Pub Date : 2020-03-01DOI: 10.1097/prs.0000000000006616
Theodore A Kung
{"title":"Joint Denervation: An Atlas of Surgical Techniques","authors":"Theodore A Kung","doi":"10.1097/prs.0000000000006616","DOIUrl":"https://doi.org/10.1097/prs.0000000000006616","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87510440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/prs.0000000000006565
R. Hopper, N. Vedder, Srinivas M Susarla, P. Manson
{"title":"Joseph Selwyn Gruss, F.R.C.S.(C.), 1945 to 2019","authors":"R. Hopper, N. Vedder, Srinivas M Susarla, P. Manson","doi":"10.1097/prs.0000000000006565","DOIUrl":"https://doi.org/10.1097/prs.0000000000006565","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79595295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/prs.0000000000006617
Alexander Y. Lin
{"title":"Aesthetic Orthognathic Surgery and Rhinoplasty","authors":"Alexander Y. Lin","doi":"10.1097/prs.0000000000006617","DOIUrl":"https://doi.org/10.1097/prs.0000000000006617","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80796156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/PRS.0000000000006381
John T. Stranix, S. Azoury, Z-Hye Lee, Geoffrey M. Kozak, N. Plana, V. Thanik, P. Saadeh, J. Levine, L. Levin, S. Kovach
BACKGROUND While the surgical microscope remains the most common method for visual magnification for microsurgical anastomoses in free tissue transfer, loupes-only magnification for free flap breast reconstruction has been demonstrated to be safe and effective. In order to evaluate the loupes-only technique in lower extremity free flap reconstruction, we compared perioperative outcomes between microsurgical anastomoses performed with loupes magnification versus a surgical microscope. METHODS Two-institution retrospective study of soft tissue free flaps for traumatic below-knee reconstruction. Optimal subgroup matching was performed using patient age, defect location, flap type (muscle vs. fasciocutaneous), and time from injury (acute <30 days vs. remote >30 days) for conditional logistic regression analysis of perioperative outcomes. RESULTS 373 flaps met inclusion criteria for direct matched comparison of anastomoses performed with loupes magnification (n=150) versus a surgical microscope (n=223). Overall major complication rates were 15.3%: takeback for vascular compromise 7.8%, partial flap failure 7.8%, and total flap loss 5.4%. No differences were observed between the loupes and microscope groups in regards to major complications (14.0% vs. 16.1%;OR=0.78(0.38-1.59)), takeback for vascular compromise (5.3% vs. 9.4%;OR=0.51(0.19-1.39)), any flap failure (13.3% vs. 13.0%;OR=1.21(0.56-2.64)), partial flap failure (7.3% vs. 8.1%;OR=1.04(0.43-2.54)), and total flap loss (6.0% vs. 4.9%;OR=1.63(0.42-6.35)). CONCLUSIONS Perioperative complication rates, takebacks for vascular compromise, partial flap losses, and total flap failure rates were not significantly different between the matched loupes and microscope groups. Overall microsurgical success rates in traumatic lower extremity free flap reconstruction appear to be independent of the microsurgical technique used for visual magnification.
