Category Archives: Plastic surgery

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects (part 5)

The venous outflow is through the communication between the deep and superficial venous system. The traditional reverse dorsal pedis flap can be designed to include the area over the extensor retinaculum and even extend proximally over the extensor retinaculum for 3 cm. In patients with problematic wounds, island or free flaps have traditionally been the method of choice. No literature on distally based fasciocutaneous flaps for distal … Continue reading

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects (part 4)

Discussion Reconstruction of distal foot defects has been always difficult problem in plastic surgery. Various methods have been used in clinical practice. Skin grafting has been the preferred technique because of ease of harvest and application. However, skin grafts cannot be used over exposed bone or tendon. Another reconstruction option is the cross-leg flap. Disadvantages of this technique include the tissue thickness, which may result … Continue reading

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects (part 3)

Surgical technique for the distally based dorsalis pedis fasciocutaneous flap A preoperative Doppler examination evaluated the blood flow and positioning of the dorsalis pedis artery. A distally based dorsalis pedis fasciocutaneous flap was designed, excluding the dorsalis pedis artery. The flap included all fascial elements, and extended from the lower margin of extensor retinaculum to the first intermetatarsal area. After the design was finalized, a pneumatic tourniquet … Continue reading

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects (part 2)

Case presentation An 18-year-old boy presented with a high-voltage electrical burn of the dorsal side of the great toe. Necrosis of skin had occurred (Figure 1). Preoperatively, both the dorsalis pedis and posterior tibial artery were palpable, and Doppler flowmetry confirmed the course of dorsalis pedis artery. Ten days after the injury, the wound was completely debrided and the necrotic skin and bone removed. The … Continue reading

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects (part 1)

Anatomy The reconstruction of distal foot defects, especially wounds of the toes, is a challenging problem in plastic surgery. Various methods, such as skin grafting, or random, cross-leg and free flaps, have been reported for reconstruction of the forefoot, but all methods have limitations. Skin grafts cannot be used over exposed bone or tendon, while many flaps are bulky and uncomfortable for patients. The reverse … Continue reading

Revisiting Gavello’s procedure for single-stage reconstruction of the earlobe (part 4)

DISCUSSION The earlobe is a small but aesthetically crucial structure. The challenge in earlobe reconstruction surgery is to obtain a natural-appearing structure with a durable outcome. The technique should be simple, preferably performed in one stage, suitable for earlobe defects of all sizes and volume, and yield acceptable cosmetic results. A variety of single-stage and two-stage reconstructive techniques have been described for earlobe reconstruction. These … Continue reading

Revisiting Gavello’s procedure for single-stage reconstruction of the earlobe (part 3)

Clinical application and results Case 1: A 19-year-old woman underwent earlobe reconstruction for congenital absence of left earlobe (Figure 3A) using the technique described above. The postoperative result is shown in Figure 3B. case 2: A 33-year-old man presented with postburn deformity of his right earlobe (Figure 4A). The deformed and extremely scarred earlobe was excised and a new earlobe reconstructed using the method described (Figure 4B). … Continue reading

Revisiting Gavello’s procedure for single-stage reconstruction of the earlobe (part 2)

THE VASCULAR BASIS OF GAVELLO’S FLAP The posterior auricular artery arises in the neck from the external carotid artery, and ascends between the auricle and mastoid process. It supplies the cranial surface of the auricle via its auricular branch, and the occipital belly of occipitofrontalis and the scalp behind and above the auricle via its occipital branch. Our observation of digital subtraction angiography (DSA) images of different … Continue reading

Revisiting Gavello’s procedure for single-stage reconstruction of the earlobe (part 1)

Deformities of the earlobe may be congenital, or acquired as a consequence of trauma, human or animal bites, burns or tumour excision. A variety of procedures for earlobe reconstruction, both one-stage and two-stage, have been described. The technique described by Gavello (quoted by Nelaton and Ombredanne, 1907) is one of the earliest and simplest and, in our opinion, this century-old technique merits revisiting for evaluation … Continue reading

Helical advancement: Pearls and pitfalls (part 6). DISCUSSION

Satisfactory surgical outcome of the neoauricle is judged on symmetry and shape preservation. In the present study, five patients were left with auricle asymmetry based on subjective observation by the surgeon and patient feedback. The defect size in these five cases was >2.8 cm and the final reduction in the vertical axis ranged from 6 mm to 8 mm. All patients in the present study … Continue reading