Good Soft Tissue Coverage Research Articles

A single stage management procedure of gustilo type-III open tibial fractures by Ilizarov with secondary clouser and flap transplantation: an article

Introduction: The management of Gustilo-Anderson type-Ⅲ open tibial fracture is complex due to neurovascular damage and soft tissue loss. Combined orthopedics, plastic and vascular surgery provides better result for reconstructing the injuries of limb. The prevalence of tibial shaft fractures is estimated about 67%.1,2 Tibial shaft fractures are approximately 15% of all adult fracture and open tibial fractures are about 23.5%.1 Rigid fixation and good soft tissue coverage are essential for management of the fracture. Ilizarov external fixator, provide multi-disciplinary management of type Ⅲ open tibial fractures with sever contamination and comminution. Purpose of the study: To evaluate the clinical efficacy of Ilizarov external fixator with or without fascio-cutaneous flap transplantation in the management of Gustilo-Anderson type-Ⅲ open tibial fracture. Methodology: In the period of 2020 -2021, we manage 5 cases of Gustilo- type-Ⅲ open tibial fracture by Ilizarov. 2 patients were type-ⅢA and 3 type-ⅢB with severely contaminated and comminution. No neurovascular damage. All are male, age 30 -65 years and caused by RTA. There was 1 diabetic and 1 hypertensive patient. Surgical toileting, debridement and posterior slab apply as immediate management. All patients managed by Ilizarov on 5th and 7th day with secondary closure of type-ⅢA and vascularized fascio-cutaneous flap with skin grafting in type-ⅢB cases by orthopedic and flap surgeon. Summary: Full weight bearing was allowed on 3rd Soft tissue was healed within 3-6 weeks. In 1 case found skin infection, treated by antibiotic and dressing, also 1 case occurred flap edge necrosis, managed by debridement and 2nd time skin graft. Bone union time was 5-6 months, RUST scores 10. According to ASAMI score all were excellent results. Conclusion: RTA is the main cause of type Ⅲ open tibial fractures. Combined multi-disciplinary managements by Ilizarov provide excellent outcomes, early mobilization and infection control. It is a single stage definite management, which reduce treatment cost, patient`s mortality and morbidity.

Use of Propeller Flaps for the Reconstruction of Defects around the Ankle

Abstract Background This article describes the clinical results of the use of propeller flaps during reconstruction of coverage defects around the ankle. Methods A retrospective study of all patients with bone and soft tissue defects around the ankle reconstruction using propeller flap between January 2021 and December 2022 was conducted. Flap survival rate and complications were the outcomes variables. Results A total of 14 reconstructions in 13 patients (mean age: 45.8 ± 16.7 years) using propeller flaps were performed in the study period. The medial malleolus was the most affected area (n = 5) and the defect size ranged from 12 to 33.7 cm2. The posterior tibial artery was used as a perforator in 11 flaps. Complications were identified in five flaps, four developed venous congestion and one case, reactivation of infection. Only one propeller flap presented complete failure associated with necrosis. Good soft tissue coverage was achieved in 13 of 14 flaps. Conclusion Propeller flaps proved to be a valid management option during reconstruction of bone and soft tissue defects around the ankle, offering adequate coverage in most cases. Adequate patient selection is important to decrease the risk of complications.

Recurrent heel ulcers with calcaneal osteomyelitis in myelomeningocele: Treatment by partial calcanectomy and posterior transfer of tibialis anterior tendon

OverviewCalcaneus deformity of the foot is common in patients with myelodysplasia, mainly due to muscle imbalance. This deformity, especially in ambulatory patients, can result in gait problems and development of pressure sores, which can be complicated by calcaneal osteomyelitis. Material and methodsThis retrospective cross-sectional study included 12 patients (18 feet), with calcaneus deformity due to myelomeningocele, and presented with penetrating heel ulcers complicated by calcaneal osteomyelitis. The mean age of the included cases was 11 years. The ulcers were unilateral in six patients and bilateral in six. Sensation was absent on the plantar aspect of the foot in all cases. The treatment was done in two stages; The first stage was eradication of infection and obtaining good soft tissue coverage, and the second stage was obtaining motor balance to achieve a more plantigrade and braceable foot. ResultsThe average follow-up period was 19.2 months. In the final follow-up, twelve feet were graded as good, five as fair and one as poor according to Legaspi grading system. ConclusionThe combination of partial calcanectomy and subsequent transfer of tibialis anterior tendon, to improve the foot position and gait, can efficiently prevent ulcer recurrence in myelomeningocele patients with calcaneal deformity. Level of clinical evidence: 4Retrospective case series study.

Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

BackgroundLarge post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects.MethodsWe retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2–58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2–18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification.ResultsThe mean duration of follow-up after frame removal was 32 months (range, 12–96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7–147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14–37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

The treatment of onychogryphosis of hand nails by total matricectomy and dorsal V-Y advancement flap.

Objectives This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails.Patients and methods A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. The Mann- Whitney U test was used to compare the pre- and postoperative Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire scores while postoperative satisfaction rate was also evaluated.Results The mean follow-up period of the patients was 15.3 months. The etiology was finger trauma in eight and surgical complication of recurrent paronychia drainage in four cases, while the remaining six were idiopathic. The mean time to return to work was 5.2 weeks, and the mean pre- and postoperative Quick DASH scores were 0.97 and 3.45, respectively, with a statistically significant difference. The postoperative satisfaction was rated as excellent in 16, good in one, and moderate in one case.ConclusionThe dorsal V-Y advancement flap technique can be performed reliably due to its good soft tissue coverage, satisfactory cosmetic and functional outcomes, and allowing a short time to return to work.

Lateral Malleolar Defect Coverage Using Abductor Digiti Minimi Muscle Flap.

The lateral malleolar region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation. The abductor digiti minimi (ADM) muscle flap offers a promising treatment option for the reconstruction of small- to moderate-sized defects that have exposed bone, joint, or tendons in the lateral malleolar area. Between 2013 and 2016, 8 patients with foot ulcers were reconstructed with ADM muscle flap. The muscle component of the flap obliterated the dead space and provided a vascularized muscle over the debrided ankle joint. When it is needed, the flap is covered with a small split-thickness skin graft. In all cases, complete healing was achieved. The muscle flap functioned well as a versatile and shock absorbent coverage without recurrence of the ulcer during a mean follow-up period of around 2 years. Coverage of a soft tissue defect at the lateral side of the ankle remains a challenge for surgeons because of the limited possibilities for local transposition. Free flaps have frequently been associated with postoperative complications and higher costs. Also, not all patients are suitable candidates for free tissue transfer because of existing comorbidities. Coverage with a split-thickness skin graft will not be possible for wounds with exposed bone or neurovascular structures or in wounds involving the weight bearing surface of the foot. Using ADM muscle offers no donor site morbidity, good soft tissue coverage, and an effective healing process. Also, no limb movement affection and normal daily life are acquired.

Conservative treatment of fingertip injuries in children - first experiences with a novel silicone finger cap that enables woundfluid analysis.

Introduction: Human fingertips are able to regenerate soft tissue and skin after amputation injuries with excellent cosmetic and functional results when treated with semiocclusive dressings. Despite bacterial colonizations, proceeding infections are not reported with this management. The underlying mechanisms for this form of regenerative healing as well as for the resilience to infections are not known. Due to the lack of mechanical protection, the leakage of maloderous woundfluid and the sometimes challenging application, conventional film dressings have their problems, especially in treating young children. We therefore treated selected patients with a novel silicone finger cap with an integrated wound fluid reservoir that enables atraumatic routine wound fluid aspiration.Methods: We report on 34 patients in between 1 and 13 years with traumatic fingertip amputations primarily treated with occlusive dressings. 12 patients were treated with a novel silicone finger cap. We summarized clinical data for each patient. This included photographs and microbiological results from wound fluid analyses, whenever available. Results: The results of both, conventional film dressing and silicone finger cap treatment, were excellent with no hypersensitivity and no restrictions in sensibility and motility. Even larger pulp defects were rearranged in a round shape and good soft tissue coverage of the distal phalanx was achieved. Nail deformities were not observed. We detected a wide spectrum of both aerobic and anaerobic bacteria in the wound fluids but infections were not observed. Epithelialization times did not differ significantly and no severe complications were seen in all primarily conservatively treated patients. Conclusion: This study provides preliminary data demonstrating that the treatment with the silicone finger cap leads to excellent clinical results in wound healing. Interestingly, the wounds were colonized with a wide range of bacteria including species that may cause wound infections. However, we saw no proceeding inflammation and the regeneration was undisturbed. In the future, the efficacy of this new management should be evaluated in randomized, controlled clinical trials to confirm the results under standard conditions and get more insight into the role of the wound microbiome as well as other factors that may promote regeneration. The aspirable Reservoir of the finger cap will enable easy atraumatic sampling of wound fluids both for diagnostic and for research purposes as well as possibly allowing direct administration of pro-regenerative drugs in the future.

