DOCSLIB.ORG

Burn Contracture Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Burn Contracture Surgery Burn Contracture Surgery Stuart Watson Canniesburn Unit Glasgow Royal Infirmary Glasgow United Kingdom [email protected] 1 Table of Contents Prevention of Contractures ................................................................................................. 4 Contracture Definitions ....................................................................................................... 4 Timing of Contracture Surgery: Indications ....................................................................... 5 Urgent ............................................................................................................................. 5 Early ................................................................................................................................ 5 Late ................................................................................................................................. 5 General Principles and Technical Tips ............................................................................... 6 Approach to Contracture Surgery ....................................................................................... 8 Split Skin Grafts .................................................................................................................. 8 Full Thickness Grafts .......................................................................................................... 9 Dermal Substitutes .............................................................................................................. 9 Locals Flaps ...................................................................................................................... 10 Free Flaps .......................................................................................................................... 10 Tissue Expansion .............................................................................................................. 11 Techniques used in Different Anatomical Sites: Important Note ..................................... 11 The Hand ........................................................................................................................... 13 General Principles ......................................................................................................... 13 Local Flap “Plasties” in the Hand ................................................................................. 13 Underlying Principles ................................................................................................... 13 Five Flap Z plasty ......................................................................................................... 13 Z-plasty ......................................................................................................................... 14 Y to V Plasty ................................................................................................................. 14 Skin Grafting and Flaps for Hand Contractures ........................................................... 14 Palmar surface—Flexion Contractures ......................................................................... 14 The PIP Joint-flexion deformity ................................................................................... 17 Extensor Surface---extension contractures ................................................................... 17 Skin grafting .................................................................................................................. 17 Severe Dorsal Contractures (role of flaps) .................................................................... 17 Interdigital web contractures ......................................................................................... 18 Square Flap Design ....................................................................................................... 18 The Axilla ......................................................................................................................... 19 Procedures for linear band contractures ........................................................................ 19 Perforator Based Flaps for Axilla ................................................................................. 20 Medial Arm Flap for Thick anterior axilla/shoulder band ............................................ 20 Posterior arm flap .......................................................................................................... 21 Procedures for Diffuse Axillary contractures ............................................................... 21 Flaps: ............................................................................................................................. 21 Grafting: ........................................................................................................................ 22 Trapezoid Flap plus grafting: ........................................................................................ 22 Linear Band Contractures--- Z plasty ........................................................................... 24 The Neck…………………………………………………………………………………22 Diffuse (broadband) Neck Contractures ....................................................................... 25 Flaps for Neck Contractures ......................................................................................... 26 Antecubital fossa ............................................................................................................... 27 Local Flaps for mild/moderate scarring ........................................................................ 27 2 Propeller Flap or Island Perforator-Based Flap ............................................................ 28 Diffuse contractures of Antecubital Fossa .................................................................... 29 The Olecranon ................................................................................................................... 30 The Wrist .......................................................................................................................... 31 The Face ............................................................................................................................ 32 The eyelids .................................................................................................................... 32 The Mouth ..................................................................................................................... 