Thin Flap Research Articles

Thin Flap Trochleoplasty With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellofemoral Instability With High-Grade Trochlear Dysplasia: A Series of 63 Consecutive Cases.

Trochlear dysplasia is present in 68% to 85% of patients with recurrent lateral patellofemoral instability (LPI) compared with 3% to 6% of healthy controls. Trochlear dysplasia has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign. To assess the clinical and patient-reported outcomes after patella-stabilizing surgery, including thin flap sulcus deepening trochleoplasty, and to explore the influence of pathoanatomic variables on postoperative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty. Case series; Level of evidence, 4. A total of 63 consecutive knees in 46 patients with recurrent LPI and high-grade trochlear dysplasia who underwent MPFL reconstruction with thin flap trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. The t test was used to determine changes in QOL. Multiple linear regression was conducted to determine significant pathoanatomic variables that affected outcomes after MPFL reconstruction. Overall, 63 knees with a mean follow-up of 32.9 ± 17.0 months (range, 12-84 months) were included. All patients had preoperative high-grade trochlear dysplasia (Dejour type B: 46%; Dejour type D: 54%), with a mean trochlear bump height of 6.1 ± 1.8 mm (range, 3.2-10.5 mm). The BPII 2.0 score increased significantly from preoperatively (29.3 ± 12.4) to postoperatively (71.8 ± 17.4) (P < .001), with a large effect size (Cohen d = -2.41). There was 1 redislocation (1.6%) and 3 reoperations (4.8%). Persistent apprehension and the J-sign were present in 8.5% and 13.6% of the knees, respectively. Multiple linear regression analysis demonstrated no statistically significant predictive relationship between the 24-month postoperative BPII 2.0 score and the preoperative BPII 2.0 score, tibiofemoral rotation, the Beighton score, or trochlear bump height (R = 0.47; R2 = 0.22; F = 5.23; P = .13). Thin flap trochleoplasty combined with MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in low redislocation and reoperation rates at a mean of 33 months. Disease-specific QOL scores were statistically significantly improved from preoperatively to postoperatively.

Features of development and progression of diffuse lamellar keratitis after different types of excimer laser correction of myopia: long-term observation

Background. Thanks to the significant advancements in vision correction, excimer laser surgery has become one of the most common methods for treating ametropia. However, like any medical interventions, there are intra- and postoperative complications, including diffuse lamellar keratitis (DLK). According to M. Moshirfar, K.M. Durnford, A.L. Lewis (2021), its incidence after the LASIK procedure is 4.3 %, and according to P. Sahay and R.K. Bafna (2021), this figure reaches 18.9 %. With FemtoLASIK, the incidence of DLK ranges from 0.5 to 37.5 % or more, according to the data provided by A. Leccisotti and S.V. Fields (2021). P. Kanclerz, R. Khoramnia (2021) reported that the risk factors for DLK include the formation of a thin corneal flap and the implementation of FemtoLASIK technology. The purpose was to investigate the characteristics of development and progression of diffuse lamellar keratitis after various types of excimer laser correction of myopia over long-term follow-up. Materials and methods. The research was conducted at the Department of Ophthalmology of the Shupyk National Healthcare University of Ukraine from 2021 to 2024. It was a prospective, cohort-based, and non-interventional study. A total of 180 patients (360 eyes) were enrolled and divided into two groups. Participants in the first group (182 eyes) underwent LASIK, while in the second group (178 eyes), FemtoLASIK was performed. All patients underwent dynamic postoperative monitoring, including visual acuity, biomicroscopy, tonometry, keratopachymetry, and other tests to detect complications, particularly DLK. The frequency and clinical course of DLK were assessed at 6 months, 1, 1.5, and 2 years after surgery. Results. At the 1.5-year follow-up, one patient in the first observation group had DLK grade III in one eye (0.56 %). By the 2-year mark, no clinical signs of DLK were observed in this group. In the second observation group, DLK grade III was found in 6 eyes (3.37 %) at 1.5 years, and this figure remained consistent 2 years after. The difference between the groups was statistically significant (p = 0.01). Conclusions. Our study found that DLK after LASIK was not observed after 2 years of follow-up. The incidence of DLK after FemtoLASIK at the 2-year follow-up was 3.37 %, which was statistically significant compared to LASIK. The clinical course and manifestations of DLK after LASIK and FemtoLASIK didn’t differ at all follow-up intervals.