虽然手术显微镜仍然是游离组织移植中显微外科吻合最常用的视觉放大方法，但仅使用显微镜进行游离皮瓣乳房重建已被证明是安全有效的。为了评估仅使用显微镜的技术在下肢自由皮瓣重建中的应用，我们比较了在显微镜下和在显微镜下进行显微外科吻合的围手术期结果。方法回顾性研究游离软组织皮瓣在创伤性膝下重建中的应用。根据患者年龄、缺损位置、皮瓣类型(肌肉或筋膜皮肤)和损伤时间(急性30天)进行最佳亚组匹配，对围手术期结果进行条件logistic回归分析。结果373个皮瓣符合纳入标准，进行了镜下(n=150)与手术显微镜(n=223)吻合的直接匹配比较。主要并发症的总发生率为15.3%:血管受损的恢复为7.8%，部分皮瓣失败为7.8%，皮瓣全部丢失为5.4%。在主要并发症(14.0% vs. 16.1%;OR=0.78(0.38-1.59))、血管受损的恢复(5.3% vs. 9.4%;OR=0.51(0.19-1.39))、任何皮瓣失败(13.3% vs. 13.0%;OR=1.21(0.56-2.64))、部分皮瓣失败(7.3% vs. 8.1%;OR=1.04(0.43-2.54))和皮瓣全部丢失(6.0% vs. 4.9%;OR=1.63(0.42-6.35))方面，镜下组和显微镜组之间没有差异。结论配镜组与显微镜组手术并发症发生率、血管损伤回收率、部分皮瓣丢失率、皮瓣总失败率无显著性差异。显微外科手术在外伤性下肢游离皮瓣重建中的总体成功率似乎与显微外科技术用于视觉放大无关。
{"title":"\"Matched Comparison of Microsurgical Anastomoses Performed with Loupes Magnification Versus Operating Microscope in Traumatic Lower Extremity Reconstruction\".","authors":"John T. Stranix, S. Azoury, Z-Hye Lee, Geoffrey M. Kozak, N. Plana, V. Thanik, P. Saadeh, J. Levine, L. Levin, S. Kovach","doi":"10.1097/PRS.0000000000006381","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006381","url":null,"abstract":"BACKGROUND\u0000While the surgical microscope remains the most common method for visual magnification for microsurgical anastomoses in free tissue transfer, loupes-only magnification for free flap breast reconstruction has been demonstrated to be safe and effective. In order to evaluate the loupes-only technique in lower extremity free flap reconstruction, we compared perioperative outcomes between microsurgical anastomoses performed with loupes magnification versus a surgical microscope.\u0000\u0000\u0000METHODS\u0000Two-institution retrospective study of soft tissue free flaps for traumatic below-knee reconstruction. Optimal subgroup matching was performed using patient age, defect location, flap type (muscle vs. fasciocutaneous), and time from injury (acute <30 days vs. remote >30 days) for conditional logistic regression analysis of perioperative outcomes.\u0000\u0000\u0000RESULTS\u0000373 flaps met inclusion criteria for direct matched comparison of anastomoses performed with loupes magnification (n=150) versus a surgical microscope (n=223). Overall major complication rates were 15.3%: takeback for vascular compromise 7.8%, partial flap failure 7.8%, and total flap loss 5.4%. No differences were observed between the loupes and microscope groups in regards to major complications (14.0% vs. 16.1%;OR=0.78(0.38-1.59)), takeback for vascular compromise (5.3% vs. 9.4%;OR=0.51(0.19-1.39)), any flap failure (13.3% vs. 13.0%;OR=1.21(0.56-2.64)), partial flap failure (7.3% vs. 8.1%;OR=1.04(0.43-2.54)), and total flap loss (6.0% vs. 4.9%;OR=1.63(0.42-6.35)).\u0000\u0000\u0000CONCLUSIONS\u0000Perioperative complication rates, takebacks for vascular compromise, partial flap losses, and total flap failure rates were not significantly different between the matched loupes and microscope groups. Overall microsurgical success rates in traumatic lower extremity free flap reconstruction appear to be independent of the microsurgical technique used for visual magnification.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77577564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/PRS.0000000000006366
J. V. van Dongen, A. J. Tuin, Martin C. Harmsen, B. van der Lei, H. Stevens
{"title":"The difference between SVF isolation and fat emulsification: a crucial role for centrifugation.","authors":"J. V. van Dongen, A. J. Tuin, Martin C. Harmsen, B. van der Lei, H. Stevens","doi":"10.1097/PRS.0000000000006366","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006366","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79863180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/PRS.0000000000006333
Jae A Jung, Hyun Park, Eun-Sang Dhong
197e Reply: Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians Sir: I thank Dr. Huan Wang for his interest in the article “Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians.”1 The main focus of this technique is to make natural lip lifting with minimal scars. Therefore, we discussed specifically key suture methods under Surgical Technique in our article. First, too much excision without careful flap dissection may cause sill problems, as you mentioned. Therefore, less lip skin excision and more underdissection toward the Cupid’s bow help to reduce the skin tension. In addition, the balance between these is the main key to the result. As we mentioned in the article, the suture between the superior edge of the orbicular muscle and the base of the nose with interrupted absorbable 5-0 