Yoshiko Iwahira

Popliteo-posterior thigh fasciocutaneous island flap for closure around the knee.

A popliteo-posterior thigh fasciocutaneous island flap to repair skin defects around the knee is presented and discussed. Included is a description of the procedure, a comparison with alternative procedures, and an evaluation of the advantages of the new method.

The Ulnar Recurrent Fasciocutaneous Island Flap: Reverse Medial Arm Flap

A new island fasciocutaneous flap raised on the inner medial surface of the upper arm has been used for reconstruction of soft-tissue defects of the elbow. The blood supply to this flap comes from the fasciocutaneous perforators of the ulnar recurrent vessels. This unique vascular arrangement allows for safe transference of the upper medial skin to the elbow region. This flap has been used to cover nine defects in eight patients, and results have been good. Except for one case of sensory disturbance, there were no complications or loss of overlying skin. It is a relatively quick and simple procedure involving only one stage that adequately corrects the skin defect around the elbow region and does not require prolonged splinting.

The axial nasodorsum flap

&NA; A new axial flap is described for reconstruction of softtissue defects of the nose, including the supratip and columella. The blood supply to this flap originates from the lateral nasal branch of the angular artery adjacent to the nasolabial fold. This flap was used in seven patients between 1989 and 1994, and there was complete survival. We recognized that this axial nasodorsum flap provided suitable shape design in each patient and produced excellent cosmetic results. The anatomy, the technique, and our clinical experience are presented. (Plast. Reconstr. Surg. 99: 1873, 1997.)

Expanded unilateral forehead flap (sail flap) for coverage of opposite forehead defect.

This report details our experience with five patients who had skin defects of their forehead that were covered with an expanded unilateral forehead flap from the contralateral side that we call the sail flap. Skin expansion provides an ideal thin flap for the forehead aesthetic unit. The viability of the sail flap is sufficient through expansion, and it is available in suitable size and shape for the defect. The donor site is minimal and well accepted because the scar coincides with the hairline.

V-Y advancement flaps in the reconstruction of skin defects of the posterior heel and ankle

A V-Y advancement pedicle flap including fascia has been used for reconstruction of soft-tissue defects of the posterior heel and ankle region. This flap has been used to cover 17 defects in 16 patients ranging in age from 4 to 58 years, and results have been good. We limited this application to patients without systemic disease and under 60 years of age and did not apply it to the elderly, debilitated, or systemic vascular damaged patients. There were no complications or loss of overlying skin, with the exception of one superficial tip necrosis of the flap. The results indicate the reliability and usefulness of this procedure in coverage of the posterior heel and ankle regions. It is a relatively quick and simple procedure that is without a free skin graft, and it involves only one stage that adequately corrects the skin defect at the posterior heel and ankle without prolonged splintings and results in negligible deformity of the donor site.

A miniunit approach to lip reconstruction.

Aesthetic units of the face have been described previously. Burget applied the subunit principle to upper lip reconstruction. When defects are too small to replace subunits, we have employed a miniunit approach for their closure. When potential or actual wrinkle lines, as well as contour subunit lines, are used in flap design, miniunit flaps can be created which improve the aesthetic results. Symmetry, normal contour, preservation of normal layered muscular anatomy, and unnoticeable scars are attainable. Included herein is a description and evaluation of the advantages of this principle.

The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction

The V-Y advancement myotarsocutaneous flap was used to avoid excessive scarring during reconstruction of a full-thickness upper eyelid defect following surgical excision of a malignant tumor. This method has a number of advantages: It has a short operative time, it is a one-stage procedure, it does not require lining by auricular or septal cartilage, the technique is relatively simple, and the scar is inconspicuous, since both flap margins are placed in skin creases. The V-Y myotarsocutaneous flap is best suited for the repair of full-thickness upper eyelid defects ranging from 25 to 50 percent of the lid width when the remaining lateral canthal structures are adequate to support the flap.

Expanded preauricular full-thickness free skin graft

A preauricular skin graft with expansion for repair of a facial defect is presented. This technique preserves a more natural appearance in color, texture, and thickness than is otherwise possible and provides a larger graft than the usual preauricular graft method.

The sliding door flap for repair of vermilion defects

The sliding door flap raised on the surface of the vermilion to the oral mucosa has been used for reconstruction of soft-tissue defects of the lower lip. The blood supply to this flap comes from the bilateral inferior labial artery. Utilizing both sides of the arteries, bilateral flaps allow for safe and easy transfer of the vermilion tissue to partial defects of the red lip. These flaps have been used in cases of lower lip defects with complete survival. The sliding door flap has increased mobility by at least 1 cm more than by the other style of flap reported by Goldstein. Moreover, this flap contributes to excellent cosmetic results. Our technique and clinical experiences are presented.

The superficial brachial flap.

A new flap raised on the inner medial upper arm to the anterior forearm surface to cover soft-tissue defects has been described. The blood supply to this flap comes from the superficial brachial artery. The presence of this vessel permits safely transferring arm skin as on island or free flap. This vessel was present in 25% of our series of 64 angiographic investigations and 10 cadaver dissections. Some earlier reports confirm that this vessel averaged 22.8% finding. The superficial brachial flap has been used as a pedicled or free flap to cover various defects in 8 patients and the results have been excellent. There were no complications or loss of overlying skin. Furthermore, no functional impairment or sensory disturbance occurred. Raising this flap is a relatively simple procedure, as the superficial brachial artery runs superficially in the subcutaneous layer.Iwahira Y, Maruyama Y, Hayashi A. The superficial brachial flap.