Clinical outcomes of reconstruction on tissue defects with thin anterolateral thigh flap versus commonly used free soft flaps: A meta-analysis.

The thin anterolateral thigh flap (tALTF) is gaining attention in reconstructive surgery due to its aesthetic and functional advantages. However, its clinical safety and outcomes compared to other commonly used free soft flaps (CUFSFs) remain unclear. Studies were systematically searched from PubMed, EMBASE, Medline, Cochrane, Web of Science, and China National Knowledge Infrastructure Database up to November 2, 2024. Flap failure, donor and recipient site morbidity, secondary salvage surgery, and patient satisfaction were evaluated. A total of 416 cases from 7 studies were included in our analysis. No significant difference was observed between the two groups in flap failure and secondary salvage surgery. However, tALTF showed significant advantages over CUFSFs in skin grafting, donor and recipient site morbidity, and patient satisfaction. This meta-analysis highlights the clinical safety and superior outcomes of tALTF compared to CUFSFs in reconstructive surgery, suggesting its viability as a preferred option for surgeons. However, the retrospective design of the included studies and limited sample sizes necessitate further large-scale prospective studies to validate these results.

Thin flap sulcus‐deepening trochleoplasty in patellar instability yields good functional outcomes without progressive cartilage deterioration in the short‐term follow‐up—A retrospective single‐surgeon cohort study

AbstractPurposeSulcus‐deepening trochleoplasty (TP) effectively treats patellofemoral (PF) instability (PFI) caused by high‐grade trochlear dysplasia (TD), but current evidence is based on small case series. We hypothesised, that TP would result in significant functional improvements and a low re‐dislocation rate but would not accelerate the progression of PF cartilage deterioration.MethodsWe retrospectively reviewed all TP cases performed by a single surgeon between 2015 and 2021. Inclusion criteria were postoperative Magnetic resonance imaging (MRI) &gt;6 and &gt;12 months and a clinical follow‐up &gt;12 months. Patients with simultaneous cartilage repair, open physes or incomplete records were excluded. Clinical outcomes were assessed using pre‐ and postoperative scores, postoperative Banff Patellofemoral Instability Instrument (BPII) 2.0 and Knee Injury and Osteoarthritis Outcome Score (KOOS), re‐dislocation rate and patient satisfaction. PF cartilage was evaluated via Area Measurement and Depth &amp; Underlying Structures (AMADEUS) scores preoperatively, at 6 months and at the final follow‐up.ResultsWe included 113 patients (25.8 ± 8.3 years) with high‐grade TD (Dejour B–D; mean lateral inclination angle: −2.9 ± 9.1°), 85% of whom had advanced cartilage lesions. All underwent TP, lateral retinacular lengthening (LRL) and medial patellofemoral ligament reconstruction (MPFL‐R). After 34.8 ± 20.9 months, function, pain levels and Tegner scores improved significantly (p &lt; 0.001). KOOS dimensions were: symptoms 79.9 ± 13.5, pain 86.4 ± 12.1, activity 91.9 ± 8.3, sports 71.7 ± 22.2 and quality‐of‐life 58.1 ± 23.8. BPII 2.0 was 64.3 ± 31.4. Preoperative AMADEUS scores (55.2 ± 17.4) remained stable at 6 months (p = 0.343) but improved to 58.4 ± 16.0 at 28.6 (12–89) months (p = 0.004). Complication and re‐dislocation rates were 5.3% and 1.8%, with 93% patient satisfaction.ConclusionSulcus‐deepening TP with MPFL‐R and LRL yields good to excellent short‐term results without progressive chondral deterioration, enabling patients to return to their prior or higher activity levels despite advanced preoperative chondral lesions. TP can be considered a safe, joint‐preserving technique for PF stabilisation.Level of EvidenceLevel III, retrospective cohort study.