polydioxanone stitches (Ethicon, Inc., Somerville, N.J.) is the most important. Security of this suture helps to control the skin tension. Also, in some conditions, a strut graft also helps to make the nasal base stable. Second, it is crucial to pay utmost attention to the suture because the labial flap is longer than the nasal flap. Stitches taking the nasal flap perpendicular to the skin and the labial flap in parallel have to be placed. In this way, the length of the labial flap shortens and becomes as long as the nasal flap while the columellar skin can be redistributed without cutting this area. This technique is the most critical for minimizing sill deformity. Third, not all cases were successful with regard to scars, and we mentioned this in the Discussion section. In two of the 30 patients (6.7 percent), incisional scarring was noticeable from a conversational distance at the time of long-term follow-up. These patients underwent scar revision surgery and received comprehensive postoperative treatment to prevent additional scarring. Therefore, the surgeon must pay utmost attention to avoid scars with the exact procedure and even tension distribution. Fourth, our incision begins at the alar fold of the nose, enters the nostril, and rises medially on the lower margin of the medial crura of the alar cartilage. A separate incision begins at the other alar fold, enters the nostril, and rises medially, similar to the first incision. A vertical skin bridge is left intact between the left and right incisions. At first, this incision technique was planned because spare skin from lip lifting can be recruited to augment the nasal tip to solve the tip underprojection problem in an aging Asian nose. seemingly compromised or absent. This is somewhat apparent in the cases present in Figures 5 and 8. In addition, because the incision started inferiorly to the sill border, it is reasonable to speculate that tension, whether it is gravitational or dynamic from muscle movements, will be mounting on this structure. It might be especially significant when there are no accessory incisions around the nas
{"title":"Reply: Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians.","authors":"Jae A Jung, Hyun Park, Eun-Sang Dhong","doi":"10.1097/PRS.0000000000006333","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006333","url":null,"abstract":"197e Reply: Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians Sir: I thank Dr. Huan Wang for his interest in the article “Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians.”1 The main focus of this technique is to make natural lip lifting with minimal scars. Therefore, we discussed specifically key suture methods under Surgical Technique in our article. First, too much excision without careful flap dissection may cause sill problems, as you mentioned. Therefore, less lip skin excision and more underdissection toward the Cupid’s bow help to reduce the skin tension. In addition, the balance between these is the main key to the result. As we mentioned in the article, the suture between the superior edge of the orbicular muscle and the base of the nose with interrupted absorbable 5-0 polydioxanone stitches (Ethicon, Inc., Somerville, N.J.) is the most important. Security of this suture helps to control the skin tension. Also, in some conditions, a strut graft also helps to make the nasal base stable. Second, it is crucial to pay utmost attention to the suture because the labial flap is longer than the nasal flap. Stitches taking the nasal flap perpendicular to the skin and the labial flap in parallel have to be placed. In this way, the length of the labial flap shortens and becomes as long as the nasal flap while the columellar skin can be redistributed without cutting this area. This technique is the most critical for minimizing sill deformity. Third, not all cases were successful with regard to scars, and we mentioned this in the Discussion section. In two of the 30 patients (6.7 percent), incisional scarring was noticeable from a conversational distance at the time of long-term follow-up. These patients underwent scar revision surgery and received comprehensive postoperative treatment to prevent additional scarring. Therefore, the surgeon must pay utmost attention to avoid scars with the exact procedure and even tension distribution. Fourth, our incision begins at the alar fold of the nose, enters the nostril, and rises medially on the lower margin of the medial crura of the alar cartilage. A separate incision begins at the