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Concept: Flap


Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structure and bone and joint exposure. When revascularization is not possible, a thin and adequately sized flap is required to resurface the defect, restore finger function, and prevent amputation. In this report, we present our experience with reconstruction of the entire circumferential degloving injury of the digits using free fasciocutaneous flaps. Between February 2006 and January 2011, 9 male patients with circumferential degloving injury of 9 digits underwent reconstruction using free fasciocutaneous flap transfer with the posterior interosseous artery flap, medial sural artery flap, anteromedial thigh flap, or radial forearm flap. The average flap size was 14.2 × 6.9 cm. Donor sites were closed primarily or covered with split-thickness skin graft. All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 34.8 months. A maximum Kapandji score (10/10) was seen in 2 cases with crushed thumbs. All patients could achieve good key pinch and grasping functions. All skin flaps showed acceptable static 2-point discrimination and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9 on a 10-points visual analogic scale. In conclusion, the free fasciocutaneous flaps used were thin and did not interfere with finger movements. The patient’s finger formed a smooth contour and acceptable functional results were obtained after reconstruction. This method may be a valuable alternative for reconstruction of entire circumferential avulsion injury of the digits. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Concepts: Patient, Skin, Injuries, Forearm, Finger, Arteries of the upper limb, Avulsion injury, Flap


OBJECTIVE: To determine the feasibility, complications, and clinical outcome of consecutive free trapezius flap transfers in 20 dogs and a wallaby. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 20) and 1 wallaby METHODS: Medical records of 20 dogs and 1 wallaby that had free trapezius flap transfers were evaluated retrospectively for indications, date of transfer, site of flap relocation, flap composition (myocutaneous, muscular, myoosseus), recipient artery and veins, flap ischemia times, surgery time, antithrombotic strategies used, intra- and postoperative complications related to the flap, hospitalization, in hospital duration after flap transfer, and outcome. RESULTS: Free flap transfers (16 muscle, 4 myocutaneous, 1 myoosseus) were used to treat traumatic soft tissue loss (13), neoplasm excision (2), osteomyelitis (4), and soft palate reconstruction (2); all flaps survived. Anti-thrombotic therapy was used in all cases although strategies varied. Postoperative complications were infrequent, generally of low severity, and primarily included donor site seroma formation and infection. CONCLUSIONS: Free trapezius flap was successfully used in 21 consecutive cases for a wide variety of reconstructive techniques with good, functional long-term outcome.

Concepts: Blood, Surgery, Tissues, Plastic surgery, Soft palate, Flap, Palate, Hard palate


Widespread adoption of the extended latissimus dorsi myocutaneous flap in breast reconstruction has been limited by donor-site complications. The dissection plane may be either above or below the superficial layer of the thoracolumbar fascia, which may be transferred with the flap or retained on the back skin flaps. The aim of this study was to investigate whether varying the plane of dissection improves donor-site morbidity and complications.

Concepts: Latissimus dorsi muscle, Wing, Flap, Leading edge slats


The aim of this study was to investigate the somatosensory changes at the forearm donor region after using different types of modified flap surgical techniques.

Concepts: Flap


The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n=6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.

Concepts: Cancer, Oncology, Hospital, Surgery, Tumor, Old age, Ageing, Flap


Muscle flap is a valuable option in soft tissue reconstruction. Denervated skeletal muscle is known to undergo degeneration. However, information regarding histological and genetic changes in muscle free flap without reinnervation over long-term follow-up remains unclear.

Concepts: Histology, Tissues, Soft tissue, Flap


During the last decade, perforator flaps have become popular for defect cover in the head and neck because they increase the choice of reconstructive possibilities and can lead to minimal donor site morbidity. In particular, the lower leg is considered a suitable option, as it provides thin and pliable skin for intraoral lining. Having gained experience with 131 flaps raised from four different donor sites at the lower leg, the aim of this paper is to evaluate success rates and patient satisfaction, but also difficulties and pitfalls during flap transfer.

Concepts: Head and neck anatomy, Head and neck, Human leg, Flap


Performing a greater number of free flap procedures inevitably results in an increase in the number of cases that experience free flap failure. In cases that require a second free flap after the failure of the first, recipient vessel selection becomes difficult. Furthermore, recipient vessel selection can be complicated if the vessel is deep in the recipient site, or if there is an increased risk of vessel damage during the dissection. Thus, we present our experience where a subfascial vessel beneath the deep fascia was used as a recipient vessel for a second free flap in lower extremity reconstruction due to total or partial first flap failure.Between January 2010 and April 2015, 5 patients underwent second free flap reconstruction using a subfascial vessel as the recipient vessel. The flaps were anastomosed in a perforator-to-perforator manner, using the supermicrosurgery technique. We measured the sizes of the flaps, which varied from 5 × 3 to 15 × 8 cm, and the recipient subfascial vessel diameters.The mean time for the dissection of the recipient perforator was 45 minutes. All the flaps exhibited full survival, although a partial loss of the skin graft at the flap donor site was observed in 1 patient; this defect healed with conservative management.We recommend using a subfascial vessel as the recipient vessel for both first and second free flaps, especially if access to the major vessel is risky or challenging.

Concepts: Risk, Retrospective, Free flap, Fascia, Flap, Flapper


Vascularized lymph node transfer is a quite innovative physiological surgical procedure for the lymphedema treatment. Although is gaining more popularity due to its promising results, there are some concerns regarding difficult to harvest it and the potential risk of iatrogenic lymphedema. Here, we present alternative vascular constructs of lymph node flap for the treatment of lymphedema, which provide the benefits of a technically easier dissection and physiological reconstruction of the damaged lymphatics. Furthermore, we introduce a classification based on the flap vascular supply including six types of flaps and we provide the details of the surgical technique.

Concepts: Medicine, Surgery, Lymphatic system, Anesthesia, Al-Andalus, Scalpel, Lymphedema, Flap


The laying hen industry is implementing aviary systems intended to improve welfare by providing hens with more space and resources to perform species-specific behaviors. To date, limited research has examined spatial requirements of various strains of laying hens for performing key behaviors and none has been conducted within an alternative housing system. This study investigated the amount of space used by 4 strains of laying hens (Hy-Line Brown [HB], Bovans Brown [BB], DeKalb White [DW], and Hy-Line W36) to perform 5 different behaviors in the litter area of a commercial-style aviary. Hens were recorded standing [S], lying [L], perching [P], wing flapping [WF], and dust bathing [DB] on an open-litter area with an outer perch between 12:00 and 15:00 at peak lay (28 wk of age). Still images of each behavior were analyzed using ImageJ software for 16 hens per strain, and maximum hen length and width were used to calculate total area occupied per hen for each behavior. Brown hens required, on average, 89.6cm2 more space for S (P≤0.021) and 81.5cm2 more space for L (P≤0.013) than white hens. White hens used, on average, 572cm2 more space to perform WF than brown hens (P≤0.024) while brown hens used 170.3cm2 more space for DB than white hens (P≤0.022). On average, hens of all strains were wider while perching than the 15cm commonly recommended per hen (e.g., DW: 18.03; HB: 21.89cm), and brown hens required, on average, 3.38cm more space while perching than white hens (P≤0.01). Brown and white hens occupy different amounts of space when performing key behaviors. These differences, along with factors such as behavioral synchrony, clustering, and preferred inter-bird distances associated with these behaviors, should be considered when creating industry guidelines, crafting legislation and designing and stocking laying hen facilities to ensure hens can fulfill their behavioral needs.

Concepts: Psychology, Chicken, Behavior, Human behavior, Behaviorism, Wing, Flap