UNASSIGNED: Use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction has increased in recent years. Limited but improving experience among reconstructive surgeons with the procedure have exposed numerous issues associated with flap success. The objective of this study is to examine the role of flap size on viability.
UNASSIGNED: Retrospective case series.
UNASSIGNED: Tertiary Academic Medical Center.
UNASSIGNED: Review of patients undergoing SCAIF reconstruction between January 2014 and March 2022 was performed. Flap failure was defined as >50% skin paddle loss. The total flap surface area was examined. Multivariable analysis was performed to evaluate the association of other variables associated with flap failure.
UNASSIGNED: Eighty-nine supraclavicular island flaps were reviewed. Mean patient age was 63.2 ± 11.4 years. Fifty-five (61.2%) were male. Forty-five flaps (50.6%) were used for the reconstruction of defects of the skin of the neck/face. Twenty-nine flaps (32.6%) were utilized for defects of the pharynx/oropharynx, and 15 (16.9%) were utilized for oral cavity defects. Flap success rate was 94% (73/89). Flap site was not associated with flap failure (P = .46). Flaps >25 cm2 were 75% more likely to be successful. Multivariable logistic regression to assess the association of flap size in the context of other co-morbidities indicated flaps >25 cm2 were 3.6 times more likely to succeed regardless of co-morbidities, and patients with chronic obstructive pulmonary disease (COPD) have a 7-fold risk of flap failure (odds ratio: 7.3, 1.72-30.98, P = .007).
UNASSIGNED: An association with improved flap outcomes and larger skin paddles was observed in this series. The applicability of these observations to smaller flaps and larger series with more surgeons requires further study. Co-morbidities, particularly, COPD, continue to impact flap outcomes.

UNASSIGNED: Reconstruction of the head and neck is dominated by free flaps, and for bone reconstruction by fibula and scapula flaps. However, this choice is sometimes difficult to make in patients who cannot tolerate an extensive and lengthy surgical procedure. In addition, vascular micro-anastomoses are sometimes complicated in patients who have been previously irradiated. Pedicle flaps remain an option and can sometimes be considered as first choice for head and neck reconstruction.
UNASSIGNED: In this study, we describe the feasibility of a split temporal muscle pedicled flap with coronal harvesting for a reconstruction that can reach the midline.
UNASSIGNED: Ten fresh-frozen human cadaver heads were dissected, and the length of the split flap was noted, followed by the length of the non-split flap.
UNASSIGNED: The mean length was 155.7 mm (± 20.0) for the split flap, from the point of rotation to the tip of the coronoid process. These results coincide with the tragus-midline distance, which makes it possible to consider reconstruction of the midline, especially the maxilla and the mandible, which has not yet been described in the literature.
UNASSIGNED: This technique would then allow a supply of pedicled vascularized bone for loco-regional reconstruction.

Hypoxia-Inducible Factor-1α (HIF-1α) has presented a new direction for ischemic preconditioning of surgical flaps to promote their survival. In a previous study, we demonstrated the effectiveness of HIF-1a DNA plasmids in this application. In this study, to avoid complications associated with plasmid use, we sought to express HIF-1α through mRNA transfection and determine its biological activity by measuring the upregulation of downstream angiogenic genes. We transfected six different HIF-1a mRNAs-one predominant, three variant, and two novel mutant isoforms-into primary human dermal fibroblasts using Lipofectamine, and assessed mRNA levels using RT-qPCR. At all time points examined after transfection (3, 6, and 10 h), the levels of HIF-1α transcript were significantly higher in all HIF-1α transfected cells relative to the control (all p < 0.05, unpaired Student\'s T-test). Importantly, the expression of HIF-1α transcription response genes (VEGF, ANG-1, PGF, FLT1, and EDN1) was significantly higher in the cells transfected with all isoforms than with the control at six and/or ten hours post-transfection. All isoforms were transfected successfully into human fibroblast cells, resulting in the rapid upregulation of all five downstream angiogenic targets tested. These findings support the potential use of HIF-1α mRNA for protecting ischemic dermal flaps.

UNASSIGNED: Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer.
UNASSIGNED: A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated.
UNASSIGNED: Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104).
UNASSIGNED: Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

The aim of this article is to describe an island flap, harvested from the inguinal fold, which can be used for vulvar reconstruction: the inguinal fold island flap (IFI flap). IFI flap is indicated for reconstruction of defects of vaginal vestibule and labia minora and it could be raised bilaterally safeguarding regional symmetry and avoiding vaginal introitus or urethral distortion. This flap has been utilized to reconstruct defects after vulvar melanoma and squamous cell carcinoma resections and in one case to restore vaginal vestibule anatomy in a revision surgery in a transgender woman. IFI flap is an example of an \"aesthetic/functional\" reconstruction which could be proposed to younger patients too.