Assessment of radiological outcomes in gap non-union of long bones using non-vascularised fibular strut graft augmented with corticocancellous graft

Background: A prospective study was conducted in the department of Orthopaedics & Traumatology in Dr. D.Y Patil Hospital, Navi Mumbai from January 2015 to June 2017 to assess radiological outcomes in traumatic gap non-union of long bones after primary plate fixation failure using non-vascularised fibular strut graft augmented with corticocancellous graft. Methods: A total of 20 patients were included in study presenting with non-union of humerus. In 13 males and 7 females, age between 18-65 years (average 41 years), were operated using non-vascularized fibular strut graft taken from ipsilateral site augmented with auto corticocancellous graft. All the patients were operated by same surgeon with removal of previous plate and fixing with re-plating and intramedullary fibular grafting. The mean follow-up was 9 months (range 6-12 months). The patients were assessed for functional range of motion along with x-ray. Union was achieved after confirming on x-ray. Observations & Results: In study 20 patients there were 13 males and 7 females with average age being 41.35 yrs, average length of fibular graft was 6.3 cm and mean duration of union 21.15 weeks.1 patient was lost in follow up and none of patients showed non union or secondary intervention thus ensuring Bony union in all 20 patients treated with graft and plating Conclusion: This procedure successfully showed that union at nonunion site with adequate vascularity and good soft tissue coverage can be achieved with proper patient selection and using fibular graft in addition to traditional plating and CC graft technique. Even though procedure is lengthy but it’s simplicity, reproducibility and non expensive and patient compliant outcomes makes it a valid option to achieve union in nonunion.

Autologous fibula transplantation for reconstruction of bone defects

The reconstruction of large bone defects following tumor resection, trauma or infection is difficult and subject to individual preferences of each surgeon. Free autologous fibula grafts are areliable biological treatment method, whereas both avascularised and anon-vascularised transplantation is possible. The use of either treatment option - vascularised or non-vascularised - is accompanied by individual advantages and/or disadvantages that should be taken into consideration during the preoperative planning process. Vascularised fibula transplants should be used especially for the reconstruction of large segmental defects and in patients, in whom adjuvant chemo- and/or radiation therapy is to be administered. Non-vascularised fibula grafts - which offer the advantage of acertain regeneration potential at the donor site as well as ashorter operation time - might be beneficial for bridging hemicortical defects and segmental defects with good soft tissue coverage.

Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap

PurposeTo evaluate the role of immediate and definitive management of Gustilo type III A/B tibia fractures with intramedullary nailing and fasciocutaneous flap. MethodsFrom August 2010 to July 2012, 22 patients with Gustilo Grade III A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap & reamed intramedullary nailing and were included in the study. The severity of the injury was calculated with Ganga Hospital injury severity score. ResultsThe mean age of patients was 41 years and the follow-up time ranged from six months to one year. Among the 22 patients, 73% were type III B fractures with upper leg involved in 55% of them. The time interval from injury to completion of surgery was 8–14 h. The incidence of bone infection requiring secondary procedure was 9%; the major and minor soft tissue complication rate was 9% and 14% respectively. The limb salvage rate was 100%. ConclusionMultidisciplinary management of severe lower limb trauma is important and provides good outcomes. Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade III A & B tibia fractures.

Sternoclavicular Joint Infection Treated with Debridement, Vancomycin-Loaded Calcium Sulfate, and Partial Pectoralis Muscle Flap: A Case Report.

We report the case of a forty-six-year-old man with a left sternoclavicular joint infection that was treated effectively with surgical debridement, the implantation of vancomycin-loaded calcium sulfate, a partial pectoralis major muscle flap, and two weeks of intravenous antibiotics. Sternoclavicular joint infection is a rare problem that has received little attention in the orthopaedic literature. The combined surgical procedure detailed here provided good soft-tissue coverage, avoided the potential toxic effect of prolonged systemic antibiotic therapy, and resulted in a good clinical outcome.