other alar fold, enters the nostril, and rises medially, similar to the first incision. A vertical skin bridge is left intact between the left and right incisions. At first, this incision technique was planned because spare skin from lip lifting can be recruited to augment the nasal tip to solve the tip underprojection problem in an aging Asian nose. seemingly compromised or absent. This is somewhat apparent in the cases present in Figures 5 and 8. In addition, because the incision started inferiorly to the sill border, it is reasonable to speculate that tension, whether it is gravitational or dynamic from muscle movements, will be mounting on this structure. It might be especially significant when there are no accessory incisions around the nas","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75949595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/PRS.0000000000006393
Ramón Varela, C. Casado-Sanchez, S. Zarbakhsh, J. Díez, J. Hernández-Godoy, L. Landin
BACKGROUND Breast reconstruction with DIEP flap can be associated with complications such as fat necrosis. Our objective was to assess the safety and efficacy of fluorescent angiography with indocyanine green (FA-ICG) to reduce fat necrosis. METHODS We designed a parallel, randomized, controlled clinical trial for unilateral breast reconstruction (NCT02759796). The poorly vascularized tissues of the DIEP flap were removed based on a clinical evaluation in group 1 and based on angiographic criteria in group 2. We recorded the flap dimensions, perfusion in terms of fluorescence intensity, complications, reoperations and BREAST-Q questionnaire scores for both groups. RESULTS The study included a total of 51 patients. The flaps showed no size differences after excising the tissue. The flaps of group 2 presented higher perfusion rates (p=.001). The incidence of fat necrosis was 59.3% in group 1 and 8.3% in group 2 (p=.001). Four cases of partial necrosis were recorded in group 1 (18.2%) and none in group 2 (0%) (p=.131). Four patients underwent reoperation in group 1 (14.8%) and none in group 2 (0%) (p=.113). The patients in group 2 reported higher scores in all domains of the BREAST-Q. CONCLUSIONS FA-ICG significantly reduced the incidence of fat necrosis without diminishing the flaps' dimensions. The perfusion rates were significantly higher in the flaps tailored according to FA-ICG. The patients in the FA group reported significantly greater satisfaction and quality of life. FA-ICG may be considered a safe and effective tool to enhance the outcomes of breast reconstruction with DIEP flap.
{"title":"Outcomes of DIEP flap and fluorescent angiography: a randomized controlled clinical trial.","authors":"Ramón Varela, C. Casado-Sanchez, S. Zarbakhsh, J. Díez, J. Hernández-Godoy, L. Landin","doi":"10.1097/PRS.0000000000006393","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006393","url":null,"abstract":"BACKGROUND\u0000Breast reconstruction with DIEP flap can be associated with complications such as fat necrosis. Our objective was to assess the safety and efficacy of fluorescent angiography with indocyanine green (FA-ICG) to reduce fat necrosis.\u0000\u0000\u0000METHODS\u0000We designed a parallel, randomized, controlled clinical trial for unilateral breast reconstruction (NCT02759796). The poorly vascularized tissues of the DIEP flap were removed based on a clinical evaluation in group 1 and based on angiographic criteria in group 2. We recorded the flap dimensions, perfusion in terms of fluorescence intensity, complications, reoperations and BREAST-Q questionnaire scores for both groups.\u0000\u0000\u0000RESULTS\u0000The study included a total of 51 patients. The flaps showed no size differences after excising the tissue. The flaps of group 2 presented higher perfusion rates (p=.001). The incidence of fat necrosis was 59.3% in group 1 and 8.3% in group 2 (p=.001). Four cases of partial necrosis were recorded in group 1 (18.2%) and none in group 2 (0%) (p=.131). Four patients underwent reoperation in group 1 (14.8%) and none in group 2 (0%) (p=.113). The patients in group 2 reported higher scores in all domains of the BREAST-Q.\u0000\u0000\u0000CONCLUSIONS\u0000FA-ICG significantly reduced the incidence of fat necrosis without diminishing the flaps' dimensions. The perfusion rates were significantly higher in the flaps tailored according to FA-ICG. The patients in the FA group reported significantly greater satisfaction and quality of life. FA-ICG may be considered a safe and effective tool to enhance the outcomes of breast reconstruction with DIEP flap.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87018854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/PRS.0000000000006396