A Thin Anterolateral Thigh Free Flap for Severe Hand Burn Deformity

Background: Hand is one of the most commonly involved areas in burn injury, resulting in contracture.1 Reconstruction of severe postburn hand deformity is very challenging. Because there is no adjacent skin laxity to allow for local flaps in the burned hand, distant or free flaps should be considered. 2 Application of the thin anterolateral thigh flap in hand reconstruction has become one of the most preferred options for resurfacing of soft-tissue defects after contracture release. 3 Other than closing the defect after contracture release, restoration of hand function is also essential.Patient and Methods: In 2010, a man, 37 years old presented with severe contracture on the right hand due to an explosive flame burn 1,5 years ago. On the right hand, there was hyperextension at the metacarpophalangeal (MCP) joint with flexion on the wrist and thumb abduction with hyperextension at the interphalangeal joint. Our goal is to reconstruct this severe hand burn deformity using thin ALT free flap with flap thickness 4 mm to achieved good hand contour.Results: The thin ALT free flap was vital, and 1-year follow-up gives good hand contours. Patient under rehabilitation therapy from 2 weeks postoperative to attain good functional hand.Summary: A thin anterolateral thigh free flap gives good alternative for resurfacing defect in reconstruction of burn hand than other fasciocutaneous flaps. The advantage are it provides the same color and texture, thin and pliable flap to form good hand contour.

Bilateral Versus Unilateral Repair of Nasal Septal Perforation: A Two-Center Retrospective Study.

There are two main approaches for nasal septal perforation (NSP) surgery-bilateral and unilateral repair. There are advantages and disadvantages to each of these techniques. At the same time, there is a lack of comparative studies on the effectiveness of these approaches. The study aims to compare the effectiveness of unilateral and bilateral closure of NSP. A total of 99 patients with symptomatic NSP underwent surgery between 2021 and 2022 and were followed up at two large tertiary centers. The "unilateral closure" group (Group 1, N = 47) utilized an anterior ethmoidal artery (AEA) flap to close the perforations. Group 2 (N = 52) consisted of patients, who underwent bilateral closure of NSP. Complete closure of the NSP was achieved in 39 of 47 (83%) patients in Group 1 and in 48 of 52 (92.3%) patients in Group 2. There was a trend toward a higher incidence of incomplete defect closure among Group 1 patients when analyzing the subgroups of large (>2 cm) NSP (RR = 2.75 [95% CI: 0.96; 7.87], p = 0.072). There was a statistically significant decrease in SNOT-25 score after surgery in each of the study groups (p < 0.001) with no significant differences between groups (p = 0.51). The relative advantages of the thin flap are outweighed by the obtained data of higher efficacy of the bilateral technique in large NSP cases. Therefore, in cases of surgical repair of small and medium-sized NSP, the closure rates after single-layer and double-layer closure are comparable. III Laryngoscope, 2024.

Thinning of the Medial Sural Artery Perforator Flap: The Anatomical Examination of the Medial Sural Artery Perforator Branch.

The medial sural artery perforator (MSAP) flap is thin, pliable, and versatile. This study aims to understand the anatomical basis of the MSAP flap and the subcutaneous course of the perforator for safe flap thinning. A total of 24 MSAP flaps were dissected under red silicone dye injection guidance. Full-thickness horizontal slides of flaps were performed, and the perforator courses were identified in the subcutaneous plane. Slides were placed on a millimeter board, and the perforator patterns were photographed and observed with loupes. A total of 68 perforator courses were identified: type 1: 30.9%, type 2: 57.3%, and type 3: 11.8%. They traveled 1-25 mm to the subdermal plexus, with percentile 2.5 at 1 mm, percentile 90 at 18.2 mm, percentile 95 at 21.65 mm, and percentile 100 at 25 mm. The mean flap thickness was 7.75 ± 1.7 mm, with an average of 5.7 ± 1.3 perforators per flap. Perforators clustered between 2 and 18.4 cm from the popliteal crease and 0-8 cm from the posterior midline of the leg. The dominant perforators accounted for 45.2% (62 of 137), averaging 2.58 per flap. The medial sural artery branching pattern types were type 1: 37.5%, type 2: 50%, and type 3: 12.5%. The average pedicle length was 16.2 ± 1.3 cm, and the mean external diameter of the medial sural artery was 1.98 ± 0.13 mm. MSAPs branch within a maximal radius of 2.5 cm after emerging from the deep fascia. To maintain vascularity, the safe suprafascial dissection should be 2.5 cm apart from the point of emerging.

Investigating the Thickness of the Deltoid Free Flap Using Ultrasonography and Clinical Application in Foot and Hand Soft-Tissue Defect Reconstruction.

