A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities | ||||
The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
Article 24, Volume 43, Issue 1, January 2019, Page 153-157 PDF (8.26 MB) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/ejprs.2019.65174 | ||||
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Authors | ||||
Ahmed Abdel Salam Hafiz* ; Ahmed NAwar; Ahmed Maher Sami | ||||
The Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Cairo University | ||||
Abstract | ||||
Background: Distally based (reversed flow) fasciocautaneous flaps are used for coverage of distal extremity soft tissue defects. However, there is a high incidence of venous congestion that may lead to partial or total flap loss. Various modifications for these flap design have been made aiming to improve flap survival. Aim of Work: In this paper, a tongue like extension from the skin island was done aiming to improve its versatility and decrease complication rate especially venous congestion. Patients and Methods: Eight patients (five males and three females), average age thirty years old. Most cases where post traumatic, one case necrotizing fasciitis of heel, one case with squamous cell cancer of dorsal hand skin. Five patients underwent reversed sural flap and three patients underwent radial forearm flap. Results: All cases had viable flaps with good wound healing. However female patients complained of the scarring later on. One case of reversed sural flap had minimal distal congestion that improved later on. Conclusion: Advantage of this modification is that it acts to stabilize the critical vascular pattern of the pedicle during its axial rotation minimizing the post insetting vascular problem. It improves the venous drainage through the subdermal and subcutaneous venous plexuses and limits the excess kinking of the fascial pedicle. This tongue of tissue can also serve as an extra tissue to be used for coverage in some cases. It also has a superior cosmetic appearance when compared to skin grafting of the pedicle. The use of this modified technique can be extended to any island flap that has to pass through a tight tunnel to reach the defect. | ||||
References | ||||
1- Li J-H., Xing X., Ouyang T-X., Li P. and Xu J.: An innovation in the subcutaneous island pedicle flap for cutaneous reconstruction. J. Plast. Reconstr. And Aesthetic Surgery, 59: 174-180, 2006. 2- Kneser U., Bach A.D., Polykandriotis E., Kopp J. and Horsh R.E: Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast. Reconstr. Surg., 116 (7): 1910-17, 2005. 3- Sabapathy S.R. and Bhardwaj P.: Skin cover in hand injuries. In mini-symposium: Hand trauma. Current Orthopaedic., 22: 1-8, 2008. 4- Li Y-F. and Lao J.: A simple design to improve venous drainage in retrograde island flaps: Surgical technique. J. Plast. Reconstr. and Aesthet. Surg., 63: e211-e212, 2010. Egypt, J. Plast. Reconstr. Surg., January 2019 157 5- Dragu A., Bach A.D, Kneser U. and Horch R.E.: Two easy and simple modifications when using a distally based sural flap to reduce the risk of venous congestion. Plast. Reconstr. Surg. Let. August, 122 (2): 683-84, 2008. 6- El-Shazly M. and Yassin O.: Increasing the success rate of the reverse-flow fasciocutaneous island sural flap.A clinical experience in 26 cases. Ann. Plast. Surg., 57: 653-657, 2006. 7- Al-Qattan M.M.: A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: Inclusion of a gastrocnemius muscle”cuff” around the sural pedicle. Ann. Plast. Surg., 47: 269, 2001. 8- Buluc L., Tosun B., Sen C. and Sarlak A.Y.: A modified technique for transposition of the reverse sural artery flap. Plast. Reconstr. Surg., 117: 2488, 2006. 9- Loonen M.P.J., Moshe K. and Schuurman A.H.: Correspondence letter. Plast. Reconstr. Surg. August, p 684, 2008. 10- Akhtar S. and Hameed A.: Versatility of the sural fasciocautaneous flap in the coverage of the lower third leg and hind foot defects. J. of Plast., Reconstr. And Aesthet. Surg., 59: 839-845, 2006. 11- Almeida M.F., da Costa P.R. and Okawa R.Y.: Reverse flow island sural flap. Plast. Reconstr. Surg., 109: 583, 2002. 12- Maffi T.R., Knoetgen III J., Turner N.S. and Moran S.L.: Enhanced survival using the distally based sural artery interpolation flap. Ann. Plast. Surg., 54: 302-305, 2005. 13- Soucacos P.N., Zoubos A.B., Korompilias A.V. and Vekris M.D: Versatility of the island forearm flap in the management of extensive skin defects of the hand. Injury, Int. J. Care Injured, 39s: S49-S56, 2008. 14- Mathes Stephen J. and Nahai Foad: Radial forearm flap, Reconstructive surgery, principles, anatomy and technique, Volume 2, p.775-802, 1997. | ||||
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