Platelet rich fibrin as a membrane for coverage of immediate implants: Case-series study on eight patients

PurposeTo evaluate the efficacy of platelet rich fibrin as a membrane for coverage of immediate implants in the maxillary anterior region. Patients and methodsTwelve implants were inserted into eight adult patients indicated for extraction & immediate implant insertion in one or more of the upper anterior teeth. A venous blood sample of 10 cc was obtained for each single implant. After implant placement, the peri-implant defect was filled with a mixture of autogenous bone (collected from the chin) and fibrin. A platelet rich fibrin membrane was used to cover the implant site. Clinical & radiographic evaluation was performed immediately, 3 and 6 months postoperatively to evaluate soft tissue healing & crestal bone stability. ResultsAfter 6 months, the marginal bone was stable in 83% of cases. Clinically, good soft tissue coverage was obtained. Radiographically, bone height showed a statistically significant decrease in the distal side while there was no statistically significant decrease at the mesial side. The change in defect depth was limited to 2 mm. ConclusionPlatelet rich fibrin provided good soft tissue coverage over the immediate implants and it enhanced bone stability. The technique was easy to perform with good esthetic results.

Resurfacing of hand injury with groin flap: an analysis of thirty four cases

Hand injuries are prevalent among the young adult and middle aged active people specially who are engaged with machinery works. Hand performs the unique and essential mechanical function and for fulfillment of this function it is imperative to provide good soft tissue coverage with sensibility. Skin grafting causes wound contraction and result in gliding of tendon directly under skin and is also unable to provide sensibility. Though cutting and slicing injury can be closed directly, crushing, degloving and avulsion injury needs coverage with a flap. Free flap require highly skilled microvascular anastomoting technique and needs expertise. Pedicle flap are suitable for this purpose where facilities for free flap transfer are not available. This prospective observational study which was done in National Institute of Traumatology and Orthopadic Rehabilitation during the period from January 2000 to december 2001 involving thirty four patients with a age range of 15-50 yrs who sustained hand injury from machinery injury, road traffic accident and electric burn.The patients were followed up at 4th (week), 6th (week), 8th (week), 16th and 20th week. Majority of patient are male. 58.82% of patient had suffered from machinery injury and 23.52% of patient had suffered from road traffic accident. During resurfacing of hand injuries, 58.82% of patient needed a flap length between 15 to 17 cm and rest of the patient (41.16%) requires flap length below 15 cm.Among all patients, 70.6% required 7 cm to 10 cm wide flap and rest of the patient between 5 cm to 7 cm. About 86% of patients had no loss of flap, 10.71% had marginal distal flap loss, 3.57% patient had distal flap loss up to 5% and no patient had distal flap loss >5%. Functional out come in terms of Eating, drinking, dressing,washing, writing were satisfactory in all cases except only one patient who developed stiffness of hand which was 3.58% of total patient. Functional outcome were evaluated in terms of eating, drinking, dressing, washing, writing and other purposeful movement; and also in terms of joint movement, power grip and pinching. All patient regained full range of movement except one patient who had deficit of finger movement. In conclusion groin flap can be a better choice for resurfacing the hand injury with acceptable results. This study recommends the use of groin flap as routine choice for resurfacing larger hand injuries. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21372 Bangladesh Med J. 2014 January; 43 (1): 21-25

Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting

Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian.

Die Arthrodese des Tarsometatarsal-I-Gelenks mit einer plantaren Zuggurtungsosteosynthese

Treatment of hallux valgus in patients with a pathology of the first metatarsocuneiform (MC) joint by a fusion of the first MC fixed by a plantar plate. The plantar plate has biomechanical advantages and has good soft tissue coverage by the M. abductor hallucis. Instability or degenerative arthritis of the first MC joint in patients with hallux valgus. Short first metatarsal. Bone-saving resection of the first MC joint. Arthrodesis using a compression screw and a plantar interlocking plate. Distal soft tissue procedure and resection of the exostosis. For 6 weeks, a long sole, post-operative shoe with weight bearing as pain allows. Mobilization of the first metatarsophalangeal joint when the wound healing is assured. Full weight bearing after 6-8 weeks in a normal shoe, when the bone healing is completed on the x-rays. No sports with high demands on the foot for 12 weeks. Orthotics only in cases with persisted pain or associated pathology. In a case control study including 72 patients, a significantly lower rate of nonunion and soft tissue problems, compared to dorsal or medial plate positioning, was observed.

