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      Is Open Access

      Crane Principle Revisited

      research-article
      , MD 1 , , MD 1 ,
      Plastic and Reconstructive Surgery Global Open
      Wolters Kluwer Health

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          Abstract

          Background:

          Scalp and forehead defects represent one of the most complex defects for reconstruction. The nature of these sites being hair bearing, together with the complicated nature of the injuries, for example, electrical burns and motor vehicle accidents, and of course the aesthetic concern being in the face, all add to the complexity of reconstruction.

          Methods:

          This is a case series representing the experience of the authors in using the “crane principle” in the reconstruction of various defects in the forehead and the scalp presented to emergency department, Cairo University Hospital, for the period between January 2018 and January 2019.

          Results:

          Twenty patients, 15 men and 5 women, presented with various soft tissue defects of the forehead and the scalp. The injuries of eighteen patients were due to motor vehicle accidents, and 2 patients had postelectrical burns. Age range was from 20 to 65 years, with a mean follow-up of 8 months. The number of total complications was 5. Three patients had wound dehiscence, and 2 patients had ulceration in the grafts placed at the flap donor site.

          Conclusion:

          Crane principle represents an adequate reconstruction tool for forehead and scalp defects especially when the access to free flap and more complex reconstruction techniques is not available.

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          Most cited references13

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          Reconstruction of scalp defects with free flaps in 30 cases.

          29 consecutive patients treated for reconstruction of various scalp defects with 30 free flaps were reviewed. The scalp defects resulted from accidents (13), electric burns (4), tumour excision (8), chronic osteomyelitis (1), and osteoradionecrosis (1). Secondary reconstructions for cosmetic improvement were performed in 2 patients. The defects involved scalp with bone exposure in 21 patients, and both scalp and calvarium in 8 patients. The average extent of the defects was 130 cm2 (23-420 cm2). Free flaps employed for reconstruction included radial forearm flaps (15), latissimus dorsi muscle flaps (10), medial arm flaps (2), juri flap (1), rectus abdominis muscle flap (1), and scapular flap (1). In 6 cases bone grafts were used for skull reconstruction. Three patients required dura repair. There were two flap failures. Donor-site morbidity was negligible. No local recurrence occurred in 7 tumour cases who are still alive. Secondary procedures (tissue expansion, debulking) were performed in 6 patients. The authors recommend selection of reconstructive options for scalp defects according to their aetiology, localisation, and duration of treatment, whereas the size of the defect dose not seem to be the most important determinant. They conclude that a free flap procedure is appropriate for scalp reconstruction in trauma, osteomylitis, and osteoradionecrosis cases, and following radical resection of malignant tumours.
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            Facial transplantation for an irreparable central and lower face injury: A modernized approach to a classic challenge

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              • Abstract: found
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              Neovascularization of skin flaps: route and timing.

              Axial flaps were elevated in a pig and rat model. Selective ligation of the vascular pedicles on days 1 to 7 following elevation of the flap demonstrated total necrosis of all flaps when the pedicles were ligated on the first, second, and third postoperative day in the pig, and up to 6 days inthe rat. Pedicle ligation beyond this time did not produce flap necorsis, indicating the establishment of adequate neovascularization for flap survival. Selective ligation of the artery or vein did not appear to be significant in the pig. In the rat flap, however, survival tended to occur sooner. Adequate neovascularization for flap survival was demonstrated as arising from both the wound edges and the bed, although vascular channels occurring from the bed appeared to be of greater importance. The relatively rapid rate of neovascularization that occurs for adequate flap survival suggests that if some way could be found to maintain flap viability during the first week, the feeding vessels need no longer remain patent and may be ligated or used for other purposes. This interesting observation has already allowed very early successful defatting of clinically transferred flaps.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                April 2020
                22 April 2020
                : 8
                : 4
                : e2741
                Affiliations
                [1]From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt.
                Author notes
                Ahmed A. Taha, MD, Department of Plastic Surgery, Faculty of Medicine, Cairo University, Kasr Al-Ainy Street, Cairo 12627, Egypt, E-mail: dr.ahmed.ali.taha@ 123456gmail.com
                Article
                00023
                10.1097/GOX.0000000000002741
                7209862
                32440411
                5a570bf9-1a5e-4c8b-aa55-59782d3d6635
                Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 15 November 2019
                : 5 February 2020
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