33 Anaesthesia ................................................................................................................... 34 The Groin and Perineum ................................................................................................... 35 Perineum ....................................................................................................................... 36 Popliteal Fossa and Knee .................................................................................................. 37 The Foot and Ankle .......................................................................................................... 38 Dorsum .......................................................................................................................... 38 Sole and Tendo Achilles ............................................................................................... 40 Final Notes ........................................................................................................................ 40 Recommended Further Reading ....................................................................................... 40 3 Prevention of Contractures Many burn scar problems can be prevented by appropriate intervention and work from the burns multidisciplinary team (which includes the patient) Typical interventions include the following Nurses: Prevention of infection Encourage mobilization Surgeons: Skin grafting to achieve early healing Patient and family: Compliance with exercises, massage, splints and pressure garments Physiotherapist/occupational therapist: Crucial role in encouraging and providing physical rehabilitation; instilling determination and compliance with rehabilitation regime in the patient and family. Manufacture and fitting of splints, moulds, silicone and pressure garments for scar therapy. Anaesthesia/Pain management: Providing physical comfort so that patient can mobilize stiff joints. Contracture Definitions Intrinsic contracture: a contracture where scarring directly involves the site affected by contraction Extrinsic contracture; a contracture of normal structures that are pulled out of position by scarring distant to the site. A typical example of this is a normal lower eyelid pulled into ectropion by scarring on the cheek. Linear band contracture: a band of scar tissue surrounded by relatively normal skin. This is readily treatable by local flap plasties with or without band excision. Linear band contracture in diffuse scarring; The skin surrounding a band contracture is scarred and Z plasties that require flap elevation carry a high risk of necrosis. Y to V plasties that do not require flap elevation may be an option. However, in scarred skin, the Y-V plasties may simply move the site of the troublesome band to an adjacent area, and a larger flap or graft may be required instead. Broadband contracture: The contracture involves the whole of an anatomical surface and requires an incisional release or excision with inset of flap
Load more

Recommended publications
  • Optimizing Breast Reconstruction After Mastectomy University of Antwerp Faculty of Medicine and Health Sciences
    Optimizing breast reconstruction after mastectomy mastectomy after reconstruction Optimizing breast Filip Thiessen University of Antwerp Faculty of Medicine and Health Sciences Optimizing breast reconstruction after mastectomy The use of dynamic infrared thermography Filip THIESSEN 2020 Antwerp, 2020 Thesis submitted in fulfilment of Promoters: Prof. dr. Wiebren Tjalma the requirements for the degree of Prof. dr. Gunther Steenackers Doctor in Medical Sciences at the Prof. dr. Guy Hubens University of Antwerp Co-promoter: Prof. dr. Veronique Verhoeven University of Antwerp Faculty of Medicine and Health Sciences Optimizing breast reconstruction after mastectomy: The use of dynamic infrared thermography Optimaliseren van borstreconstructies na mastectomie: Het gebruik van dynamic infrared thermography Thesis submitted in fulfilment of the requirements for the degree of Doctor in Medical Sciences at the University of Antwerp to be defended by Filip THIESSEN Proefschrift voorgelegd tot het behalen van de graad van doctor in de Medische Wetenschappen aan de Universiteit Antwerpen te verdedigen door Antwerpen, 2020 Promotoren: Prof. dr. Wiebren Tjalma Prof. dr. Gunther Steenackers Prof. dr. Guy Hubens Begeleider: Prof. dr. Veronique Verhoeven Promotoren Prof. dr. Wiebren Tjalma Prof. dr. Gunther Steenackers Prof. dr. Guy Hubens Begeleider Prof. dr. Veronique Verhoeven Members of the jury Internal Prof. dr. Jeroen Hendriks Prof. dr. Manon Huizing Prof. dr. Wiebren Tjalma Prof. dr. Gunther Steenackers Prof. dr. Guy Hubens External Prof. dr. Emiel Rutgers Prof. dr. Assaf Zeltzer © Filip Thiessen Optimizing breast reconstruction after mastectomy: The use of dynamic infrared thermography / Filip Thiessen Faculteit Geneeskunde, Universiteit Antwerpen, Antwerpen 2020 Thesis Universiteit Antwerpen – with summary in Dutch Lay-out and cover : Dirk De Weerdt (www.ddwdesign.be) Cover figure: Cold challenge to bilateral DIEP in skin sparing mastectomy (top), rapid and overall rewarming of the skin islands of the DIEP flap (bottom).
    [Show full text]
  • Thin Anterolateral Thigh Perforator Flaps: Minimizing the Partial Necrosis Rate
    Extremity/Lymphedema Original Article The perforator-centralizing technique for super- thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate Young Chul Suh, Na Rim Kim, Dai Won Jun, Jung Ho Lee, Young Jin Kim Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea Background Despite the wide demand for thin flaps for various types of extremity recon- Correspondence: Young Chul Suh struction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular Department of Plastic and Reconstructive Surgery, Bucheon St. because of its technical difficulty and safety concerns. This study proposes a novel perforator- Mary Hospital, College of Medicine, centralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a The Catholic University of Korea, 327 skewed-perforator group. Sosa-ro, Wonmi-gu, Bucheon 14647, Methods From June 2018 to January 2020, 41 patients who required coverage of various Korea Tel: +82-32-340-2095 types of defects with a single perforator-based super-thin ALT free flap were enrolled. The in- Fax: +82-32-340-7227 cidence of partial necrosis and proportion of the necrotic area were analyzed on postopera- E-mail: [email protected] tive day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap.
