Shigenobu Sakai

A compound radial artery forearm flap for the reconstruction of lip and chin defect

This report presents a successful case of lip and chin reconstruction by a compound radial artery forearm free flap. This was a versatile source of tissue in the absence of local tissue for reconstruction.

A distally based island first dorsal metatarsal artery flap for the coverage of a distal plantar defect

An intractable plantar ulcer of the great toe was successfully covered with a distally based island first dorsal metatarsal artery flap. Common dorsal digital veins served as venous drainage for the flap. The results show that this flap can be used as a reliable alternative to conventional techniques to repair a distal foot defect.

Avulsion of the scalp : which one is the best artery for anastomosis?

We present a patient who underwent successful replacement of a large avulsed scalp with microvascular anastomosis of one artery and three veins. The left occipital artery in the avulsed scalp and a frontal branch of a right superficial temporal artery in the recipient forehead were anastomosed. Three veins in the occipital area in the avulsed scalp were anastomosed via vein grafts to three veins in the frontal area, respectively. For successful replacement, the selection of the vessels depends on each individual case. To give easy anastomosis, a good cosmetic result, and a comfortable postoperative period, it is not always necessary to reconstruct a previously normal anatomical position.

A subcutaneous pedicle flap for perineal reconstruction

The application of the subcutaneous pedicle flap for perineal defects is presented. We recognize from clinical experience that the perineal area has a sufficient subcutaneous vascular network from internal and external pudendar arteries. We found that the subcutaneous pedicle flaps can be used safely in the perineal area the same as the facial area. The perineal defect that reaches to the vaginal orifice or anus needs to be reconstructed three dimensionally, not flat. The subcutaneous pedicle flap with vertical pedicle can produce natural shape and depth of the perineum.

Subcutaneous pedicle flaps for scalp defects

We report the reconstruction of scalp defects by subcutaneous pedicle flaps with transverse pedicles. These flaps are supplied by vascular networks in the upper and lower parts of the epicranial aponeurosis. We have used this technique in 12 cases and have found it to be a useful alternative to other methods of scalp reconstruction.

Modification of the island subcutaneous pedicle flap for the reconstruction of defects of the sole of the foot

Defects in the metatarsal head region of the sole were successfully reconstructed by a modified island subcutaneous pedicled flap. The technique is simple and easy to perform. This flap can be mobilised farther than the conventional island vertically-supplied subcutaneous pedicled flaps.

Distally based lateral plantar artery island flap.

We report on the reconstruction of the lateral metatarsal head defect by a distally based lateral plantar artery island flap using the flexor digitorum brevis muscle. The pedicle for this flap was provided by a retrograde lateral plantar artery. We found that this flap was relatively simple and easy to perform and could cover large defects better than any other conventional local flap.

Bilateral island vermilion flaps for vermilion border reconstruction

Reconstruction of a large defect of the vermilion border of the lip poses difficult problems. It may result in a vermilion border deformity or reduce the buccal cavity. In this article we describe reconstruction of the vermilion border of the lower lip using bilateral island vermilion flaps pedicled by labial arteries, a modification of Kapetanskys double-pendulum flaps. We found that our technique was a very reliable and versatile alternative to other local flaps.

Use of a combined groin-tensor fasciae latae flap for reconstruction of a full-thickness defect of the abdominal wall

Two cases are presented in whom full-thickness defects of the abdominal wall were repaired by combined groin-tensor fasciae latae flaps nourished only by the superficial circumflex iliac artery. The dissection of the flap is simple and it will probably cover even the upper parts of the flank.

Scrotal septocutaneous island flap for the reconstruction of the urethral fistula.

We report the reconstruction of the urethral fistula using a scrotal septocutaneous island flap. A scrotal septocutaneous island flap is supplied by vascular networks in the scrotal septum area from both perineal arteries and posterior scrotal arteries. This flap is divided into two flaps, one for urethral lining and the other for the skin defect. We found it to be a simple, useful, and reliable alternative to other local flaps. However, hairless skin of the scrotum must be used for the urethral lining. The musculocutaneous flap is also reliable. However, use of the scrotal septocutaneous island flap can save the musculocutaneous flap for secondary procedures.