Although the deltoid flap is widely described as a thin flap, no studies have reported on the measurement of its thickness. Thus, this study aimed to measure deltoid flap thickness at different points using brightness-mode ultrasonography and report our initial clinical experience. This study included 36 adults (26 males and 10 females; mean age: 34 years) with 72 healthy deltoid regions. Ultrasonography was employed to measure flap thickness at eight designated positions. The ultrasonography results were also applied clinically in 30 patients to evaluate its compatibility. The mean deltoid flap thickness was 5.14 ± 0.81 mm, with the thickest point being the emerging point of the flap pedicle. The subcutaneous fat gradually thinned toward the shoulder. No significant differences in the subcutaneous fat layer thickness were observed between the right and left sides, different ages, or the two sexes. Body mass index was the most critical factor related to flap thickness (p < 0.001). All deltoid free flaps were successfully transferred, resulting in good or excellent final clinical outcomes. The ultrasonography results suggest harvesting the deltoid flap upward toward the shoulder area and across the acromion from the emerging position of the flap pedicle to optimize flap thinness. The results showed that besides the flaps that have been clinically well established, the deltoid flap should be considered a valuable alternative for reconstructing limb soft-tissue defects, particularly where thin flaps are required and favorable aesthetic results are crucial.

Surgical refinements and sensory and functional outcomes of using thinned sensate anterolateral thigh perforator flaps for foot and ankle reconstruction: A retrospective study.

To improve the use of sensate anterolateral thigh (ALT) flaps for foot and ankle reconstruction, we employed a thinned nerve-selective harvesting technique. The data of 31 patients in whom sensate ALT perforator flaps were transferred for reconstruction of soft-tissue defects in the foot and ankle were reviewed. Flaps were elevated with 2 refinements. The first is the initial selection of the "true" sensory branch in the medial incision on the suprafascial plane. The second is flap thinning by keeping a cuff of thin deep fat surrounding the point where the perforator or nerve branch inserts into the superficial fat layer. The recipient site assessment consisted of complications, monofilament touch perception, sharp-blunt discrimination, axial circumference, and American Orthopedic Foot and Ankle Society score. After a mean follow-up of 31.7 months, all flaps survived uneventfully, except for marginal necrosis in 1 patient, infection in 1 patient, ulceration in 2 patients, and secondary thinning in 3 patients. The sensation of each flap was restored. A total of 87% and 90% of the patients exhibited 5 or more positive response points in the Semmes-Weinstein monofilament touch and sharp-blunt discrimination testings, respectively. The mean axial circumference of the reconstructed foot was 27.4 cm (the unaffected side was 25.8 cm). All patients achieved mobility in ordinary shoes with a mean functional score of 74.6. The thinned nerve-selective sensate ALT perforator flap can be a favorable option for foot and ankle reconstruction. This method also offers the possibility of preserving the nerve branch at the donor thigh.

Trochleoplasty and à-la-carte procedures for patellar instability in young and active patients: Clinical outcomes at minimum 2 Years follow-up

IntroductionPatellar instability is a common condition affecting approximately 6 individuals per 100,000, but among adolescents, this incidence is notably higher. Trochlear dysplasia has been recognized as the pathoanatomic risk factor exerting the most significant biomechanical influence. Over time, various surgical techniques have been developed to address trochlear dysplasia. The purpose of this study is to evaluate the clinical outcomes, return to sport, as well as complications and re-operation rate of sulcus deepening trochleoplasty performed in a cohort of young and active patients using the Bereiter technique. Materials and methodsBetween January 2019 and February 2022, 11 cases of recurrent patellar dislocations underwent trochleoplasty. Preoperative radiological assessment included X-rays, CT scans following the Lyons and MRI. Inclusion criteria for the study and trochleoplasty indications included patients aged 10–25 with recurrent patellar dislocations unresponsive to nonoperative treatment and minimum type B trochlear dysplasia. Clinical follow-up occurred at 1-3-6 months and annually, with control X-rays at these intervals. Patient-reported outcome scores included the Knee Society Score, Kujala score, and Karnofsky performance status scale. ResultsBetween January 2019 and February 2022, 11 patients underwent trochleoplasty and were included in this study. Preoperative radiological measurements indicated mean values: sulcus angle (152.5°), trochlear depth (3.4 mm), Caton-Deschamps index (1.2), tibial tuberosity to trochlear groove (TT-TG) distance (17.5 mm), external patellar tilt angle (6.8°), femoral anteversion (11.5°), and tibial torsion (32°). All patients were followed up for at least 2 years, with an average of 43 months. Concurrent surgeries included tibial tuberosity transposition (100 %), MPFL reconstruction in 9 cases (81.8 %) and 2 patients also underwent division of the external alar ligament (18,2 %). PROMs at final follow-up showed mean values: Knee Society Score (KSS) (80.5), Kujala score (88.3), and Karnofsky performance status scale (88.8). Return to sport was reported by all active patients. Three cases required secondary surgical intervention for removal of the screws. ConclusionTrochleoplasty, especially with the Bereiter "thin flap" approach, improves patellofemoral congruency. Combining trochleoplasty with tibial tuberosity transposition addresses mal-tracking related to severe dysplasia and other à-la-carte procedures like medial patellofemoral ligament (MPFL) reconstruction enhance stability. In young and active patients, it resolves instability issues and reduces the likelihood of further dislocations with high return to sport rates.

