Objective: To summarize and popularize the application of temporalis muscle flap in repair and reconstruction after the resection of tumor or necrotic foci following radiotherapy of nasopharyngeal carcinoma (NPC). Methods: A retrospective analysis was made on the patients treated in the Department of Otorhinolaryngology Head and Neck Surgery of Xiangya Hospital between January 2019 and March 2021 who underwent surgical resection of tumor or necrosis of NPC after radiotherapy and temporalis muscle flap repair. The effect of the repair and the patients' postoperative conditions were analyzed. Results: A total 29 patients, 19 males and 10 females, aged from 33 to 65 years old, were included in the study, and were followed up for 6-35 months. Except for 2 patients who were not followed due to bleeding or special bacterial infection, the others' temporalis muscle flap healed well and no cerebrospinal fluid rhinorrhea or massive hemorrhage occurred. After the operation, all patients had no nasopharyngeal reflux or new open rhinolalia, and in some patients, the open rhinolalia even got relieved. Except for one case of depressed temporal fossa caused by infection and followed debridement and another one case of shallowed forehead wrinkles, the appearances of the other patients were basically symmetrical. Some patients had temporary mouth opening limitation after operation, and all of them recovered after rehabilitation exercises. Conclusions: The temporalis muscle flap can protect the skull base and internal carotid artery, and improve the quality of life of patients after the resection of NPC or necrotic foci. It is a reliable pedicled flap for repairing skull base defect with simple operation procedures and relatively few complications.
Humans ; Male ; Female ; Adult ; Middle Aged ; Aged ; Nasopharyngeal Carcinoma ; Retrospective Studies ; Quality of Life ; Plastic Surgery Procedures/methods* ; Surgical Flaps/blood supply* ; Nasopharyngeal Neoplasms/surgery* ; Necrosis ; Speech Disorders ; Muscles

OBJECTIVETo investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture.

METHODSBased on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly.

RESULTS17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance.

CONCLUSIONSExpanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Arteries ; Cicatrix ; surgery ; Clavicle ; Contracture ; surgery ; Dissection ; methods ; Fasciotomy ; Humans ; Neck ; blood supply ; Neck Muscles ; anatomy & histology ; Surgical Flaps ; blood supply

OBJECTIVETo investigate the effect of vascularized composite flap with iliac crest and nternal oblique muscle of abdomen for half mandibular reconstruction.

METHODSFrom July 2009 to Sept. 2013, 14 cases with half mandibular defect after tumor resection were treated with composite flap of iliac crest and internal oblique muscle of abdomen pedicled by deep circumflex iliac vessels. During operation, one group performed tumor resection and got the recipient area vessels ready for anastomosis. The other group performed harvesting of composite flap. Then the flap was trimmed and fixed to construct the defect with vessel anastomosis.

RESULTSAll the 14 composite flaps survived with local infection only in 1 case. The size of harvested iliac crest ranged from 6 cm x 3 cm to 9 cm x 3 cm. The size of harvested internal oblique muscle of abdomen ranged from 5 cm x 4 cm to 7 cm x 5 cm. The patients were followed up for 6 months to 26 months (mean, 13 months) with satisfactory results and no complication. Mandibular panoramic radiographs showed new bone formation and good union.

CONCLUSIONSVascularized composite flap with iliac crest and internal oblique muscle of abdomen has the advantages of abundant bone volume, as well as soft tissue reconstruction in one stage. The reconstructed mandible can attain normal function and appearance.

Abdominal Muscles ; transplantation ; Abdominal Wall ; Humans ; Ilium ; transplantation ; Mandibular Reconstruction ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; transplantation

OBJECTIVETo explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy.

METHODSSix patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back.

RESULTSPain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well.

CONCLUSIONSOn the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.

Breast Neoplasms ; radiotherapy ; surgery ; Debridement ; Humans ; Mastectomy, Radical ; methods ; Myocutaneous Flap ; Neck Injuries ; surgery ; Necrosis ; Pressure Ulcer ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Superficial Back Muscles ; Surgical Flaps ; blood supply ; Wound Healing

OBJECTIVETo investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography, and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages.

METHODS30 female patients received abdominal CT angiography. (1) The distance between internal mammary artery and the sternum midline were recorded; (2) The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th, 6th, 7th rib was observed; (3) The points where the superior epigastric artery gets through the rectus abdominis muscle were located.

RESULTS( The average distance between left internal mammary artery to the sternum midline is from 1. 66 cm (0. 62-2. 39 cm ) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space. The average distance between right internal mammary artery to the sternum midline is from 1.55 cm(0. 66-2. 29 cm) to 2.29 cm(0. 73-3. 67 cm) at the level from 4th to 6th intercostal space; ) The number of branches is the most at the level of 6th intercostal space; (3) There are 235 branches in the superior epigastric artery.

CONCLUSIONSThis imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction. It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.

Abdominal Muscles ; blood supply ; Epigastric Arteries ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Mammaplasty ; Mammary Arteries ; anatomy & histology ; diagnostic imaging ; Multidetector Computed Tomography ; Rectus Abdominis ; anatomy & histology ; diagnostic imaging ; Sternum ; anatomy & histology ; diagnostic imaging ; Surgical Flaps

OBJECTIVETo investigate the application of pedicled expanded flaps for the reconstruction of facial soft tissue defects.