    [Show full text]
  • The Use of the Thoracodorsal Artery Perforator Flap in Both Autologous and Implant Based Breast Reconstruction Salvage Surgery
    Research Article Clinics in Surgery Published: 28 Nov, 2020 The Use of the Thoracodorsal Artery Perforator Flap in Both Autologous and Implant Based Breast Reconstruction Salvage Surgery Nizamoglu M1*, Hardwick S1, Coulson S1 and Malata CM1,2,3 1Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, UK 2Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, UK 3Anglia Ruskin University School of Medicine, UK Abstract Introduction: Since its introduction by Angrigiani the Thoracodorsal Artery Perforator (TDAP) flap has become a popular choice in partial breast reconstruction for volume replacement. Although mainly used to provide volume, it has also been reported as an adjunct to implant-based breast reconstruction. Methods: Patients undergoing salvage breast reconstruction surgery with the TDAP flap in the last 20 years were identified from the senior author’s logbook and their clinical data collected from EpicTM, the hospital electronic medical records system. Results: Two such patients, aged 44 and 52 years, were identified. The first had “impending failure” of a subpectoral implant reconstruction following severe cutaneous radiation reaction and poor quality soft tissues overlying the implant, coupled with recurrent seromas. The second had partial SIEA abdominal free flap fat necrosis, leading to volume loss, severe cutaneous scarring and significant deformity. The flap dimensions were 10 ×cm 25 cm and 8 cm × 25 cm, respectively. They OPEN ACCESS were each based on a single vascular perforator– one arising from the horizontal and the other from the vertical branch of the thoracodorsal vessels. Both flap transfers were successful and resulted in *Correspondence: viable reconstructions despite the challenging indications.
    [Show full text]
  • Liposuction Contouring After Head and Neck Free Flap Reconstruction
    plastol na og A y Ibrahim AE, et al., Anaplastology 2015, 4:2 Anaplastology DOI: 10.4172/2161-1173.1000145 ISSN: 2161-1173 Review Article Open Access Liposuction Contouring After Head and Neck Free Flap Reconstruction Amir E Ibrahim*, Hamed Janom, Mohamad Raad Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon *Corresponding author: Amir E Ibrahim, Faculty Member, Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon, Tel: +9613720594; E-mail: [email protected] Received date: May 28, 2014, Accepted date: April 22, 2015, Published date: April 27, 2015 Copyright: © 2015 Ibrahim AE et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Resection of bulky head and neck tumors is typically followed by microvascular free flap reconstruction. The latter has shown an acceptable success rate but often requires a secondary revision with a free tissue transfer reconstruction to improve outcome; both cosmetic and functional. Direct surgical revision via electrocautery/scalpel poses a high risk of flap perfusion compromise. Suction assisted lipectomy on the other hand is a feasible and safe technique that offers favorable contouring with comparable restoration cosmetic and functional outcomes. In this article, we review the indications and advantages of this technique and provide an outlook on its safety and pitfalls. Keywords: Liposuction; Free Flap; Reconstruction theoretically minimal since fibrous structures containing blood vessels remains unharmed as the fat is removed with liposuction [8].
    [Show full text]
  • Treatment of Ischemia-Reperfusion Injury of the Skin Flap Using Human
    LAB/IN VITRO RESEARCH e-ISSN 1643-3750 © Med Sci Monit, 2017; 23: 2751-2764 DOI: 10.12659/MSM.905216 Received: 2017.05.08 Accepted: 2017.05.19 Treatment of Ischemia-Reperfusion Injury Published: 2017.06.06 of the Skin Flap Using Human Umbilical Cord Mesenchymal Stem Cells (hUC-MSCs) Transfected with “F-5” Gene Authors’ Contribution: G 1 Xiangfeng Leng* 1 Department of Plastic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Study Design A ADE 1 Yongle Fan* Shandong, P.R. China Data Collection B 2 Department of Nephrology, Qingdao Municipal Hospital, Qingdao, Shandong, Statistical Analysis C E 1 Yating Wang P.R. China Data Interpretation D B 2 Jian Sun 3 Tianjin University, Tianjin, P.R. China Manuscript Preparation E D 1 Xia Cai 4 The Eighth People’s Hospital of Qingdao, Qingdao, Shandong, P.R. China Literature Search F Funds Collection G F 1 Chunnan Hu C 3 Xiaoying Ding B 4 Xiaoying Hu AG 1 Zhenyu Chen * These authors contributed equally to this work Corresponding Author: Zhenyu Chen, e-mail: [email protected] Source of support: Natural Science Foundation of Shandong Province, China (ZR2014HM113) Background: Recent studies have shown that skin flap transplantation technique plays an important role in surgical pro- cedures. However, there are many problems in the process of skin flap transplantation surgeries, especially ischemia-reperfusion injury, which directly affects the survival rate of the skin flap and patient prognosis after surgeries. Material/Methods: In this study, we used a new method of the “stem cells-gene” combination therapy. The “F-5” gene fragment of heat shock protein 90-a (Hsp90-a) was transfected into human umbilical cord mesenchymal stem cells (hUC- MSCs) by genetic engineering technique.