Versatility of Proximal Sural Island Sensate Fasciocutaneous Flap in Reconstruction of Soft Tissue Defects of Knee and Proximal Leg

Background: The proximal sural island sensate (PSIS) fasciocutaneous flap presents an ideal alternative in reconstruction of defects of the knee and proximal leg. It provides a thin sensate flap with good aesthetic outcomes and reduced donor site morbidity. However, only limited reports exist in the literature about this flap.Methods: This is a retrospective study done between December 2018 and December 2021 including 30 patients, among which seven cases had defects located on the knee and 23 cases in the proximal part of the leg. Mean age of the study population was 41 years. The maximum flap size was 8×12 cm, while the maximum pedicle length was 15 cm.Results: All 30 flaps survived well with only minimal complications occurring in a few patients such as epidermal loss and distal tip necrosis. No arterial or venous crisis occurred postoperatively in any case. Donor sites were managed with one-stage primary closure or split-thickness skin grafts. Functional deficits were not detected in any of the cases.Conclusion: We found the PSIS fasciocutaneous flap to be a simple and reliable technique to perform. The flap offers extensive coverage, reaching from the knee to the proximal leg, and provides thin, pliable, and sensate skin, resulting in excellent aesthetic and functional outcomes.

Application of Free Flaps in Reconstruction of Head and Neck Soft Tissue Defects With Bone Exposure.

Reconstruction of head and neck soft tissue defects with bone exposure is both challenging and technically demanding for plastic surgeon. Objectives in head and neck soft tissue defects with bone exposure reconstruction are consistent restoration of functionality while also improving appearance. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 4 years. A retrospective analysis was conducted from June 2019 to June 2023 on 12 patients treated at our hospital for head and neck soft tissue defects with bone exposure due to various causes. These included 4 cases of trauma from car accidents, 1 burn case, and 7 postoperative malignant tumor removals. The defect sizes ranged from 4 × 6 to 15 × 45 cm. Different free flaps were used for repair based on the defect, including 6 anterolateral thigh flaps, 3 forearm flaps, 2 latissimus dorsi flaps, and 1 dorsalis pedis flap. Flaps were designed and harvested to match the defect size and transplanted via anastomosed vessels. All 12 flaps survived successfully. One patient required flap thinning surgery postoperatively. All patients were followed up for over 3 months, showing good color and texture of the transplanted flaps, satisfactory healing, and significant aesthetic improvement. Donor sites showed significant scarring without functional impairment. Free flap repair for head and neck soft tissue defects with bone exposure is feasible and yields good results.

Complex Scalp Reconstruction with Super Thin DIEP Free Flap

Complex Scalp Reconstruction with Super Thin DIEP Free Flap

Reliability and Safety of the Superthin Anterolateral Thigh Flap: Evaluating Perfusion-Related Complications and Donor Morbidity.

