Scalp and forehead reconstruction.

The treatment of scalp and forehead defects is challenging. There are few cases in which an untreated scalp defect can heal by secondary intention. However, lack of adequate treatment can also lead to fatal consequences.

Versatility of the free vastus lateralis muscle flap.

Background: A flap that carries sufficient tissue with satisfactory pedicle length or diameter and with minor donor site morbidity is an ideal option for the reconstructive surgeon. Many flaps have been described with each one having specific advantages. The vastus lateralis (VL)-muscle flap is among them, but no special attention has been given to its valuable use.

Aesthetic correction of a hypertrophic sinus frontalis: a long-term follow-up evaluation and refinement of the method.

Two cases treated for hypertrophy of the frontal sinus are presented. In both patients, the excised frontal bone was inverted, and the resultant cavity was filled with either bone dust from the parietal region or Medpor. The first patient is shown with an excellent result after a follow-up period of 16 years.

Extended "C" myectomy of the lateral orbicularis oculi muscle-A safe and successful method for treatment of "crow's feet".

Background: Commonly, patients who seek facial rejuvenation complain about "crow's feet." Botulinum toxin injections can effectively correct such wrinkles but require repeated treatments.

Objective: A modification of the earlier described vertical myectomy of the lateral orbicularis oculi muscle is presented.

Beauty of skin-grafted free muscle flaps in head and neck reconstruction.

In the era of perforator flaps, muscle flaps might seem "out of fashion" for use in microvascular reconstructions. In this presentation, the advantages of pure muscle flaps covered with full-thickness (FTSG) or split-thickness (STSG) skin grafts employed in certain head and neck reconstructions shall be demonstrated. The free vastus lateralis muscle flap (n = 13) and latissimus dorsi flap (n = 1), covered with either FTSG (n = 8) or STSG (n = 6), were used for major head and neck reconstructions in a total of 13 patients.

Microsurgical workhorse flaps in head and neck reconstruction.

The aim of reconstruction after resection of head and neck tumors is to achieve acceptable functional and esthetic results with minimal donor site morbidity. Although many flaps have been developed for bone and soft tissue reconstructions, our experience in the past years has identified the anterolateral thigh flap (cutaneous or myocutaneous), the radial forearm flap, and the osteoseptocutaneous fibula flap as the most useful flaps for head and neck reconstruction. These three flaps can be used for reconstruction of almost all kinds of defects, either as a single flap or in combination.

Morphological and functional evaluation of leg-muscle reinnervation after coupler coaptation of the divided rat sciatic nerve.

Mechanical couplers are successfully used for microvascular venous anastomoses. The advantages include a simple and fast technique and a high patency rate. Couplers offer a secluded coaptation site, and might also be of use in peripheral nerve repair.

Structural and functional regeneration of muscle-related axons after transection and repair of the rat sciatic nerve using nonvascularized autologous fascia as a barrier between tibial and peroneal nerve fascicles.

Aberrant reinnervation of target organs caused by misdirected axonal growth at the repair site is a major reason for the poor functional outcome usually seen after peripheral nerve transection and repair. This study investigates whether the criss-crossing of regenerating rat sciatic nerve axons between tibial and peroneal nerve fascicles can be reduced by using non-vascularized autologous fascia as a barrier. The left sciatic nerve was transected and repaired at midthigh as follows: epineurialy sutures (Group A); fascicular repair of tibial and peroneal nerve fascicles (Group B); fascicular repair of tibial and peroneal nerve fascicles separating the two fascicles by non-vascularized autologous fascia (Group C).

Nitrosoglutathione promotes flap survival via suppression of reperfusion injury-induced superoxide and inducible nitric oxide synthase induction.

Background: Evidence suggests that failure of flap reconstruction is related to ischemia/reperfusion (I/R)-mediated endothelial damage. Using a rat inferior epigastric artery flap as an I/R injury model, we investigated whether administration of nitrosoglutathione (GSNO), an exogenous nitric oxide (NO) donor, can scavenge superoxide and promote flap survival.

Methods: Thirty minutes before flap reperfusion, normal saline, N-acetylcysteine (75 and 150 mg/kg), or GSNO (0.

The role of a barrier between two nerve fascicles in adjacency after transection and repair of a peripheral nerve trunk.

Aberrant reinnervation of target organs caused by misdirected axonal growth at the repair site is a major reason for the poor functional outcome usually seen after peripheral nerve transection and repair. The following two studies investigate whether criss-crossing of regenerating rat sciatic nerve axons between tibial and peroneal nerve fascicles can be reduced by using a barrier at the coaption site. The left sciatic nerve was transected and repaired at mid-thigh as follows: epineural sutures (group A, A-II), fascicular repair of tibial and peroneal nerve fascicles (group B, B-II), fascicular repair of tibial and peroneal nerve fascicles separating the two fascicles with a pedicled fat flap (group C), Integra (group D) or non-vascularized autologous fascia (group C-II).

One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata.

Objective: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata.

Angle-to-angle mandibular reconstruction with two free fibular flaps in a patient with two consecutive gingival cancers.

Two consecutive mandibular reconstructions with free vascularised fibular grafts in a patient with gingival cancers are presented. After resection of a gingival cancer on the left side, reconstruction was performed with a free vascularised fibular graft from the left leg. Two-and-a-half years later, a second free vascularised osteoseptocutaneous fibular graft from the right leg was used to reconstruct the right mandible and floor of the mouth after resection of a new gingival cancer.

Nitrosoglutathione improves blood perfusion and flap survival by suppressing iNOS but protecting eNOS expression in the flap vessels after ischemia/reperfusion injury.

Background: The effects of nitric oxide (NO) on the microcirculation and free tissue survival remain controversial. With the use of a rat inferior epigastric artery flap as an ischemia/reperfusion injury (I/R) model, we investigated whether exogenous NO donation regulates endogenous NO synthase (NOS) expression in the flap vessels and promotes flap survival.

Methods: Thirty minutes before flap reperfusion, normal saline (1 ml), nitrosoglutathione (GSNO 0.

Reconstruction with microvascular free flaps by visiting microsurgeons.

Twenty-two free flap reconstructions were done by one of both authors as visiting microsurgeons to a hospital a long distance away. The reconstructions were performed in the head and neck (n = 21) and the soft tissue of the lower leg (n = 1). Free flaps included: fibula (n = 8), radial forearm (n = 6), anterolateral thigh (n = 4), iliac crest (n = 1), and musculocutaneous latissimus dorsi flap (n = 3).

One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment.

The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata.

Basic principles on toe-to-hand transplantation.

Within the last three decades, toe-to-hand transplantation has become a well-established method for function and appearance reconstruction after trauma and in congenital hand anomalies. An otherwise healthy and cooperative patient is the ideal candidate for toe transplantation after trauma. In such patient, even primary toe transplantation is possible, if the stump is clean and viable.

Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor-related scalp defects.

Eleven patients underwent free-flap reconstruction of tumor-related defects of the scalp, forehead, and temporal region. Flap selection aimed at achieving acceptable functional and aesthetic results combined with negligible donor-site morbidity. Ten males and one female, aged 61.