patients with various complications after injected polyacrylamide hydrogel visited the author’s department. Most of these patients had undergone injection of both breasts. The average age of the patients was 27.6 years, and the time of consultation for the complications was from 3 to 36 months postopertively. Nearly all the patients had breast lumps and other common complications including breast pain, disfigurement, and infection. Ultrasound examination showed diffuse, irregular, anechoic zones of mammary tissue. Pathologic results indicated inflammatory cell infiltration and fibrous capsular formation. An open suction technique and partial mastectomies via periareolar incisions were performed for the all patients. Most of their symptoms were relieved after removal of the polyacrylamide hydrogel. Only one patient had undergone immediate breast reconstruction with implants, whereas five patients had received breast implants secondarily via an axillary incision. The authors conclude that polyacrylamide hydrogel should be prohibited for injected breast augmentation before more scientific data are available about the long effect of the gel in breast tissue.

A new technique of vaginal reconstruction with the deep inferior epigastric perforator flap: a preliminary report.

Background: Vaginal reconstruction after tumor resection or in congenital vaginal agenesis remains a challenging area in surgery, with many techniques previously described underlining the continued search for an ideal method. In this preliminary report, a series of patients are presented who underwent vaginal reconstruction using a deep inferior epigastric artery perforator (DIEP) flap. Methods: Between May of 2004 and February of 2005, five patients underwent vaginal reconstruction using the pedicled DIEP flap. Four patients had congenital vaginal agenesis and one had a complete vaginal resection because of a tumor. Results: The flaps ranged in size from 9 × 10 cm to 11 × 12 cm. All flaps survived, although one patient developed a posterior space hematoma that required draining. Of the five patients, two were sexually active and enjoyed satisfactory penetrative intercourse after reconstruction. Conclusions: This series demonstrates that a new vagina can be created from the pedicled DIEP flap and that the reconstruction is reliable, with low donor-site morbidity. The major disadvantage of this technique is the conspicuous abdominal scar.

Free anterolateral thigh adipofascial flap for hemifacial atrophy.

Though the etiology of hemifacial atrophy is still unknown, the aim of its reconstruction is cosmetic amelioration of the defect. Among many techniques introduced, microsurgical reconstruction has become the gold standard to restore the symmetry of the face. Seven free anterolateral thigh adipofascial flaps were used to reconstruct hemifacial atrophy between September 1999 and May 2005. There were 1 male and 6 females in the series. All the patients had unilateral disease (6 right and 1 left). The average age of onset of disease was 11.9 years. The average duration of atrophy was 6.7 years. The patients’ average age was 25 years (range, 21 to 32 years), and the average follow-up period was 12.6 months (range, 6 to 36). The size of the transferred flap ranged from 8 × 6 cm to 12 × 13 cm. All adipofascial flaps survived completely. No complications occurred. The result is stable, and no recurrence of facial atrophy was seen in the patients after follow-up. One patient received minor revision because of the bulky reconstructed face. The esthetic appearance of the reconstructed face was acceptable. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the anterolateral thigh adipofascial flap, the authors conclude that this is a safe and reliable adipofascial flap for hemifacial atrophy.

Reduction mammaplasty and correction of ptosis: Dermal bra technique

&NA; A new technique for reduction mammaplasty or mastopexy techniques is presented, which the authors call the dermal bra. The surgical steps are described point by point. A series of 36 patients underwent reduction mammaplasty or mastopexy by means of this technique front January of 1998 to April of 2001. Thirty‐two patients were followed; 28 presented satisfactory results, including a good mammary appearance, invisible scar, good and stable breast projection, and lasting results. Nipple‐areola complex sensitivity was unchanged in all 32 patients. The overall complication rate was 12.5 percent (one patient suffered purse‐string suture exposure, and three had a cutaneous rend). The advantages and disadvantages of this technique are discussed. (Plast. Reconstr. Surg. 111: 1122, 2003.)

Clinical and histologic evaluation of a new injectable implant: hydrophilic polyacrylamide gel.

Hydrophilic polyacrylamide gel is a new, jellylike transparent implant that consists of 95% water and 5% polyacrylamide, and it has been applied in many countries for many years as a sort of injectable implant. However, there are no data regarding human tissue reaction to hydrophilic polyacrylamide gel to date. Thirty-one patients who had undergone the injection of hydrophilic polyacrylamide gel for soft-tissue augmentation from September 1998 to November 2001 wanted to remove the implant. Hematoxylin–eosin-stained sections from each cyst of tissue sample were investigated and analyzed with light microcopy. The tissue slices of 12 patients who had received an injection of silicone from 1988 to 1994 were reviewed. The difference in histologic features was assessed. The inflammatory reaction of hydrophilic polyacrylamide gel was characterized by the presence of more foreign body giant cells. The cellular response ranged from moderate or marked (4 to 18 months) to mild (>18 months). The difference was statistically significant (P < 0.05). Little lymphocyte infiltration was shown in all slices of hydrophilic polyacrylamide gel. There were clusters or diffuse lymphocyte infiltration on histologic observation of the liquid silicone. The difference was significant (P < 0.001). In summary, hydrophilic polyacrylamide gel may evoke a human tissue inflammatory response similar to other foreign materials. Lumpy subcutaneous nodules, mastodynia, and difficult removal may limit its application in breast augmentation.

