Abdominal-based free flaps are the mainstay of autologous breast reconstruction; however, the region may not be ideal for patients with inadequate soft tissue or history of abdominal surgery. This case describes the use of a novel conjoined flap based on the profunda artery perforator and upper gracilis pedicles, named the perforator and upper gracilis (PUG) flap. This flap design aims to maximize medial thigh flap volume while ensuring robust tissue perforation. Here, we present our experience with the PUG flap in a breast cancer patient undergoing autologous reconstruction. The patient was a 41-year-old woman seeking nipple-sparing mastectomy and immediate autologous reconstruction with the PUG flap due to limited abdominal tissue availability. The gracilis and profunda artery perforator flaps were elevated using one boomerang-style skin paddle. Once harvested, the flaps were inset with antegrade and retrograde flow off the internal mammary arteries and both respective internal mammary veins. The donor site was closed in a V-Y pattern resulting in a thigh lift-type lift and concealed scar. In conclusion, the boomerang-style PUG flap maximizes medial thigh free tissue transfer volume, offers internal blood flow redundancy, and maintains good cosmesis of the donor site.
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http://dx.doi.org/10.1097/GOX.0000000000005544 | DOI Listing |
Plast Reconstr Surg Glob Open
March 2024
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix, Ariz.
Abdominal-based free flaps are the mainstay of autologous breast reconstruction; however, the region may not be ideal for patients with inadequate soft tissue or history of abdominal surgery. This case describes the use of a novel conjoined flap based on the profunda artery perforator and upper gracilis pedicles, named the perforator and upper gracilis (PUG) flap. This flap design aims to maximize medial thigh flap volume while ensuring robust tissue perforation.
View Article and Find Full Text PDFPlast Reconstr Surg
August 2021
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ir Vet J
January 2021
CIISA- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.
Background: Brachycephalic breeds have anatomical skull changes that are responsible for ocular clinical signs, known as the brachycephalic ocular syndrome (BOS). Their popularity has increased in recent years but the excessive pressure of selection lead to extreme conformation of skull shapes, resulting in facial alterations that can put these dogs' vision at risk.
Objectives: This study aimed to analyse the ocular disorders in a sample of 93 brachycephalic dogs to better characterize the disease complex BOS.
A 20-year-old man with a congenitally short nose underwent a corrective two-stage technique. The technique consists of wide undermining of supranasal and paranasal skin, use of composite auricular grafts from the ear to lengthen the upper lateral cartilages, use of a chondromucosal septal flap for lengthening the septum, and postoperative downward taping to assure adequate stretching of dorsal skin for the first-stage procedure. A second stage to reaugment the dorsum using septal cartilage and vomer was performed one year later, and the results 15 months after the second stage show persistent successful lengthening, including downward rotation, less obtuse nasolabial angle, and elimination of the pug nose stigma.
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