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Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

Pedicled flap and free flap are two common types of superior gluteal artery (SGA) perforator flap (SGAP) used to cover lumbosacral soft tissue defects. In order to take advantage of the SGAP flap, all surgeons are required to have substantial knowledge of its cutaneous distribution of perforator. This study describes the anatomical characteristics of the perforators of SGA on Vietnamese adults; and locates the perforator of SGA on the gluteal region. We investigated the perforators origin and measured the length, diameter, course, and coordinates of each perforator on 32 Vietnamese adult cadavers at Department of Anatomy of Ho Chi Minh University of Medicine and Pharmacy, from Jan 2017 to June 2019. On average, SGA gives off 4-5 perforators, while none was found on the deep branch. The Average length of perforator from the skin to the dissecting point is short (5.5-7.5mm) compared to that of from skin to origin (4-9cm); diameter at origin is quite large (1mm). The chance of finding 3-5 perforators in the upper triangle is 75% and 87% on the right and left side, respectively. Also, the probability of finding a single perforator in the upper triangle is 100% based on the x-axis, most perforators are found in segment 2/5 to segment 3/5 with the center being the midpoint between two segments; based on the y-axis, most perforators are found in segment 1.5/5 to segment 3.5/5 with the center being the midpoint between the two. Thus, the probability of finding 3-5 perforators in the upper triangle is over 75% of the time, and the chance of finding a single perforator in the upper triangle is 100%. They are distributed from segment 2/5 to segment 3/5 on the x-axis and segment 1.5/5 to segment 3.5/5 on the y-axis. [ J Adv Biotechnol Exp Ther 2020; 3(2.000): 143-151]

Objective: Radiation therapy to treat hemangiomas is an old method that is no longer used due to its severe side effects. However, in Vietnam, radiotherapy has long been used to treat infantile hemangiomas, which has led to severe sequelae in adulthood. This article shares our experience in reconstructing the sequelae of radiation therapy for facial hemangioma using free anterolateral thigh (ALT) flap. Materials and methods: Six patients underwent facial lesion reconstruction using different ALT flaps, including volume augmentation, fascial, and thinning flaps. Results: The largest flap used was 20 × 8 cm2 and the smallest flap was 11 × 6 cm2. All flaps survived completely and no post-operative complications were noted. The patients were highly satisfied with the surgical outcomes, and the aesthetics of the flap were also excellent, with the flap being similar in color to the facial skin. Conclusion: The ALT flap has several advantages, including flexibility in use, diversity in flap components, and minimal impact on the donor site, making it increasingly popular and effective.

Abstract Facial reconstruction is challenging for plastic surgeons, as it can be difficult to decide the best approach. One technique that has been widely used is the anterolateral thigh (ALT) flap due to its numerous benefits. However, its thickness can be a drawback, especially regarding facial reconstruction. The thinning technique is not a new novel, but how to apply it to the ALT flap to get the best result hasn’t been reported yet. Our study involved 117 patients, and we used 73 thinned ALT flaps to determine the best method to increase the flap’s safety. After thinning, we significantly reduced the flap’s thickness from an average of 22.5 mm to 5.9 mm, making it more suitable for contouring purposes. We apply a thinned ALT flap for coverage, contouring, and recreating the facial 3D structure. The 12/45 flap has the chance to make the multiple-paddle ALT flap, which helps to reconstruct difficult positions even more flexibly. The key to successfully thinning the ALT flap is understanding the perforator’s structure and pathway through the fascia. With the thinning technique, we have overcome the limitations of the flap’s thickness, making it suitable for use in whole-body reconstruction. The ALT flap can overcome the restriction of its thickness and can be applied even more extensively in whole-body reconstruction.

Giant congenital nevi, especially on the head and neck, pose a challenge for plastic surgeons. This requires extensive experience in detailed planning, combining different techniques, and selecting appropriate materials for reconstruction. There have been reports of using a tissue expander, serial resection method, and full-thickness skin grafts for this type of nevus. However, the best way to completely remove a giant congenital nevus is endless. In this article, we would like to present a case of a left hemifacial giant congenital nevus in which we used multiple tissue expansion to fully replace the nevus, along with some of our modification techniques.