Anterolateral thigh flap-based reconstruction for oncologic vulvar defects.

Background: Vulvar defects after tumor extirpation always require immediate reconstruction. Transferring a skin flap from a distant region may be required for large defects. Although the anterolateral thigh flap has gained popularity in other types of oncoplastic surgery, it has rarely been reported for vulvar reconstruction. The aims of this retrospective study were to evaluate the outcome of anterolateral thigh flap–based vulvar reconstruction and to develop an operative strategy. Methods: Eleven patients with vulvar carcinoma underwent resection and immediate reconstruction with the anterolateral thigh flap between 2005 and 2009. Based on defect type and local soft-tissue quality, four types of anterolateral thigh flap–based reconstructions were performed: unilateral anterolateral thigh flap, ipsilateral anterolateral thigh flap combined with contralateral advancement flap or local flap, fenestrated anterolateral thigh flap, and split anterolateral thigh flap. Postoperative complications were recorded and clinical outcomes were evaluated. Results: Partial flap necrosis occurred in one patient with a fenestrated anterolateral thigh flap for bilateral reconstruction. One wound dehiscence occurred in the contralateral local flap. Two patients had prolonged serous drainage. Mean follow-up was 8 months. One patient developed stricture of the urethral meatus and another had regional metastasis. Conclusion: With careful design, the anterolateral thigh flap may provide reliable and durable soft-tissue coverage for various vulvar defects with good outcomes and minimal donor-site morbidity.

Clinical application of the anterolateral thigh flap for soft tissue reconstruction.

The purpose of this article is to describe the authors experience using the anterolateral thigh (ALT) flap for the reconstruction of a variety of soft tissue defects. The flap utility and donor site morbidity were evaluated in 126 cases from March 1985 to August 2007. The ALT flaps were harvested as either free fasciocutaneous, free adipofascial, fasciocutaneous island, or reversed fasciocutaneous island flaps to repair facial, neck, breast, trunk, and extremity defects. In 40 cases (32%), the skin vessels were found to be septocutaneous perforators, and in 86 cases (68%), they were found as musculocutaneous perforators. Of the 126 flaps, 121 survived completely, providing a success rate of 96.0%. There were four cases undergoing multidetector-row computed tomographic angiography (CTA) for preoperative perforator mapping, and all perforators were confirmed intraoperatively. In conclusion, the ALT flap is a versatile and reliable flap that could well be a priority option for soft tissue reconstruction. CTA can provide more valuable and accurate anatomic information about the pedicle and perforators, making it safer and faster to harvest a targeted ALT perforator flap with less donor site morbidity.

Treatment of divided eyelid nevus with island skin flap: report of ten cases and review of the literature.

Purpose: Three different techniques used in 10 cases of divided eyelid nevus and the results are reported and discussed. Methods: A retrospective study of 10 patients who had undergone treatment of divided eyelid nevus with skin flap between March 2003 and March 2008 was conducted. According to the location, shape, and size of the upper and lower eyelids nevus orbicularis oculi musculocutaneous flap, postauricular superficial musculoaponeurotic system (SMAS)-pedicled flap, or reversal superficial temporal artery (STA) flap was designed to repair the eyelid defects. Results: Ten patients were treated in this series with 10 oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal STA flaps. One postauricular SMAS-pedicled flap and 1 reversal STA flap showed distal flap venous refluence (reflux) obstruction and partial epidermal necrosis in the early postoperative stage, but after active treatment, they healed well and needed no surgical revision. All the other flaps survived well. Four flaps showed slight trapdoor deformation needing no revision. No other complication developed during the follow-up periods of 6 to 36 months. All the donor sites were closed directly and healed well with inconspicuous scarring. This series has exhibited satisfactory cosmetic and functional results. Conclusions: Treating divided eyelid nevus with well-selected skin flaps is satisfying with excellent color and texture matching, normal eyelid function, and inconspicuous donor deformity.

Anterolateral thigh adipofascial flap for correction of facial contour deformities and micromastia

The anterolateral thigh (ALT) flap has gained popularity, yet the donor site remains problematic. With increased knowledge of the vascular anatomy, we anticipated that we would be able to contour the ALT adipofascial flap when reconstructing facial deformities and micromastia without sacrificing skin at the donor site. A total of 24 cases of hemifacial atrophy and 1 case of micromastia underwent anterolateral thigh adipofascial flap transplantation with vascular anastomosis. All surgical reconstructions resulted in satisfactory results with minimal donor-site morbidity. The anterolateral thigh adipofascial perforator flap is an ideal choice for autologous tissue reconstruction with primary defatting.