    [Show full text]
  • Plastic Surgery Essentials for Students Handbook to All Third Year Medical Students Concerned with the Effect of the Outcome on the Entire Patient
    AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair Eighth Edition 2012 Essentials for Students Workgroup Lynn Jeffers, MD Adam Ravin, MD Sami Khan, MD Chad Tattini, MD Patrick Garvey, MD Hatem Abou-Sayed, MD Raman Mahabir, MD Alexander Spiess, MD Howard Wang, MD Robert Whitfield, MD Andrew Chen, MD Anureet Bajaj, MD Chris Zochowski, MD UNDERGRADUATE EDUCATION COMMITTEE OF THE PLASTIC SURGERY EDUCATIONAL FOUNDATION First Edition 1979 Ruedi P. Gingrass, MD, Chairman Martin C. Robson, MD Lewis W.Thompson, MD John E.Woods, MD Elvin G. Zook, MD Copyright © 2012 by the American Society of Plastic Surgeons 444 East Algonquin Road Arlington Heights, IL 60005 All rights reserved. Printed in the United States of America ISBN 978-0-9859672-0-8 i INTRODUCTION PREFACE This book has been written primarily for medical students, with constant attention to the thought, A CAREER IN PLASTIC SURGERY “Is this something a student should know when he or she finishes medical school?” It is not designed to be a comprehensive text, but rather an outline that can be read in the limited time Originally derived from the Greek “plastikos” meaning to mold and reshape, plastic surgery is a available in a burgeoning curriculum. It is designed to be read from beginning to end. Plastic specialty which adapts surgical principles and thought processes to the unique needs of each surgery had its beginning thousands of years ago, when clever surgeons in India reconstructed individual patient by remolding, reshaping and manipulating bone, cartilage and all soft tissues.
    [Show full text]
  • Factors Affecting the Outcome of Lower Extremity Osteomyelitis Treated With
    Thai et al. Journal of Orthopaedic Surgery and Research (2021) 16:535 https://doi.org/10.1186/s13018-021-02686-x RESEARCH ARTICLE Open Access Factors affecting the outcome of lower extremity osteomyelitis treated with microvascular free flaps: an analysis of 65 patients Duy Quang Thai1,2, Yeon Kyo Jung1, Hyung Min Hahn1 and Il Jae Lee1* Abstract Background: Free flaps have been a useful modality in the management of lower extremity osteomyelitis particularly in limb salvage. This study aimed to determine the factors affecting the outcome of free flap reconstruction in the treatment of osteomyelitis. Methods: This retrospective study assessed 65 osteomyelitis patients treated with free flap transfer from 2015 to 2020. The treatment outcomes were evaluated in terms of the flap survival rate, recurrence rate of osteomyelitis, and amputation rate. The correlation between outcomes and comorbidities, causes of osteomyelitis, and treatment modalities was analyzed. The following factors were considered: smoking, peripheral artery occlusive disease, renal disease, diabetic foot ulcer, flap types, using antibiotic beads, and negative pressure wound therapy. Result: Among the 65 patients, 21 had a severe peripheral arterial occlusive disease. Osteomyelitis developed from diabetic foot ulcers in 28 patients. Total flap failure was noted in six patients, and osteomyelitis recurrence was noted in eight patients, for which two patients underwent amputation surgery during the follow-up period. Only end-stage renal disease had a significant correlation with the recurrence rate (odds ratio = 16.5, p = 0.011). There was no significant relationship between outcomes and the other factors. Conclusion: This study showed that free flaps could be safely used for the treatment of osteomyelitis in patients with comorbidities and those who had osteomyelitis developing from diabetic foot ulcers.
