Prefabricated flap is so named as the skin flaps is prepared by prefabricating a circulation-rich skin flap by implanting a named blood vessel or a portion of fascia which is incorporated with rich blood supply. After the flap has been proven as a flap supplied by ample blood supply, it is transplanted to a wound as a local or free transplantation. The core of prefabricated flap is vascularization. Beside the different methods of prefabrication, vascularization can be facilitated by use of growth factors and cytokines, skin and soft tissue expansion technique, and biomaterial. Prefabricated flap is currently widely used in clinic. With the advances in the research of prefabrication technology and advances in its clinical application, prefabricated flap transplantation is becoming a promising strategy in wound healing.
Biomedical Research ; trends ; Humans ; Skin ; Skin Transplantation ; trends ; Surgical Flaps ; Tissue Engineering ; methods

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.
Evidence-Based Medicine ; Face/*surgery ; Facial Injuries/*surgery ; Facial Transplantation/*methods/trends ; Forecasting ; Humans ; Reconstructive Surgical Procedures/*methods/trends ; Surgical Flaps/*trends ; Treatment Outcome

Burns ; surgery ; Research ; trends ; Research Design ; Skin Transplantation ; methods ; Surgical Flaps

This paper systematically reviewed and analyzed the recent publications of robotic-assisted surgeries in the field of tissue repair and reconstruction. Surgical robots can elevate skin flap more accurately and shorten the time of tissue harvest. In addition, robotic-assisted surgery has the advantage of minimal tissue trauma and thus forms minimal scar. The utilization of surgical robots reduces the occurrence of complications after oral radical tumor resection while achieving cosmetic sutures. Robotic-assisted radical mastectomy could radically remove invasive breast cancer lesions and achieve breast reconstruction in the first stage through the small incisions in the operation areas. Surgical robots enable precise microvascular anastomosis and reduce tissue edema in the surgical field. Robotic-assisted technology can help appropriately locate the target tissues at different angles during sinus and skull base surgeries and accurately place tissues during urethroplasty. The robotic-assisted technology provides a new platform for surgical innovation in the field of tissue repair and reconstruction. However, the uncertainty in the survival rate after tumor radical surgery, the increase of operating time, and the high costs are barriers for its clinical application in tissue repair and reconstructive surgery. Nevertheless, robotic-assisted technology has already demonstrated an impact on the field of tissue repair and reconstruction in a meaningful way.
Breast Neoplasms ; surgery ; Cicatrix ; prevention & control ; Humans ; Minimally Invasive Surgical Procedures ; methods ; trends ; Mouth Neoplasms ; surgery ; Operative Time ; Reconstructive Surgical Procedures ; methods ; trends ; Robotic Surgical Procedures ; methods ; trends ; Skull Base ; surgery ; Surgical Flaps ; Tissue and Organ Harvesting ; Urethra ; surgery

Foot Diseases ; history ; surgery ; Foot Injuries ; history ; surgery ; Forecasting ; History, 20th Century ; Humans ; Microsurgery ; history ; trends ; Reconstructive Surgical Procedures ; history ; trends ; Surgical Flaps ; history

The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.
Humans ; Perforator Flap/*blood supply/classification/trends ; Reconstructive Surgical Procedures/*methods ; Skin Transplantation/*methods ; Surgical Flaps/*blood supply ; Tissue and Organ Harvesting/*methods

OBJECTIVETo investigate the feasibility and advantages of total auricular reconstruction with single big expander at dual plane through incision at remnant ear.

METHODS52 patients with microtia were treated. Through incision at remnant ear, one big expander (150 ml) was implanted in the post-auricular area beneath the superficial facial in the hairless area, and above the superficial fascia in the area with hair. In the second stage, total auricular was reconstructed with autologous cartilage framework and expanded skin. Skin graft was not necessary. Another 32 paitents with single big expander above the superficial fascia were used as control. The downward shift distance of expanders, the appearance of auriculocephalic sulcus and complication were recorded in order to assess the effect of these two methods.

RESULTSThe downward shift distance of expanders in the dual plane group (0.7 ± 0.3) cm were lower than that in the control group (1.3 ± 0.4) cm, showing significant difference (P < 0.05). After a follow-up period of 6-12 months, shallow auriculocephalic sulcus was presented in 5 patients of the dual plane group and 12 patient of the control group. The shallow auriculocephalic sulcus was cut to make it deeper and covered with full skin graft.

CONCLUSIONSDual plane skin expansion could reduce the downward shift distance of expander. Adequate skin on the upper part of expander could make satisfactory auriculocephalic sulcus.

Cartilage ; transplantation ; Congenital Microtia ; surgery ; Feasibility Studies ; Hair ; Humans ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Subcutaneous Tissue ; Surgical Flaps ; trends ; Tissue Expansion ; methods ; Tissue Expansion Devices

OBJECTIVETo explore the current trends of breast reconstruction (BR) for breast cancer patients in China.

METHODSA questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail.

RESULTSBy July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

CONCLUSIONSWith more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the intrahospital framework of multi-disciplinary service, the training for doctors and the educational program for patients, etc.

Breast Neoplasms ; epidemiology ; surgery ; China ; epidemiology ; Humans ; Mammaplasty ; Mastectomy ; trends ; Postoperative Complications ; Postoperative Period ; Quality of Life ; Reconstructive Surgical Procedures ; Surgical Flaps ; Surveys and Questionnaires