Concept: Leading edge slats
Flying lizards of the genus Draco are renowned for their gliding ability, using an aerofoil formed by winglike patagial membranes and supported by elongated thoracic ribs. It remains unknown, however, how these lizards manoeuvre during flight. Here, I present the results of a study on the aerial behaviour of Dussumier’s Flying Lizard (Draco dussumieri) and show that Draco attaches the forelimbs to the leading edge of the patagium while airborne, forming a hitherto unknown type of composite wing. The attachment of the forelimbs to the patagium suggests that that aerofoil is controlled through movements of the forelimbs. One major advantage for the lizards is that the forelimbs retain their complete range of movement and functionality for climbing and running when not used as a part of the wing. These findings not only shed a new light on the flight of Draco but also have implications for the interpretation of gliding performance in fossil species.
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.
Although the anterolateral thigh flap (ALT) is one of the most frequently applied free flaps in plastic surgery, it remains controversial if the flap should be raised in a sub- or suprafascial plane. The purpose of this study was to compare both harvest techniques regarding donor-site morbidity and outcomes.
Reconstruction of the lower limb presents a complex problem after skin cancer surgery, as proximity of skin and bone present vascular and technical challenges. Studies on vascular anatomy have confirmed that the vascular plane on the lower limb lies deep to the deep fascia. Yet, many flaps are routinely raised superficial to this plane and therefore flap failure rates in the lower limb are high. Fascio-cutaneous flaps based on perforators offer a better cosmetic alternative to skin grafts. In this paper, we detail use of a thermal imaging camera to identify perforator ‘compartments’ that can help in designing such flaps.
Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m(2), respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.
Background Perforator flaps have been used extensively in the field of reconstruction, and the thoracodorsal artery perforator (TDAP) flap is very popular. However, the perforator flap can be relatively bulky in some cases, depending on the defect’s location. Thus, several methods have been developed to address this bulkiness, including modification of the flap elevation, application of an ultrathin flap using microdissection, and the defatting technique. However, these methods have various disadvantages, so we developed an adjustable thin TDAP flap using modification of the flap elevation and defatting technique. Methods Between January 2012 and February 2015, 13 patients underwent reconstruction of defects of their upper and lower extremities using TDAP flaps. We measured all the flap dimensions, except for thickness, because it was adjusted for the target defect. Results The mean flap size was 94 cm(2) (range: 48-210 cm(2)), and all flaps were ≤10 cm wide to facilitate primary donor-site closure. Two subjects with a history of diabetes exhibited partial flap loss, so we performed secondary skin graft surgery. Conclusions The TDAP flap elevation was modified at the superficial fascia plane, and the defatting technique was used to adjust the flap volume. This technique provided more natural contours and minimized the need for secondary debulking.
Since the introduction of microvascular free flaps, the pectoralis major myocutaneous flap (PMMF) has been relegated to background for most reconstructive surgeons. The objective of this article is to show the advantages of cervicofacial defects reconstruction with PMMF using the subclavicular plane route in a challenging clinical case. An 83-year-old man presented with cutaneous temporomalar lesion with orbital spread. Tumor resection was performed, including 12 × 11 cm skin and subcutaneous tissue, overlying zygomatic and malar bone, and orbital exenteration. Radical parotidectomy and functional neck dissection were performed. PMMF was chosen as reconstructive option routing the pedicle to the subclavicular plane. The length of the pedicle was 31 cm. The subclavicular route for PMMF increases the flap’s length and arc of rotation compared with the conventional supraclavicular one. This procedure decreases the bulk of the PMMF pedicle which makes it functionally and cosmetically favorable. By using this modification, we may widen the “safe” reconstructive possibilities.
The aim for microsurgical reconstruction has broadened from achieving functional to also providing good esthetic outcomes. The perforator flaps are widely used for this goal. However, perforator flaps can still be bulky especially to resurface the skin defect. We hypothesized that elevation from the superficial fascial plane can obtain a thin and viable flap. In this retrospective study, we report consecutive perforator flaps elevated at the superficial fascial plane from November 2007 to July 2013. Total of 304 flaps which were 196 superficial circumflex iliac perforator (SCIP) flaps, 81 anterolateral thigh (ALT) flaps, and 27 gluteal artery perforator (GAP) flaps were reviewed. The patient group composed of 189 male and 115 female patients with an average age of 35.8 years. The average body mass index was 23.5 kg/m2 (range, 15.91-34.57 kg/m2). All 304 flaps were successfully elevated with this approach with at least one viable perforator. The thickness averaged approximately 6 mm for ALT flap (range, 4-11 mm), 5 mm for SCIP flap (range, 3-12 mm), and 8.5 mm for GAP flap (range, 5-11 mm). Complete survival was noted in 282 flaps, partial loss of flaps requiring secondary procedures in 6 cases, partial loss healing secondarily in 8 cases, and total loss in 9 cases. During the average follow-up of 34 months, secondary debulking procedures were required in six flaps. This new approach of elevation on the superficial fascia is reliable, provides a viable tissue, and is able to obtain a thin flap achieving good functional and esthetic outcome.
Free-Style Dual Plane Recycling Tensor Fascia Lata Musculocutaneous Perforator Flap for Reconstruction of Recurrent Trochanteric Defects
- The international journal of lower extremity wounds
- Published over 5 years ago
Sequential flap coverage might be required for recurrent defects, but reusing a flap as a donor site has seldom been reported. The concept of a “free-style flap” has been developed, and it allows reconstructive surgeons to raise flaps with various designs reliably, even at sites of previous flap surgery. This article presents the concept of free-style recycling of a tensor fascia lata flap into a perforator-based flap separated in 2 planes in a patient with a recurrent bilateral trochanteric defect. If a reliable perforator is preserved and identified within the tissues by computed tomography angiography or a Doppler device, a new perforator flap can be designed and raised at the previous flap site.