    [Show full text]
  • SKIN GRAFTS and SKIN SUBSTITUTES James F Thornton MD
    SKIN GRAFTS AND SKIN SUBSTITUTES James F Thornton MD HISTORY OF SKIN GRAFTS ANATOMY Ratner1 and Hauben and colleagues2 give excel- The character of the skin varies greatly among lent overviews of the history of skin grafting. The individuals, and within each person it varies with following highlights are excerpted from these two age, sun exposure, and area of the body. For the sources. first decade of life the skin is quite thin, but from Grafting of skin originated among the tilemaker age 10 to 35 it thickens progressively. At some caste in India approximately 3000 years ago.1 A point during the fourth decade the thickening stops common practice then was to punish a thief or and the skin once again begins to decrease in sub- adulterer by amputating the nose, and surgeons of stance. From that time until the person dies there is their day took free grafts from the gluteal area to gradual thinning of dermis, decreased skin elastic- repair the deformity. From this modest beginning, ity, and progressive loss of sebaceous gland con- skin grafting evolved into one of the basic clinical tent. tools in plastic surgery. The skin also varies greatly with body area. Skin In 1804 an Italian surgeon named Boronio suc- from the eyelid, postauricular and supraclavicular cessfully autografted a full-thickness skin graft on a areas, medial thigh, and upper extremity is thin, sheep. Sir Astley Cooper grafted a full-thickness whereas skin from the back, buttocks, palms of the piece of skin from a man’s amputated thumb onto hands and soles of the feet is much thicker.
    [Show full text]
  • Munique Maia, M.D
    MUNIQUE MAIA, M.D. EDUCATION AND CREDENTIALS Aesthetic Plastic Surgery Fellowship HARVARD MEDICAL SCHOOL, BIDMC - Boston, MA. July 2017 – July 2018 Plastic Surgery Residency NORTHWELL – Great Neck, NY. July 2012 – June 2017 Internship - General Surgery July 2011 – June 2012 CLEVELAND CLINIC FOUNDATION- Cleveland, OH. Research Fellowship UNIVERSITY OF TEXAS SOUTHWESTERN, Dallas, TX Oct. 2009 -June 2010; January 2011-May 2011 Plastic Surgery and General Surgery Rotations – Electives and Observerships Penn State University, Hershey, PA November and December 2010 Mount Sinai Hospital, New York, NY September and October 2010 Cleveland Clinic, Cleveland, OH August 2010 Memorial Sloan- Kettering Cancer Center, New York, NY July 2010 Children’s Medical Center Dallas, Dallas, TX April to May 2010 Alpert Medical School, Brown University, Providence, RI January 2009 University of Texas Southwestern, Dallas, TX December 2008 Memorial Sloan- Kettering Cancer Center, New York, NY November 2008 Ivo Pitanguy Institute, Rio de Janeiro, Brazil May 2008 Harvard Medical School, Boston, MA September to October 2007 Wayne State University, Detroit, MI July, August and November 2007 University of Manitoba, Winnipeg, Canada July to August 2006 Medical Degree FEDERAL UNIVERSITY OF CEARA, Fortaleza, Brazil. – Magna Cum Laude March 2002- March 2009 Licensure New York State Medical License #286528 September 2016 Massachusetts Medical License # 271024 September 2017 USMLE Step1 – 246/99th percentile May 2009 USMLE Step 2 Clinical Knowledge: 242/99th percentile August
    [Show full text]
  • Digital Artery Perforator Flap Use in Reconstruction of Fingertip Defects
    SELÇUK TIP DERGİSİ Araştırma Makalesi SELCUK MEDICAL JOURNAL Research Article Selcuk Med J 2020;36(4): 343-351 DOI: 10.30733/std.2020.01480 Digital Artery Perforator Flap Use in Reconstruction of Fingertip Defects Parmak Ucu Doku Defektlerinde Dijital Arter Perforatör Flebinin Kullanımı Alper Ural1, Fatma Bilgen1, Öz 1 Amaç: Parmak ucu defektlerinin rekonstrüksiyonunda dijital arter perforatör flebi kullanarak yapılan Mahmut Durak Ceviz , rekonstrüksiyonlar ile ilgili deneyimimizi bildirmeyi amaçladık. Mustafa Ridvan Yanbas1, Hastalar ve Yöntem: Aralık 2019-Eylül 2020 arasında parmak defektleri nedeniyle ameliyat edilen ve Mehmet Bekerecioglu1 dijital arter perforatör flep ile rekonstrüksiyon yapılan 8 hasta çalışmaya dahil edildi. Hastalar etyoloji, cinsiyet, yaş, komorbidite ve sonuçlar açısından değerlendirildi. Bulgular: Hastaların ortalama yaşı 43,6 (19-66) idi. 8 flebin 6'sı tam olarak sağ kaldı ve sorunsuz iyileşti. 1Kahramanmaraş Sütçü İmam University, Fleplerin boyutları 20x10 mm ile 25x20 mm arasındaydı. Bir flepte kısmi cilt nekrozu yaşanırken 1 flep ise Department of Plastic,Reconstructive and tamamen kaybedildi. Hiçbir hasta soğuk intoleransından veya eklem kontraktüründen şikayetçi değildi. Aesthetic Surgery, Kahramanmaraş, Turkey Hastalardan birinde hafif tırnak deformitesi oluştu. Sonuç: Dijital arter perforatör flebi (DAPF), komorbiditesi olmayan ve sigara içmeyen hastalarda parmak ucu defekti rekonstrüksiyonları için güvenilir ve çok yönlü bir fleptir. Tek aşamalı ameliyat prosedürü, flebi Geliş Tarihi/Received: 18 August
