Letters to Editor

Superiorly based V flap for inguinal soft tissue defect reconstruction Sir, Various reconstructive options are available for the soft tissue coverage over the inguinal region. We present a superiorly based “V” shaped flap, which provides stable soft tissue cover for femoral vessels, reduces the risk of wound dehiscence and lymphatic drainage problems, better tolerance to radiotherapy and decreased incidence of donor site morbidity. Six patients with posttumour excision inguinal defects were operated for flap cover using the said technique over a period of 9 months from October 2012 to June 2013. The vascularity of the flap is based on the excellent longitudinal network of vessels formed by the anastomoses

between branches of transverse branch of the lateral circumflex femoral and individual branches of profunda perforators, which emerge along the lateral intermuscular septum and fan out over the iliotibial tract [Figure 1]. As per requirements of the defect [Figure 2], a lateral “V” flap is planned [Figure 3] from the anterolateral aspect of the thigh, centered on the lateral intermuscular septum, with its base at the lateral end of the inguinal defect (usually at the level of the greater trochanter of femur) and the tip at distal end like a “V” shaped flap. Flap is raised from distal to proximal direction in the plane just superficial to the tensor fascia lata preserving as much of perforators to the flap from the lateral side. Then the medial flap, overlying the soft tissue of the anterior thigh, is elevated superficial to the deep fascia of the thigh. Now the two flaps are transposed as in a technique similar to “Z” plasty [Figure 4]. Hence, the “V” shaped flap will cover the inguinal defect; medial side flap mobility facilitates primary closure of the donor defect.

Figure 1: Anatomy of perforators through tensor fascia lata muscle

Figure 2: Postinguinal dissection soft tissue defect

Figure 3: Immediate post-operative picture “V” flap

Figure 4: Immediate post-operative picture of “Z” transposition flap

Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3

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Letters to Editor fascia lata as a pedicled flap. Surg Gynecol Obstet 1934;59:766-80. Nahai F, Hill L, Hester TR. Experiences with the tensor fascia lata flap. Plast Reconstr Surg 1979;63:788-99. 3. Gupta AK, Kingsly PM, Jeeth IJ. Groin reconstruction after inguinal block dissection. Indian J Urol 2006;22:355-9. 2.

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Website: www.ijps.org DOI: 10.4103/0970-0358.146693

Figure 5: Post-operative day 12 following surgery

Our Flap dimensions ranged from 16 cm × 8 cm to 22 cm × 10 cm and all the donor defects were closed primarily. All the flaps did well without any complications [Figure 5]. A superiorly based “V” flap to provide a stable soft tissue cover over the femoral vessels reduces the risk of wound dehiscence and lymphatic drainage problems with minimal donor site morbidity when compared with other flaps. The technique is simple, with lesser operating time (50-60 min). It is a reliable flap for covering femoral vessels and groin with good tolerance to radiotherapy. Moreover, no muscle is sacrificed, [1,2] and donor site is closed primarily. Superiorly based “V” flap being a single staged procedure meets the criteria formulated by Gupta et al.,[3] with the blood supply of precisely known anatomy, with arterial base out of the field of resection or radiation. However, assessment of aesthetic and functional outcomes of this flap over other flaps and the “ideal” form of reconstruction for groin defects needs additional investigation with more number of patients and longer follow-up.

Vinoth Kumar Dilliraj, Pradeoth Korambayil Mukundan1 Departments of Plastic Surgery and Burns, Vijaya Hospital, Vadapalani, Chennai, Tamil Nadu, India 1Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India Address for correspondence: Dr. Vinoth Kumar Dilliraj, Departments of Plastic Surgery and Burns, Vijaya Hospital, No. 434, N.S.K. Salai, Vadapalani, Chennai - 600 026, Tamil Nadu, India. E-mail: [email protected]

REFERENCES 1. 475

Wangensteen OH. Repair of recurrent and difficult hernias and other large defects of the abdominal wall employing the iliotibial tract of

“Bottle cap as bite block”: An innovative intraoral splint Sir, Bite blocks[1] are commercially available devices, which can be used to prop open a patient’s oral cavity during a prolonged treatment session. After certain surgeries on the mouth such as temporomandibular joint (TMJ) ankylosis or cases of submucosal fibrosis release the jaw needs to be kept in the open position by using bite blocks. We have devised a simple technique of creating bite blocks using the rubber caps of the glass bottles used for intravenous (IV) infusion. The material is pliable, easily available with a wide range of innovative options as per the case demands. After the desired intraoral procedure has been performed (free flap for intraoral reconstruction or release of TMJ ankylosis/submucosal fibrosis), a cap from the intravenous glass bottle which is readily available in the operation theatres is removed after breaking the seal. The inner rim of the cap that fits into the mouth of the bottle is fashioned in such a way to accommodate the maxillary and mandibular molars by cutting two small semicircles of the rubber at 6’O clock and 12’O clock positions [Figure 1]. Then, pack gauze is threaded through the IV set insertion holes and knotted outside and hence that once fitted in the mouth it can then be strapped to the cheek to prevent it from accidental slippage [Figures 2 and 3].

Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3

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Superiorly based V flap for inguinal soft tissue defect reconstruction.

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