ABSTRACT: Background: Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL. Methods: Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm2. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically. Results: The skin paddle size ranged from 12 to 23 cm in length and 6 to 11 cm in width, and the FL flaps ranged from 3 × 5 to 12 × 5 cm. The mean pedicle length was 7.88 cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3–6 mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction. Conclusion: The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.

Objective: Arteriovenous malformations (AVMs) are aggressive diseases with a high tendency to recur. AVM treatment is complex, especially in the anatomically difficult head and neck region. This study analyzed correlations between extracranial head and neck AVM presentations and the frequency of recurrence. Methods: We retrospectively assessed AVM recurrence among 55 patients with head and neck AVMs treated with embolization and resection between January 2008 and December 2015. Recurrence was defined as any evidence of AVM expansion following embolization and resection. Patient variables, including sex, age, AVM size, AVM location, stage, and treatment modalities, were examined for correlations with the recurrence of head and neck AVMs. Statistical analysis was performed using SPSS 20.0. Results: A total of 55 patients with at least 6 months of follow-up following AVM treatment with embolization and surgical resection were enrolled in this study. During follow-up, 14 of 55 patients experienced recurrence (the long-term recurrence rate was 25.5%). Sex, stage, AVM size, and treatment modality were identified as independent predictors of recurrence. Recurrence was less likely following the treatment of lower-stage or smaller lesions and did not correlate with age or location. Conclusions: AVMs of the head and neck are among the most challenging conditions to manage due to a high risk of recurrence. Early and total AVM resection is the best method for preventing recurrence. [ABSTRACT FROM AUTHOR]

Objective: The pedicled Internal Mammary Artery Perforator (IMAP) flap is not yet a well-known technique. However, it seems practical for use in thoracic radiation-induced ulcer, especially in recurrence after the failure of convenient reconstructive techniques. This technique is applied to patients with breast hypertrophy. In this article, we present our experience with the indications, surgery details, and advantages of this technique. Materials and methods: A 63-year-old woman had a right mastectomy 11 years ago. The patient's ulcers recurred after radiotherapy and were treated with a regional and local flap. The opposite breast was ptotic, and the patient was not eligible for microsurgery. The patient underwent reconstruction using the contralateral pedicle IMAP flap. Results: The IMAP flap was designed with a size of 14 × 22 cm, including the inferior half of the breast and the areolar. The flap could completely cover the chest wall defect, and the contralateral breast was reduced to match. The final results were evaluated after two years of follow-up. Conclusion: The contralateral breast pedicle IMAP flap is a reliable, versatile, and easy-to-perform technique. This flap is a useful technique for chest wall coverage after radiation-induced ulcers, particularly in elderly patients. The major limitation of this technique is the higher risk of second primary breast cancer as the transfer flap of the contralateral breast.

ABSTRACT: Objective: This study aimed to share the experience of inserting a deep inferior epigastric perforator (D.I.E.P) flap obliquely in immediate breast reconstruction after total mastectomy. Method: Forty patients underwent immediate breast reconstruction with flap D.I.E.P after total mastectomy. The flaps were placed obliquely, with the upper edge facing downward and inward. After being placed in the recipient region, parts of the flap at both ends were removed, the upper end was fixed into the II–III intercostal space next to the sternum, and the lower end was folded to create a projection of the lateral lower pole of the breast. The flap pedicle was anastomosed to the thoracodorsal vessels (TDVs) if the contralateral flap pedicle was used; conversely, the mammary vessels (IMVs) were used. Satisfaction with breast shape was assessed after 6 months using the BREAST-Q questionnaire. Results: A total of 37/40 flaps were well vascularized; 36/37 patients with a survival flap were interviewed, showing that the average BREAST-Q evaluation score of satisfaction with breast shape was 62.22 (51–78). The number of answers for satisfied and very satisfied with breast shape accounted for 94.44%. Conclusion: Inserting the D.I.E.P flap obliquely has the advantage of being easy to shape the breast contour, creating a moderate projection and symmetry to the opposite breast. The author suggested using the IMVs as the receiving vessels when using the pedicle of the flap on the ipsilateral side and the TDVs when the contralateral pedicle flap was used.