    [Show full text]
  • Plastic and Reconstructive Surgery • November 2007 1746
    Plastic and Reconstructive Surgery • November 2007 sured treatment outcomes. It should be considered as a preferred surgical option for treating primary hyperhi- drosis of the axilla. DOI: 10.1097/01.prs.0000291614.29714.54 Jugpal S. Arneja, M.D. Section of Plastic Surgery Children’s Hospital of Michigan Wayne State University 3rd Floor Carls Building Detroit, Mich. 48201 [email protected] DISCLOSURE The author has no conflict of interest associated with the preparation or submission of this communication. REFERENCES 1. Wagner, D. S., and Alfonso, D. R. The influence of obesity and volume of resection on success in reduction mammaplasty: An outcomes study. Plast. Reconstr. Surg. 115: 1034, 2005. 2. Arneja, J. S., Hayakawa, T. E., Singh, G. B., et al. Axillary hyperhidrosis: A 5-year review of treatment efficacy and re- currence rates using a new arthroscopic shaver technique. Plast. Reconstr. Surg. 19: 562, 2007. 3. Klein, J. A. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast. Reconstr. Surg. 92: 1085, 1993. Perforator-Plus Flaps or Perforator-Sparing Fig. 1. Arthroscopic shaver handpiece with 4.0-mm blade can- Flaps: Different Names, Same Concept nula tip (above); manual traction and placement of shaver into Sir: theaxilla,withdebridement(500rpm)andaspiration(50mmHg) e congratulate Dr. Mehrotra on his thoughtful of the undersurface of the axillary flap. Treatment is terminated Warticle (Plast. Reconstr. Surg. 119: 590, 2007). We with direct visual confirmation and palpable change in consis- have independently described a flap of very similar 1,2 tency of the flap from “pebbly” to “smooth” (below). design that we call the perforator-sparing flap, and we would like to share our experience in light of this article.
    [Show full text]
  • The Versatility of the Inter-Costal Artery Perforator (ICAP) Flaps
    Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) 59, 644–652 The versatility of the inter-costal artery perforator (ICAP) flaps Moustapha Hamdi*, Koenraad Van Landuyt, Bob de Frene, Nathalie Roche, Phillip Blondeel, Stan Monstrey Plastic Surgery Department, Gent University Hospital, De Pintelaan 185, 9000 Gent, Belgium Received 15 April 2005; accepted 1 January 2006 KEYWORDS Summary Introduction: Anatomy and classification of intercostal perforator flaps Intercostal vessels; in addition to our experience with will be demonstrated for different indications. Perforator flaps; Material and methods: The intercostal vessels form an arcade between the aorta Pedicled flaps; and the internal mammary vessels. Different pedicled perforator flaps can be raised Clinical experience on this neurovascular bundle to cover defects on the trunk. They are classified as following: dorsal intercostal artery perforator flap (DICAP); lateral intercostal artery perforator (LICAP); and anterior intercostal artery perforator (AICAP) flap. Results: Between 2001 and 2004, 20 pedicled (ICAP) flaps were harvested in 16 patients. The indications were: immediate partial breast reconstruction in eight patients who had a quadrantectomy for breast cancer; midline back and sternal defects in three patients who had radical excisions for a dermatofibrosarcoma or malignant melanoma; and autologous breast augmentation (four bilateral and one unilateral flap) infive post-bariatric-surgery patients. The average flap dimension was 18!8cm2 (range 8!5–24!12 cm2). There were two DICAP flaps, two (AICAP) flaps and 16 (LICAP) flaps. All but two flaps were based on one perforator. Mean harvesting time was 45 min for a single flap. Bilateral breast augmentation with LICAP flap necessitated longer operative time (range 2–3 h) depending whether it was combined or not with mastopoexy.
    [Show full text]