Total maxillectomy usually results in defects on anterior, posterior, medial and lateral wall of the maxilla besides the palate and the orbit floor. The traditional reconstructive approaches to maxillectomy include skin grafting to line the internal cavity and palatal prosthesis to obturate the palate and serve as a denture. This method is easy to detect tumor recurrence by direct examination. The drawback of this method is that the infection rate is very high and it can not yield structural support to the upper midface. It is not possible to repair the maxillary defects effectively when using only the hard tissue like bone. The reconstruction by using soft tissue makes it possible to repair the defects on the medial nasal wall, eye socket and the palate, but it is impossible to reconstruct the malar eminence. Therefore, the transfer of soft and hard tissue is recommended for the ideal and effective reconstruction of the defect after the total maxillectomy. We have acquired satisfactory results for both fuctional and aesthetical purposes in the cancer patient who received the maxillectomy by using the vascularized calvarial bone and the free rectus abdominis myocutaneous flap.
Dentures ; Humans ; Maxilla ; Myocutaneous Flap* ; Orbit ; Palate ; Prostheses and Implants ; Rectus Abdominis* ; Recurrence ; Skin Transplantation

OBJECTIVETo investigate the clinical application of TRAM-RPAS flap in the one-stage breast reconstruction for patients with breast cancer, and to discuss the method to reduce the incidence of abdominal hernia and abdominal bulging.

METHODSFrom 2002 to 2004, 16 cases of breast cancer (9 cases in stage I or II and 7 in stage III) received radical resection and breast reconstruction with TRAM-RPAS flaps at the same stage.

RESULTSGood symmetry was achieved in 12 cases. In the other 4 cases, 3 cases had moderate breast poptosis and one case had breast hypoplasia on the unaffected side. All the flaps survived with only one case of abdominal bulging.

CONCLUSIONSTRAM-RPAS flap can achieve the same result as traditional TRAM-RPAS flap in the one-stage breast reconstruction, while the incidence of abdominal complication is lower for TRAM-RPAS flap.

Adult ; Breast Neoplasms ; surgery ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Rectus Abdominis ; transplantation ; Surgical Flaps

OBJECTIVETo evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator (DIEP) and the transverse rectus abdominis musculocutaneous (TRAM).

METHODSThe DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side. The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally.

RESULTSWe have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases. All of the flaps survived, and the reconstructed breasts were well-shaped with the follow-up of 6-18 months.

CONCLUSIONSThe DIEP and TRAM united flap possesses of advantages such as rich blood supply, abundant tissue volume and easy shaping. It is especially applicable to the cases who have large chest defect and need large volume tissue.

Adult ; Epigastric Arteries ; transplantation ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Rectus Abdominis ; transplantation ; Skin Transplantation ; Surgical Flaps ; blood supply

OBJECTIVETo observe the effect of the early transplantation of double rectus abdominis musculo-cutaneous flaps on the repair of electrical injury of the wrist.

METHODSThe study involved six patients suffering from circumferential deep electrical burn with only small amount of normal skin left on the dorsal side. The wounds were covered with double rectus abdominis musculo-cutaneous flaps raised from the upper abdomen with pedicles in both proximal and distal ends at an early postburn stage. The postoperative recovery of wrist function and wound repair were evaluated.

RESULTSThe wrist wounds in all the 6 patients were primarily healed, with perfect function and appearance.

CONCLUSIONEarly application of double rectus abdominis musculocutaneous flaps on the electrically injured wrists can promote the wound healing processes and plays important roles in the preservation of wrist function.

Abdomen ; surgery ; Adult ; Burns, Electric ; surgery ; Humans ; Rectus Abdominis ; transplantation ; Skin Transplantation ; Surgical Flaps ; Wound Healing ; Wrist Injuries ; surgery

OBJECTIVETo explore the method for repairing circumferential wound in the wrist region due to high-voltage electrical burn.

METHODSSix patients with circumferential wound in the wrist region after high-voltage electrical burn were admitted to our hospital from January 2009 to December 2011. After debridement, wounds in the wrist were repaired with combined abdominal axial pattern flaps. The wound of wrist on the flexor aspect was repaired with paraumbilical flap carrying a portion of rectus abdominis that filled the wound cavity of the wrist on the flexor aspect. The wound of wrist on the dorsal aspect was repaired with lower abdominal flap. Pedicle division was performed 4 - 5 weeks post surgery. Some donor sites were sutured directly, and the others were closed by skin grafting after the suture of anterior sheath.