Clinical analysis of 86 cases of replantation of amputated distal fingers

Objective To summrize the clinical results of replantatiion of 126 amputated distal fingers in 86 patients. Methods The amputated part was debridod under 16X high power magnification. Kirschner wires were uniformly used for bony fixation. Tendon repair was carried out next. Severed distal fingers were revasculafized with different kinds of operations according to type Ⅰ, type Ⅱ and type Ⅲ classification of the distal parts. Vein grafts were used in cases of venous or arterial gaps and continuous external bleeding was used in finger replantation with no venous anastomosis or venous congestion after the operation. Results All 114 replants survived uneventfully. The success rate of replantation was 90.5%. Follow up was carried out and showed that the successfully replanted fingers had good soft-tissue coverage and recovery of pain and touch sensation. Two-point discrimination of the finger pulp was 6 to 8 mm. The distal interphalangeal joint had normal flexion and extension. Conclusion The amputated distal fingers should be replanted whenever possible because it provides good appearance and maintains good joint motion. Vein grafts should be used in cases of venous or arterial gaps. Continuous external bleeding could be applied to enhance the survival rate of the replanted finger when no venous anastomosis was done or venous congestion occurred after the operation. Key words: Replantation; Finger injuries; Distal fingers

Case report and surgical solution for nasal spine agenesis in a woman with Binder syndrome

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissue. We report a 19-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine agenesis. We present a surgical technique for nasal spine agenesis treatment. We used a titanium screw without a graft, which supported the nasal tip and increased tip projection. As there is good soft-tissue coverage over the screw, infection or extrusion was not encountered, and the patient had no complaints 1 year after surgery.

PR10 DUAL PLANE BREAST AUGMENTATION FOR TUBEROUS BREAST DEFORMITY

The tuberous breast deformity is an uncommon congenital breast anomaly which affects young women unilaterally or bilaterally. It is associated with usually a constriction in the lower pole of the breast as a result of the constricting fibrous ring with hypoplasia of the breast gland and pseudo‐herniation of breast tissue into an enlarged areola.Several methods have been suggested to correct this deformity. A retrospective analysis has been undertaken of six consecutive patients with tuberous breast deformity using a dual plane breast augmentation via an inferior peri‐areolar approach creating a dual plane pocket and using Marionette sutures to control the lower pectoralis major edge. Surgical release of the constricting lower pole glandular tissue was undertaken with excellent aesthetic results. Either immediate or delayed areolar reduction was carried out if required.Results show excellent expansion of the lower pole with good soft tissue coverage of the implant by the pectoralis major in the supero‐medial aspect of the breast. The dual plane pocket combined with lower pole release assists lower pole expansion in a one stage procedure without requiring two stage tissue expansion.The results have been uniformly acceptable and compare favourably with those presented in the literature where other methods were used. The dual plane breast augmentation technique is a simple and reliable way to treat tuberous breast deformity.

The Anterior Popliteal Approach for Popliteal Exploration, Distal Femoral Resection, and Endoprosthetic Reconstruction

Distal femoral resection and endoprosthetic reconstruction are sometimes associated with flap necrosis and inadequate soft tissue coverage. We evaluated the anterior popliteal surgical approach, which was designed to reduce those complications by using a posteromedial myocutaneous flap based upon the vastus medialis. A retrospective analysis of 46 consecutive patients was performed, and results were compared with historical controls. Compared with 19.4% with wound complications and 22.7% with gastrocnemius flap transfers in previous series by the senior author, 7.8% of patients in the present study had minimal superficial flap necrosis, and no gastrocnemius transfers for soft tissue coverage were required. The median Musculoskeletal Tumor Society score was 26, and the local recurrence rate 2 years or more after resection of osteosarcoma was 4%. The anterior popliteal approach to the distal femur limited wound complications and provided good soft tissue coverage of the endoprostheses.

Microsurgery as an Integrated Part of the Rehabilitation of Severely Burned Patients

The first step in the reconstruction of severely burned patients is the preservation of existing functional structures, using classical methods. The possibility of using microsurgical techniques for reconstruction in a second step completes the concept of rehabilitation. In the first 12 cases reported, the free transfer of soft tissue via microsurgical technique was sufficient to preserve existing structures and achieve better function. In cases 13–16, soft-tissue closure enabled the reconstruction of the extensor tendons in a subsequent operation. In the last 6 cases, microsurgical techniques were used to achieve good soft-tissue coverage as well as for reconstructing injured nerves and tendons. Results were demonstrated in these 22 cases.