• Archives of Plastic Surgery
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• v.34 no.5
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• pp.653-655
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• 2007

Purpose: The umbilicus is an important aesthetic component of the abdomen. Its absence is both cosmetically and psychologically distressing to the patient. Umbilical reconstruction should always be aimed at creating an umbilicus of sufficient depth and good morphology with less scarring. The C-V flap developed for nipple reconstruction was used in an inverted fashion in case of umbilical reconstruction. The aim of this article is to report our experience of scarred umbilical reconstruction using inverted C-V flap. Methods: A 22-year-old woman presented with contracted scar tissue in the umbilical region because she had undergone surgical correction of an umbilical hernia at 5 year of age. Pedicle of the inverted C-V flap was based cephalically. For enhancing depth of the umbilicus, three anchoring sutures to linea alba were done at both lateral and caudal aspects of the umbilical tube. Primary closures were done at donor sites of the V flaps and bolster sutures were done in the caudal direction of the inverted umbilical tube. Results: The patient was satisfied with the appearance of umbilicus. Major complications such as dehiscence, infection, and delayed healing did not occur. Conclusion: The inverted C-V flap is easy and simple technique, and it can produce a satisfactory reconstruction of umbilical structure.

• International Journal of Aeronautical and Space Sciences
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• v.14 no.1
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• pp.46-57
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• 2013

Flutter stability and buffeting response have been the topics of most concern in the design state of long-span suspension bridges. Among approaches towards the aerodynamic stability, the aerodynamic-based control method which uses control surfaces to generate forces counteracting the unstable excitations has shown to be promising. This study focused on the mechanically controlled system using flaps; two flaps were attached on both sides of a bridge deck and were driven by the motions of the bridge deck. When the flaps moved, the overall cross section of the bridge deck containing these flaps was continuously changing. As a consequence, the aerodynamic forces also changed. The efficiency of the control was studied through the numerical simulation and experimental investigations. The values of quasi-steady forces, together with the experimental aerodynamic force coefficients, were proposed in the simulation. The results showed that the passive flap control can, with appropriate motion of the flaps, solve the aerodynamic instability. The efficiency of the flap control on the full span of a simple suspension bridge was also carried out. The mode-by-mode technique was applied for the investigation. The results revealed that the efficiency of the flap control relates to the mode number, the installed location of the flap, and the flap length.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.79-81
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• 2015

Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects joints, and patients with rheumatoid arthritis are predisposed to development of chronic skin ulcers. In addition, skin ulcers with rheumatoid arthritis tend to persist despite treatment because of sustained inflammation and poor healing capacity. Treatment of skin ulcers involves medications, wound coating agents, and surgical procedures including skin grafting, however, wound dressing or skin grafts are generally excluded because of excessive cost and time and poor intake rate. The dorsal metacarpal artery perforator (DMAP) flap, a vascular island flap for coverage of soft tissue defects on the fingers, provides promising results including matched quality and color. We experienced a case of DMAP flap for reconstruction of a rheumatoid ulcer, and a DMAP flap may be considered as a good faithful option for treatment of patients with rheumatoid ulcer.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.86-92
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• 2001

Failure of replantation is inevitable in finger replantation surgery, around 10% of failure rate are reported in many authors. Management of the failed finger replantation is one of big dilemma to microsurgeons. We report 5 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as revered radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; Pinch Power was average 1.2 Pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.43-47
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• 2013

Purpose: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. Materials and Methods: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. Results: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. Conclusion: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.

• Archives of Reconstructive Microsurgery
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• v.16 no.1
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• pp.14-22
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• 2007

Perforator free flap (PFF) is currently a major reconstructive option for soft tissue reconstruction in adults. Although PFFs have been used commonly, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 8 consecutive cases of successful transfer of thoracodorsal artery (TDA) & anterolateral thigh (ALT) perforator flap in children. Between 2003 and 2005, 8 children(4 to 13 years old) with soft tissue defects of the extremities were reconstructed with TDA & ALT PFFs. All flaps completely survived. There were no problems relating to vascular spasm or occlusion. Range of motion of reconstructed extremities were fully recovered. Among 8 patients, only 1 patient was performed an additional flap thinning procedure. 8 cases of TDA & ALT perforator flaps were successfully transferred in children. PFF is an excellent option in reconstruction of children as well as in adults because of its thinness, long pedicle length, least donor site morbidity and acceptable donor site scar.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.441-446
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• 2005

Sole reconstruction should consider both functional and aesthetic aspects; durable weight bearing surface, adequate contour for normal footwear, protective sensation and solid anchoring to deep tissue to resist shearing. The anterolateral thigh perforator free flap has such favorable characteristics as long pedicle, reliable perforators and minimal donor site morbidity. This flap can be safely thinned to 3-4 mm. It can also be elevated with sufficient bulk with muscles like vastus lateralis for complex defect. Between June 2002 and December 2004, 48 cases of sole reconstruction were performed with anterolateral thigh perforator free flaps. Follow up period ranged from 4 to 34 months with a mean of 14.7 months and with exception of one case, all flaps survived. One case of total flap loss was noted due to infection in a patient who was administered lifetime immunosuppressant. Partial necroses developed in three cases but were treated conservatively. Satisfactory aesthetic and functional results were achieved and acceptable gait recovery was noted. Seventy-eight percent of the patients regained protective sensation by 6 months and earlier sensory recovery was noted in sensate flap group. The authors also present a standardized protocol for preoperative patient evaluation and postoperative management and rehabilitation.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.69-72
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• 2020

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique three-dimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.

• Journal of Periodontal and Implant Science
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• v.31 no.1
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• pp.233-242
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• 2001

In the treatment of chronic adult periodontitis, scaling and root planing have been generally performed prior to periodontal flap surgery. The purpose of this study was to evaluate the clinical significance of nonsurgical periodontal therapy prior to periodontal flap surgery in patients with chronic adult periodontitis. Fifty six molars showing bilateral bony defects and 4-6mm periodontal pocket in twelve patients with chronic adult periodontitis were selected. By randomized split-mouth design, in one side, flap operation was performed 4 weeks after scaling and root planing, in the other group, flap operation was only performed without scaling and root planing. Probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index, and tooth mobility were measured at baseline, before flap operation and post-operation

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.525-528
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• 2011

A deep circumflex iliac artery (DCIA) flap is usually used for reconstruction in oral and maxillo-facial surgery department since introduced by O'Brien in 1975. Various flap designs are possible for osteomusculocutaneous, musculocutaneous, musculosseous and vascularized bone types. Iliac crest shape is similar to contour of mandible. Moreover, though a fibular flap has only 15~20 mm of cutting plane width, a DCIA flap contains much more bone amount, making this a similar reconstruction compare with normal mandible. A 68 year-old male with squamous cell carcinoma on the anterior floor of the mouth had an impression with T2N0Mx and the treatment procedure was DCIA reconstruction after wide resection and marginal mandibulectomy, with both supraomohyoid neck dissection. We present an experience of DCIA flap for reconstruction with a literature review.