Reconstruction of the burned ear using a temporalis fascial flap

A case report is presented in which a temporalis fascial flap is used to reconstruct a burned ear complicated by full-thickness skin loss with exposed cartilage. The method provides a simple, reliable means for covering exposed auricular cartilage with readily obtainable vascularized tissue. Donor-site morbidity is minimal because the scar lies within the hairline.     

Reconstruction of the concha of the ear using a postauricular island flap

An effective method of reconstruction of the auricular conchal cavity using a postauricular island flap containing the postauricular blood vessels is described. In this procedure, the island flap is brought in to cover the defect of the conchal cavity through a tunnel between the defect and the retroauricle. Sound anatomic and mechanical principles are introduced in this technique. Two patients underwent the operation, and good results were obtained.     

Reconstruction of soft-tissue defects using serratus anterior adipofascial free flap

The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. The adipofascial layer overlying the serratus anterior muscle is the anatomic layer, which is supplied by the same branch of thoracodorsal artery. Even though great progress has occurred in the prevention of postoperative adhesion of extremity injuries, the problem has not been completely solved and is still of special importance in complex injuries. Between March of 1995 and February of 1996, seven patients underwent reconstructive operation as a result of soft-tissue defects of the upper or lower extremities or the scalp. We transferred free adipofascial tissue overlying the serratus anterior muscle in three patients and both serratus anterior muscle and adipofascial tissue in four patients. A free adipofascial flap overlying serratus anterior muscle was transferred when a gliding surface was required, owing to the exposure of tendons and neurovascular structures. The average duration from operation to follow-up examination was 8 months (from 4 to 16 months). The results of the operations were satisfactory in functional and cosmetic aspects. This kind of flap was very effective in reconstruction of soft-tissue defects and gliding surfaces for these reasons: easy dissection, the capability of obtaining a long vascular pedicle, large-sized flap, composite flap including muscle or rib, and the fact that there was no serious functional or cosmetic deficit at the donor site.     

Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip

Massive facial defects involving the oral sphincter are challenging to the reconstructive surgeon. This study presents the authors' approach to simultaneous reconstruction of complex defects with an advancement flap from the remaining lip and free flaps. From January of 1997 to December of 2001, 22 patients were studied following ablative oral cancer surgery. Their ages ranged from 32 to 66 years. Nineteen patients had buccal cancer, two patients had tongue cancer, and one patient had lip cancer. In all cases, the disease was advanced squamous cell carcinoma. Nine patients underwent composite resection of tumor with segmental mandibulectomy, and seven patients underwent marginal mandibulectomy. Cheek defects ranged from 15 x 12 cm to 4 x 3 cm, and intraoral defects ranged from 14 x 8 cm to 5 x 4 cm in size. One third of the lower lip was excised in nine patients, both the upper and lower lips were excised in 10 patients, and only commissure defects were excised in three patients. An advancement flap from the remaining upper lip was used for reconstruction of the oral commissure and oral sphincter. Then, the composite through-and-through defect of the cheek was reconstructed with radial forearm flaps in 13 patients, fibula osteocutaneous flaps in five patients, double flaps in three patients, and an anterolateral thigh flap in one patient. The free flap survival rate was 96 percent, and only one flap failed. With regard to complications, there were two patients with cheek hematoma, six patients with orocutaneous fistula or neck infection, and one patient with osteomyelitis of the mandible. All but one patient had adequate oral competence. All patients had an adequate oral stoma and could eat a regular or soft diet; two patients could eat only a liquid diet. For moderate lip defects, immediate reconstruction of complex defects took place using an advancement flap from the remaining lip to obtain a normal and functional oral sphincter; the free flap can be used to reconstruct through-and-through defects. This simple procedure can provide patients with a useful oral stoma and acceptable cosmesis.     

Extremity reconstruction using the free deltoid flap

The deltoid fasciocutaneous flap is a thin, reliable flap that is easily dissected from the posterolateral arm. It has large-caliber vessels and is capable of sensory reinnervation to portions of the flap above the deltoid/triceps groove through the lateral brachial cutaneous nerve. There is little sensory return to the large vascular territory, which can be extended inferiorly below the deltoid triceps groove. The donor site can be closed primarily or skin grafted and when large may be objectionable to some patients. The flap is an excellent choice for extremity soft-tissue reconstruction on the plantar or palmar surfaces. Protective sensibility has returned to all reinnervated flaps. We present our experience in 10 patients with extremity problems.     

The rectus abdominis free flap as an emergency procedure in extensive upper extremity soft-tissue defects

Stable wound coverage after extensive soft-tissue loss of the upper extremity remains a difficult problem in the management of large defects of the upper limb. To prevent further tissue loss owing to infection or inadequate cover when important structures such as vessels, tendons, nerves, joints, and bones are exposed, various free flaps have been introduced into the therapeutic armamentarium of acute plastic surgical management options. Emergency or delayed early reconstruction has been proposed to prevent chronic infection and further tissue loss. We report a series of 12 emergency and delayed early reconstructions of the forearm, wrist, carpus, metacarpus, and hand using the free rectus abdominis muscle flap with split-skin coverage, demonstrating the versatility of this flap within this special context. Emergency free rectus muscle flap transfer is safe, technically easy, and expandable.     

Reconstruction of the floor of the mouth with a free Dorsalis pedis flap.

The dorsalis pedis flap used for immediate reconstruction in two patients after resection of cancers of the floor of the mouth. The procedure has much to recommend it in the immediate repair of such defects.     

Reconstruction of a socket using a retroauricular temporal flap

The reconstruction of a continent socket with a skin graft may be difficult because of varying degrees of contracture. In an effort to solve this problem, a retroauricular temporal flap was successfully transposed in a two-stage procedure. The one-stage transposition of a retroauricular island flap based on a temporal pedicle was a partial failure.