With an increasing need for thin flaps, the use of superthin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin-flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRCs) and donor-site morbidity. This study aimed to evaluate the outcomes of superthin ALT flap-based reconstruction compared with those of suprafascially elevated flaps. Patients who underwent free ALT flap-based reconstruction between March of 2017 and June of 2023 were reviewed and categorized into 2 groups based on flap elevation plane: superthin or suprafascial. Development of PRC and donor-site morbidity, including paresthesia, was compared. Independent associations of the elevation plane with complication profiles were evaluated. Further analyses were conducted using propensity score matching. In total, 208 cases were analyzed: 80 superthin and 128 suprafascial ALT flaps. Nineteen cases (9.1%) experienced PRC, including 4 total and 14 partial necrosis. The incidence of overall and each type of PRC did not differ based on flap elevation plane even after adjusting for other variables. The superthin group exhibited significantly lower donor-site complications compared with the others, which was upheld in multivariable analyses. Elevating the flaps in a superthin fashion allowed for a higher rate of preservation of the lateral femoral cutaneous nerve, resulting in a significantly lower rate of postoperative paresthesia. Similar associations were observed in the propensity score matching analysis. Superthin ALT flap elevation does not appear to increase PRC risk and reduces donor-site complications, compared with suprafascial elevation. Therapeutic, IV.

Reconstructive strategies following surgical resection of malignant sublingual gland tumors: A single institution experience

ObjectiveTo investigate the characteristics and treatment modalities of malignant tumors originating from the sublingual gland, as well as evaluate the therapeutic outcomes following free flap reconstruction. MethodsA retrospective statistical analysis was conducted on the clinical data of nine patients diagnosed with malignant neoplasms tumor of the sublingual gland. ResultsNine case of malignant tumors originated from the sublingual glandular tissue, encompassing eight adenoid cystic carcinoma (ACC) and a single case of bipartite differentiated carcinoma—a hybrid of epithelial-myoepithelial carcinoma and adenoid cystic carcinoma. Among the nine patients, four anterolateral thigh flaps were used (three of which were thin flaps), and five forearm flaps were also empoyed. The size of flaps varied, with the lengths ranging from 4 cm to 9 cm, and the widths ranging from 2.5 cm to 6 cm. The vessels chosen for anastomosis were the superior thyroid artery in seven cases, the facial artery in one case, and the lingual artery in one case. Among the eight patients who underwent dissection of cervical lymph nodes, metastasis were found in one case. Two patients underwent adjuvant radiotherapy. Upon postoperative follow-up, there was no recurrence in any of the nine patients . ConclusionThe anterolateral thigh perforator flap thinning technique can be employed for postoperative reconstruction of malignant sublingual gland tumors.

Medial Plantar Artery Flap for Soft Tissue Coverage of Heel Defect: A Case Report

Background: Numerous flap options exist for providing soft tissue coverage for defects on the heel region. This study presents a case where a bone-exposed wound on the left heel region was successfully reconstructed using a medial plantar artery flap. Case Report: A 16-year-old girl presented with a necrotic wound on the left heel region with calcaneus, malleolus, and talus fractures following trans-ankle external fixation on her left leg. After debridement and necrotomy, the wound revealed exposed calcaneus and implant. A medial plantar artery flap was dissected, preserving its vascularization. The flap was then carefully transferred to the wounded area and sutured appropriately. A skin graft harvested from the ipsilateral femoral region was used to cover the donor site. Discussion: This case demonstrates the efficacy of the medial plantar artery flap as a local flap option for heel defect coverage. It is a relatively easy-to-perform procedure that provides a strong and thin skin flap. Moreover, it offers a favorable cosmetic outcome for the patient, as the surgical scar can be be relatively easy to hide with footwear. However, limitations of the medial plantar artery flap include its size and depth constraints, as well as loss of vascularization from a medial plantar artery on the plantar region. Conclusion: The medial plantar artery flap is a feasible option as a local flap for the heel region. It is relatively easy to perform, provides a strong thin skin flap, and can results in a preferable cosmetic outcome.

Successful salvage of upper extremity following severe crush injury associated with vascular compromise using a supra thin free anterolateral thigh flap

Traumatic injuries of the upper limbs can often result in serious and challenging wounds involving multiple compartments such as skin, bone, tendons and neurovascular structures. These type of injuries of the upper extremity pose several challenges to the plastic surgeon. The main difficulty is to provide a stable, long lasting and aesthetically acceptable coverage that enables joints excursion so that patient can return to work at the earliest. Here, we present a case of 45 years old gentlemen who sustained severe crush injury associated with avulsed radial and ulnar artery of left upper limb following road traffic accident. At presentation, there was no pin prick in his hand and hand was pale. At first surgery, hand was revascularized using a vein graft in radial artery and skin grafting was done over the forearm defect as a temporary cover. After 12 hours, when the viability of hand was reassured, the defect was covered with free supra thin anterolateral thigh (ALT) flap. Patient’s hand and flap both survived and he was discharged in a satisfactory condition.