UNASSIGNED: To determine the impact of the buccal envelope flap and pedicle design on the post-operative outcome and quality of life following lower third molar surgery (QoL).
UNASSIGNED: A randomized case-control clinical study was carried out from September 2017 to September 2019. In this study, a total number of 50 patients with mandibular third molar impaction underwent surgical removal of the same using buccal envelope flap (group A) and pedicle flap (group B). The patients were assessed postoperatively for pain, swelling, trismus, wound dehiscence, dry socket, and quality of life for one month.
UNASSIGNED: In terms of pain, swelling, and trismus, there was no statistical difference between the two groups (p > 0.05). However, there was a statistically significant difference found in group B (pedicle flap) in terms of wound dehiscence, dry socket, and quality of life (p < 0.05).
UNASSIGNED: The pedicle flap demonstrates fewer incidences of wound dehiscence, dry socket, and a better quality of life when compared to the envelope flap.

BACKGROUND: Thumb polydactyly is one of the most common congenital hand deformities, and the Bilhaut-Cloquet procedure or a modified one is often used. However, controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.
OBJECTIVE: To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.
METHODS: From January 2014 to December 2020, 15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center. The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance. Subjective parents\' evaluations and functional outcomes (ALURRA and TATA criteria) were obtained. The alignment deviation, instability, range of motion (percent of opposite thumb) of the interphalangeal and metacarpophalangeal joints, and the aesthetic aspects, including circumference, length, nail size, and nail deformity, were used to assess the clinical outcomes.
RESULTS: The average age of patients at the time of surgery was 13 mo, and the mean final follow-up occurred at 42 mo. An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs. An unstable interphalangeal joint occurred in one thumb. The flexion-extension arc at the metacarpophalangeal joint was good, while that at the interphalangeal joint was poor. Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs. The mean ALURRA score was 21.8 (range: 20-24), and the Tada score was 6.9 (range: 5-8). Compared with the non-operated side, the length of the operated thumb was approximately 95%, the girth was 89%, and the nail width was 82.9%. The mean ranges of motion were 62.1% of that of the unaffected thumb in the interphalangeal joint and 78.3% in the metacarpophalangeal joint.
CONCLUSIONS: Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure. Defects of the preserved thumb, such as the skin, nail, and bone, can be effectively restored using the complex tissue flap.

BACKGROUND: The aim of the presented study was to investigate the inhibitory effect of diltiazem on the microcirculation of the tissue flaps created in the delay phenomenon applied rabbits.
METHODS: The experiment was performed in Central Research Laboratory of Azerbaijan Medical University, Baku, Azerbaijan in 2018. Ischemia model on the flaps were formed in 30 rabbits for experiment. The subjects were divided into three groups: I (control) group - consists of 10 rabbits who underwent ischemia model, but no medication had been used during the duration of the experiment; II (comparative) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 60 mсg nitroglycerin had been applied; III (main) group - consists of 10 rabbits who underwent ischemia model, and during 14 d, with a daily dose of 45 mg diltiazem had been applied.
RESULTS: There was statistically significant difference between the control and the main groups when comparing the mean values of endothelial hyperplasia (P=0.001). However, we found a statistically significant difference when compared the mean values of the arterial vessel wall thickening in the main and the control groups (P=0.022); and the mean values of thrombosis in the main and the comparative groups (P=0.001).
CONCLUSIONS: With prescription of diltiazem, endothelial hyperplasia on microcirculatory system, the thickening of arterial vessel walls, the thrombosis in vessel\'s passage was rarely seen by statistical difference. The main achievement of our study was to discover the correlation between diltiazem and endothelial hyperplasia.

The muzzle region of dogs contains various composite tissues, which are challenging to recreate during reconstruction. Small or moderate facial/nasal defects can be closed primarily or left for second-intention healing. However, larger defects require the application of composite tissue or labial advancement flaps. Axial pattern flaps based on the caudal auricular artery, superficial temporal artery (STA), angularis oris artery, and other cutaneous arteries have been reported. In our case, we aim to report the reconstruction of a large composite defect of the rostral and dorsal nasal regions in a dog using an augmented, axial myocutaneous flap based on bilateral STAs. This is a clinical report on a spayed female mixed-breed dog (age, 7 years; weight, 15 kg), in which a large-scale nasal-facial composite tissue defect was surgically reconstructed using an axial myocutaneous flap based on bilateral STA branches. A delay technique was applied to prefabricate the flap to enrich the blood supply. New nostrils were created on a folded, rostral hard palate. As a result, the axial tube rotational flap was successfully transferred. The use of delay technique for prefabricating the tube flap optimized its size and survival. In addition to the folded rostral hard palate, the flap fully closed the defects on the face and nose. Functional and cosmetic outcomes were satisfactory, with minimal donor-site morbidity. In, conclusion, a large-scale nasal-facial defect in a dog was successfully reconstructed using an augmented tube pedicle flap based on the bilateral STAs, which may, thus, be used to repair very large facial-nasal defects in dogs.

BACKGROUND: In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19.
METHODS: Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery.
RESULTS: Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps.
CONCLUSIONS: Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.