Summary:. Venomous snakebites can cause severe injury. The loss of tendon and skin of the hand is incredibly challenging for the surgeon. A single-staged reconstruction with the free composite anterolateral thigh flap is an acceptable option for a complex thumb injury. In this case, reconstruction for a 23-year-old patient with a complex cobra-induced thumb injury had failed to cover the defect with a skin graft. There was a limitation in choice, and the patient was treated with the free composite anterolateral thigh (ALT) flap and fascia lata flap in one stage to reconstruct both the extensor tendon and the soft tissue coverage. The flap was well-vascularized, and no complications were reported. A single-stage reconstruction with a composite ALT flap with vascularized fascia was chosen as a suitable alternative. The result is satisfying both aesthetically and functionally. This technique can help shorten treatment time and restore function quickly, allowing patients to return to work in less time. The disadvantages of this technique are flap thickness, which can affect finger movement and aesthetics. The composite ALT flap with vascularized fascia lata shows that it is a reliable procedure for single-staged reconstruction, especially combined with the tendon preparation in the hand.

Background Loss of the extensor tendon with overlying soft tissue remains a complex reconstructive challenge. Successful reconstruction combines tendon repair with defect coverage by soft tissue flaps, meets the goals of approaching functionality, and achieves an esthetic result.

Summary:. Reconstruction of functional and aesthetic deformities of the neck after severe burn contracture is challenging. A free anterolateral thigh (ALT) perforator flap may be required, especially if local tissue is affected. To enlarge the surface area of this flap, donor site pre-expansion can be combined with flap transfer. Two patients with large neck defects were treated using pre-expanded free ALT perforator flaps. A rectangular expander was placed under the deep fascia after dissection of the perforator of the descending branch of the lateral circumflex femoral artery. The expansion time was from 3 to 4 months and the final expanded volume was 900–1500 ml. Defect sizes ranged from 14 × 18 to 18 × 27 cm and the expanded ALT flap was measured from 12 × 18 to 27 × 18 cm with one perforator in the flap. After immediate thinning, flap thickness was reduced, ranging from 5 to 11 mm. All flaps survived completely. Two patients were followed for 40 months. The skin color and textures of the flap were good. There was also a clear improvement in appearance and function. In summary, the subfascial expanded ALT perforator flap can be an excellent option for repairing severe neck defects due to its safe harvesting even with the large flaps. The donor area is closed primarily, and the thinned expanded skin is more aesthetically pleasing. The drawbacks are that it is a two-stage procedure, and the expander may be displaced during the expansion period.

Background: Arteriovenous malformations (AVMs) are fast-flow vascular malformations that comprise a complex network of primitive vessels directly connecting feeding arteries to draining veins. AVM is an aggressive disease with a high tendency to recur; its treatment is complex and very challenging, especially in the anatomically delicate head and neck area and requires extensive experience and an interdisciplinary approach. Objectives: This study evaluated the outcome after treatment and analyzed the correlation between the pattern of head and neck AVM and the frequency of recurrence. Materials and Methods: We retrospectively assessed the outcome and recurrence of head and neck AVM after treatment by embolization and resection. Recurrence is defined as expansion following embolization or resection. The effect of sex, age, size, location, stage and treatment modalities on recurrence of head and neck AVM were analyzed. Results: This study includes of 60 patients. All patients were treated by embolization and then resection. Of these, we have follow-up information of at least 6 months after treatment on 55 patients. The outcome was excellent in 73%, good in 20%, fair in 5% and poor in 2% (mean follow-up time, 38.6 months). Of the 55 patients, 14 had recurrences after treatment (long-term recurrence rate, 26%). Recurrence was less likely for lower-staged or small lesions, and did not correlate with age or location. Conclusions: AVM of the head and neck is a one of the most challenging diseases and has a high risk of recurrence. The best chance for long-term control is early and total resection. [ABSTRACT FROM AUTHOR]