M. Mashrah, L. Mai, Q. Wan, Zhi-Quan Huang, Jianguang Wang, Zhaoyu Lin, S. Fan, C. Pan
BACKGROUND The general aim of this study is to describe a new modification to the posterior tibial artery flap (PTAF) and its clinical application in head and neck reconstruction and to investigate the distribution of septocutaneous perforators (SP) of the posterior tibial artery (PTA). The specific aim of this study is to evaluate the effectiveness of this new modification to the PTAF and describe the flap survival rate and donor site morbidity. METHODS From November 2017 to August 2018, 85 consecutive patients underwent PTAF reconstruction of the head and neck region after tumor extirpation. All PTAFs were harvested with a long adipofascial extension, and donor site defects were closed with a triangularly shaped full-thickness skin graft (FTSG) harvested adjacent to the flap. Special consideration was given to the harvesting technique, distribution of the posterior tibial artery SP, flap outcomes and associated donor-site morbidity. RESULTS Flap survival was 100%. The number of SPs varied from 1 to 5 per leg, with a mean of 2.61(1.15), and the SP were mostly clustered in the middle and distal thirds of the medial surface of the leg. The prevalence of the presence of one, two, three, four and five SP per leg was 7%, 33%, 27%, 19%, and 14%, respectively. Total and partial skin graft loss at the donor site was reported in 2 and 6 patients, respectively, who were conservatively managed. There was no statistically significant difference when comparing the pre- and postoperative range of ankle movements (P >0.05). CONCLUSION This new modification to the PTAF allows for the incorporation of more SPs into the flap, omits the need for a second donor site to close the donor site defect, and provides sufficient tissue to fill the dead space after tumor resection and neck dissection.
{"title":"Posterior tibial artery flap with an adipofascial extension: Clinical application in head and neck reconstruction with detailed insight into septocutaneous perforators and donor site morbidity.","authors":"M. Mashrah, L. Mai, Q. Wan, Zhi-Quan Huang, Jianguang Wang, Zhaoyu Lin, S. Fan, C. Pan","doi":"10.1097/PRS.0000000000006396","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006396","url":null,"abstract":"BACKGROUND\u0000The general aim of this study is to describe a new modification to the posterior tibial artery flap (PTAF) and its clinical application in head and neck reconstruction and to investigate the distribution of septocutaneous perforators (SP) of the posterior tibial artery (PTA). The specific aim of this study is to evaluate the effectiveness of this new modification to the PTAF and describe the flap survival rate and donor site morbidity.\u0000\u0000\u0000METHODS\u0000From November 2017 to August 2018, 85 consecutive patients underwent PTAF reconstruction of the head and neck region after tumor extirpation. All PTAFs were harvested with a long adipofascial extension, and donor site defects were closed with a triangularly shaped full-thickness skin graft (FTSG) harvested adjacent to the flap. Special consideration was given to the harvesting technique, distribution of the posterior tibial artery SP, flap outcomes and associated donor-site morbidity.\u0000\u0000\u0000RESULTS\u0000Flap survival was 100%. The number of SPs varied from 1 to 5 per leg, with a mean of 2.61(1.15), and the SP were mostly clustered in the middle and distal thirds of the medial surface of the leg. The prevalence of the presence of one, two, three, four and five SP per leg was 7%, 33%, 27%, 19%, and 14%, respectively. Total and partial skin graft loss at the donor site was reported in 2 and 6 patients, respectively, who were conservatively managed. There was no statistically significant difference when comparing the pre- and postoperative range of ankle movements (P >0.05).\u0000\u0000\u0000CONCLUSION\u0000This new modification to the PTAF allows for the incorporation of more SPs into the flap, omits the need for a second donor site to close the donor site defect, and provides sufficient tissue to fill the dead space after tumor resection and neck dissection.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86962832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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