RESULTSThree flaps survived. Liquefaction necrosis of tissue was observed under two flaps, and they were healed after debridement. Radial artery embolism of wrist occurred in one flap when pedicle division was performed 5 weeks post surgery, and it was healed by a transplantation of a segment of the great saphenous vein to reconstruct radial artery right after debridement. Patients were followed up for 6 - 12 months, and satisfactory appearance and function of the flaps were observed.

CONCLUSIONSIt is a feasible option to repair circumferential wound in the wrist region due to high-voltage electrical burn by using paraumbilical flap carrying a portion of rectus abdominis muscle combined with lower abdominal flap.

Adult ; Burns, Electric ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Rectus Abdominis ; transplantation ; Skin Transplantation ; Surgical Flaps ; Wrist Injuries ; surgery

OBJECTIVETo investigate the reconstructive operative procedures of funnel chest with "sternum-costicartilage" flap carried by the abdominal rectus pedicle.

METHODS(1) In accordance with the lesioned area of funnel-like depressed deformity of anterior thoracic wall, a perpendicular median incision was designed and made; (2) The "sternum-costicartilage" flap carrying the abdominal rectus pedicle was used and reversed and transplanted to reconstruct severe funnel chest deformity.

RESULTSThe procedure was used in 7 cases from 1999 to 2005. The results of surgery were satisfactory. There were no recurrence after operation.

CONCLUSIONSThe procedure reported here is rather safe, solid and sound with good therapeutic results, and is of great value in clinical practice.

Bone Transplantation ; Child ; Child, Preschool ; Female ; Funnel Chest ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Rectus Abdominis ; transplantation ; Ribs ; transplantation ; Sternum ; transplantation ; Surgical Flaps

OBJECTIVETo investigate a method to reconstruct the breast and repair the chest wall defects at the same time.

METHODSThe operation procedure combined the transverse rectus abdominis myocutaneous (TRAM) flap with the latissimus dorsi muscle(LDM) flap for breast reconstruction and repair of chest wall defect. Two patients underwent delayed breast reconstruction using this technique.

RESULTS8 flaps in the four patients survived completely. The aesthetic results were very good.

CONCLUSIONThis method can be used to reconstruct breast and repair the defect of chest wall at the same time, avoiding the disadvantage in the flap transfer of TRAM or LDM.

Adult ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Muscle, Skeletal ; transplantation ; Rectus Abdominis ; transplantation ; Surgical Flaps ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy.

METHODSThe abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm.

RESULTS12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting.

CONCLUSIONSUsing the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.

Abdominal Muscles ; Adolescent ; Adult ; Child ; Child, Preschool ; Fascia ; transplantation ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Rectus Abdominis ; transplantation ; Surgical Flaps ; Urinary Bladder ; abnormalities ; Young Adult

OBJECTIVETo investigate the outcome of surgical reconstruction of the tongue after hemiglossectomy with reinnervated rectus abdominis musculoperitoneal flaps in the treatment of tongue cancer.

METHODSFive patients underwent immediate reconstruction of the tongue and oral floor defects with rectus abdominis musculoperitoneal flaps after resection of squamous cell carcinoma of tongue. The rectus abdominis musculoperitoneal flap consists of the rectus muscle, posterior rectus sheath, peritoneum, the 10 th, 11th, 12th intercostal nerves and the vascular pedicle that includes the deep inferior epigastric artery and veins. During the operation a reinnervated rectus abdominis musculoperitoneal free flap, in which the intercostal nerves were anastomosed to the descending branch of hypoglossal nerve, was grafted to remaining tongue stump.

RESULTSAll patients recovered uneventfully from surgery, with no immediate postoperative complications. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium 8 weeks after surgery. The average follow-up period was 10 months. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. The swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet.

CONCLUSIONSReconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method. Long-term follow-up is needed for reaching some final conclusions.

Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Peritoneum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Rectus Abdominis ; transplantation ; Surgical Flaps ; Tongue ; surgery ; Tongue Neoplasms ; surgery ; Treatment Outcome

OBJECTIVE: To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. METHODS: Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. RESULTS: All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). CONCLUSION The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
Male ; Female ; Humans ; Adult ; Myocutaneous Flap/surgery* ; Plastic Surgery Procedures ; Thoracic Wall/surgery* ; Rectus Abdominis/transplantation* ; Skin Transplantation ; Breast Neoplasms/surgery* ; Soft Tissue Injuries/surgery* ; Treatment Outcome