Thin Free Perforator Flap as a Viable Option for Forefoot Reconstruction: Comprehensive Evaluation of Outcomes.

Reconstruction of forefoot defects often necessitates free tissue transfer due to the limited availability of local tissue. Microsurgical reconstruction of the forefoot remains challenging, as it requires durable yet thin soft-tissue coverage for functional restoration. This study aimed to evaluate the efficacy of free thin perforator flaps for forefoot reconstruction, with a focus on functional outcomes. Records of patients who underwent microsurgical forefoot reconstruction between March of 2020 and September of 2023 were reviewed. Development of postoperative complications and functional outcomes were evaluated. In total, 53 patients (mean age, 62.7 years) were analyzed. The most common cause of defects was oncologic surgery, followed by chronic wound, with a majority involving the plantar side. The superthin anterolateral thigh flap and superficial circumflex iliac artery perforator flap were predominantly used. The median flap thickness was 4.0 mm. Digital vessels were the most frequently used as recipients. All but one flap survived, resulting in a success rate of 98.1%. Postoperative flap site complications developed in 20 patients, the majority of which resolved with conservative treatment. The median hospital stay was 8.0 days, and the mean time for initiating weight-bearing ambulation was 12.4 days. In the postoperative Foot Function Index questionnaire survey, the overall score was 9.41, showing minimal impairment, and it did not differ according to defect size or location. A secondary debulking operation was needed in 7 patients. Use of thin free perforator flaps might provide reliable outcomes with rapid recovery and excellent postoperative function in forefoot reconstruction. Therapeutic, IV.

Elbow coverage by the descending superficial radial artery flap: a clinical series and literature review.

Soft tissue coverage of the posterior aspect of the elbow requires thin and flexible flaps to adapt to movements without constraining them. The authors report a clinical series of reconstruction by the descending superficial radial artery (DSRA) flap, a proximal forearm perforator flap which use is rarely reported in the literature. Seven patients with a mean age of 50years (range 24-88years) were treated for a posterior elbow defect using the DSRA flap with an adipofascial pedicle. The flap was tunneled to the defect in the subcutaneous tissue or raised using the racket-like technique to avoid any pedicle compression. The mean follow-up was 3.3months (range 1-12months). A partial necrosis of the skin paddle occurred in an 88-year-old patient. In the other cases, the flap evolution was straightforward. At the last follow-up, the appearance of the flaps was satisfactory in terms of color, texture, and thickness. No complications were observed at the donor site. The DSRA flap with an adipofascial pedicle is a simple, reliable, and reproducible method for reconstruction of small to moderate-sized defect on the posterior aspect of the elbow. Its use is easier for defects on the posterolateral side, but it can reach the medial olecranon.

Enhancing Viability of the Muscle-Sparing Latissimus Dorsi Flap

Aim:The aim of this study is to enhance the viability of the muscle-sparing latissimus dorsi flap. In this study, the muscle-sparing latissimus dorsi myocutaneous flap was designed with the skin paddle of the flap over the distal perforators of the thoracodorsal artery and perforators of the 10th or 11th posterior intercostal arteries. The flap was elevated together with the deep fascia at the base. Methods: Sixteen flaps were used for the repair of defects in different regions in 14 patients, five female and nine male, with a mean age of 45 years. Flap sizes vary from 9x21 to 14x27 cm. The defects were located in anterior thoracic wall in patient four, arm in patient three, axillary fossa in patient three, deltopectoral region in patient two and posterior thoracic wall in patient two. The mean follow-up period was 13 months. Result: All flaps survived without total or partial loss. Seroma or contour deformity in the donor area did not develop. A visible scar developed in the donor area in a patient. Flap thinning was performed on two flaps. In all patients, shoulder joint function returned to normal in the last months postoperatively. Conclusions: If the muscle-sparing latissimus dorsi flap is prepared to include the skin paddle 10th or 11th posterior intercostal arteries and together with the deep fasciae (dorsal thoracic fascia and scarpa’s fascia), it can be safely elevated large sizes.