METHODSThe expanded skin flaps, pedicled with orbicularis oculi muscle, submental artery, the branch of facial artery, superficial temporal artery, interior upper arm artery, had similar texture and color as facial soft tissue. The pedicled expanded flaps have repaired the facial soft tissue defects.

RESULTSBetween Jan. 2003 to Dec. 2013, 157 cases with facial soft tissue defects were reconstructed by pedicled expanded flaps. Epidermal necrosis happened at the distal end of 8 expanded flaps, pedicled with interior upper arm artery(4 cases), orbicularis oculi muscle(3 cases) and submental artery(1 case), which healed spontaneously after dressing. All the other flaps survived completely with similar color and inconspicuous scar. 112 cases were followed up for 8 months to 8 years. Satisfactory results were achieved in 75 cases. 37 cases with hypertrophic scar at incisions need secondary operation.

CONCLUSIONSIsland pedicled expanded flap with similar texture and color as facial soft tissue is suitable for facial soft tissue defects. The facial extra-incision and large dog-ear deformity could be avoided.

Cicatrix, Hypertrophic ; surgery ; Eyelids ; Face ; surgery ; Facial Muscles ; Humans ; Reconstructive Surgical Procedures ; Skin Pigmentation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply

OBJECTIVETo report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps.

METHODSSix patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cm multiply 6 cm to 30 cm multiply 18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery.

RESULTSAll flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh) or was closed primarily (3 cases) and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.

CONCLUSIONOur experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

Adult ; Arm Injuries ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocutaneous Flap ; blood supply ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; etiology ; surgery ; Superficial Back Muscles ; transplantation ; Treatment Outcome

OBJECTIVETo describe an operative method for the repair of electric burn wound in the upper limbs with lateral intercostal perforator-based pedicled flap, and to observe its clinical effect.

METHODSIntercostal artery perforator-based pedicled abdominal flap with the blood supply originating from the lateral perforator branches of the 7th-10th intercostal arteries were used to repair the wounds of 6 patients with burn wounds in elbows, forearm, wrists and palms. The pedicles were (16. 0 cm x 12. 0 cm) - (9. 0 cm x 7.0 cm) in area, and the pedicles were severed 18 to 21 days after the operation. The survival and the appearance of the flaps were observed after operation.

RESULTSThe procedure was easy and safe, and there was reliable and adequate blood supply in the lateral intercostal perforator-based pedicled flap. All the flaps survived in 5 patients, except marginal necrosis (3.5 cm x 2. 0 cm) was found in the distal portion of flap because flap cutting exceeded the paraumbilical line. The appearance was satisfactory after operation.

CONCLUSIONThis flap is suitable for the repair of deep wounds in hands, forearms, and elbows.

Adolescent ; Adult ; Aged ; Arm Injuries ; surgery ; Burns, Electric ; surgery ; Child ; Hand Injuries ; surgery ; Humans ; Intercostal Muscles ; blood supply ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Thoracic Arteries ; transplantation ; Upper Extremity ; injuries ; Young Adult

OBJECTIVETo evaluate the vascularized (deep circumflex iliac vessels) iliac crest graft with internal oblique muscle as a method for reconstruction of composite mandibular defect.

METHODSVascularized iliac crest graft with internal oblique muscle was used to reconstruct the composite mandibular defects in 10 patients. All clinical data were analyzed retrospectively. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the surgery, the complications and the outcome. The type of mandibular defect was recorded.

RESULTSOf the 10 patients with composite mandibular defects including mandibular body, mandibular angle, mandibular ramus and the soft tissue around them, 7 patients were recorded with the defects of mandibular condyles. During the follow-up period from 3 months to 24 months, primary wound healing was observed in all patients, except one patient with minor muscular necrosis. All patients were satisfied with their facial contour and mandibular shape, without tumor recurrence. Donor site problems important enough to be recorded in the notes were minimal.

CONCLUSIONSThe vascularized iliac crest graft with internal oblique muscle offers a useful solution for reconstruction of composite mandibular defect. There is sufficient height and depth of bone to maintain a facial contour and mandibular shape. It can be used as a routine surgical technique to reconstruct composite mandibular defect.

Abdominal Muscles ; transplantation ; Adolescent ; Adult ; Female ; Humans ; Ilium ; blood supply ; transplantation ; Male ; Mandibular Injuries ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVETo improve the blood circulation of myocutaneous platysma flap and its survival rate.

METHODSThere were seventeen oral cancer patients in this group. After the tumor excision, the oral defect was reconstructed with myocutaneous platysma flap which had submandibular pedicle and contained external jugular vein.

RESULTSThere was no any circulation compromise in this group. The survival rate of the flap was 100% . Two cases encountered oral-facial fistula but were cured by dressing change.

CONCLUSIONSPreserving and containing the external jugular vein in the flap is helpful for improving the blood circulation of the myocutaneous platysma flap and making its survival rate higher.

Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Jugular Veins ; surgery ; Male ; Middle Aged ; Mouth Neoplasms ; surgery ; Neck Muscles ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; blood supply