Of note, hemodynamic instability requiring vasopressor support represents a contraindication to free tissue transfer. Closure of a palatal fistula, especially after multiple recurrences, remains a complex reconstructive problem. The optimal care for muscle and myocutaneous flap patients involves an experienced microsurgeon, anesthesia, and operating room staff familiar with complexities of flap surgery, nurses attentive to flap monitoring, and a facility with appropriate instrumentation and support. For most paramedian, melolabial, and postauricular flaps this connection is maintained for three weeks, then the pedicle is divided. Prevention is key to success. The incised portion of the nasal flap is then thinned and inset into the defect. Schmidt K, Bertani C, Martano M, et al. After the interpolated flap is raised and inset in the first surgery, the bridging pedicle is left in place to allow neo-vascularization between the flap and recipient site. Wounds that are high-risk for infection and have large dead space are ideal for muscle flaps. He's very predictable about it when my DH or I are out of sight and them come into his view. For small-to-medium alar defects, an inferiorly based flap can also be used to avoid the transfer of facial hair. Advancement flaps are contraindicated by poor patient … 3b). First used in India in about 600 BC, the medial cheek skin is an excellent color and texture match for defects on the caudal third of the nose (fig. The interpolated pedicle is broad, and gently tubing the pedicle with 3-0 Vicryl sutures can minimize oozing. Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, wall-eyed bilateral internuclear ophthalmoplegia. Other authors have demonstrated the safety of simply taking a pedicle from the glabellar midline to 1.2 cm lateral to the midline. It can recreate massive skin and soft-tissue defects of the head, face, oral cavity, pharynx, neck, and chest. The donor site can typically only be closed partially, and a skin graft is often required over the deltoid muscle. The technique was invented by Harold Gillies and developed by The flap is draped over the defect to ensure that coverage of the anterior portion of the defect does not cause excessive tension, and the Burow's triangles can be excised if necessary. A walking-stalk skin flap or waltzing tube pedicle is a reconstructive technique in which the skin and soft tissue to be used for the flap is formed into a tubular pedicle and moved from the source to the target site by anchoring at both ends, periodically severing one end and anchoring it closer to the flap target site. Muscles and myocutaneous flaps are useful for various acquired oncologic or traumatic defects throughout the body. [8][7] Foil or nonabsorbent surgical dressing is used to make a template of the surgical defect to be repaired. The template is placed behind the ear with its leading (anterior) edge over the loose portion of the posterior ear and the planned flap is drawn with a surgical marker (fig. Although perforator and fasciocutaneous flaps have recently grown in popularity, muscle and myocutaneous flaps have vascular supply from named vessels and have a consistent blood supply and remain a good option for many different reconstructions. Often pedicled muscle or myocutaneous flaps, the sacrifice of the nerve may prevent unwanted animation and lead to long-term atrophy allowing for better contour. So just another way to stake a claim. The general guideline when creating this flap is to make the arc 4× the length required to rotate the flap sufficiently to close the defect. Waltzing a facial artery musculomucosal flap to salvage a recurrent palatal fistula.

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