Pedicled Flap Research Articles

Outcome and Utility of First Dorsal Metacarpal Artery Flap for Finger Defects

Background: The First Dorsal Metacarpal Artery (FDMA) Flap or Foucher’s flap is an island pedicle flap proximally based on the first dorsal metacarpal artery and veins. A branch of radial sensory nerve is incorporated in the flap to make it a sensate flap. Objective: The aim of our study was to evaluate the functional and aesthetic outcomes of the seven FDMA flaps done over a period of four years for reconstruction of the distal thumb soft tissue defects and one defect over proximal phalanx of the index finger. Methods: This prospective study was performed between 2018 and 2022 at the Clinic of Reconstructive and Plastic Surgery. We present a series of six cases of distal thumb soft tissue defects and one patient with defect over the dorsal aspect of the index finger that were reconstructed with the FDMA flap. Results: In six patient donor site was grafted by full-thickness skin graft harvested from the groin and in one case was closed primary. All flaps survived and one case that was closed primary had donor site complication that was related to primary closure of the skin. All the patients had good fine touch and average two-point discrimination of 8.7 mm. Conclusion: FDMA flap is a useful and reliable flap to cover the defects of the dorsal aspect and to a certain extent the volar aspect of the thumb. We showed that can be used to cover the defects over proximal phalanx of the index finger. The flap provides adequate soft tissue coverage and good aesthetic results.

Nasal Reconstruction with Composite Axial Paramedian Forehead Flap – Case Report

Background. Post-traumatic, acute or secondary nasal reconstruction or after tumor ablation involves various techniques that use local, loco-regional or distant flaps, transpozitioned or freely transferred. The reconstruction can be performed at the same time in the case of acute trauma of the nasal pyramid or secondary, at a later time if the local and general situation of the patient requires this. The median frontal flap, simple or composite, ensures a good quality reconstruction of all the aesthetic subunits of the nasal pyramid. The versatility of the flap and the aesthetic quality of the reconstruction result make the median frontal flap a choice solution for nasal pyramid reconstructions where local flaps are not indicated. The reconstruction can be done in two steps or in one step if the pedicle flap is subcutaneous. Case report. The article presents a case of total reconstruction of the nasal lobe after a complex dog bite trauma in which a composite median frontal flap, doubled with auricular cartilage, was used to restore the alar and columella cartilages. Conclusion. The axial paramedian forehead flap is a valuable technique in nasal reconstruction, offering favorable aesthetic outcomes when performed by skilled surgeons.

Extensive Vulvectomy and Reconstructive Flaps for Advanced Vulvar Cancer in Young Woman: Case Reports

Introduction: : Vulvar cancer is a rare disease accounting for approximately 5% of female genital tract tumors worldwide. It is a squamous cell cancer that mostly affects older women over the age of 65. In the existing body of literature, no instances of vulvar cancer have been documented in the form of case reports. Therefore, this study aimed to report the challenges and outcomes of vulvectomy with reconstructive flap in vulvar cancer survivors in a 39-year-old woman. Case Presentation: A 39-year-old woman with a palpable lump around the vulva was present and being examined. The anatomic pathology report (APR) features suggested poorly differentiated malignant tumors. A neoadjuvant chemotherapy was then administered to the patient aimed at shrinking the size of the tumor. However, there was no effective response to the chemotherapy, which resulted in a progressive tumor. Extensive vulvectomy and reconstructive flap were carried out to support quality of life, and the outcomes were reported, including flap, survival, complications, and mortality. These outcomes were evaluated between November 2021 and March 2023. No total flap loss was observed, and neither was there any donor site morbidity or mortality during the process. Conclusions: This study showed that vulvar cancer was a rare condition at a young age. Advanced vulvar cancer was found in the patients and extensive vulvectomy surgery was carried out followed by a pedicled ALT flap. This option was currently the best for immediate reconstruction due to the preservation of sensibility and tissue availability in the donor areas. The result showed no wound dehiscence, marginal necrosis, or surgical site infection. After 15 months of follow-up, the flap was observed to have good vascularization. The association of the Gynecologist with the Plastic Surgeon offered palliative care to improve the quality of life of the patient and provide good postoperative results.

Pedicled Groin Flap for Coverage of Soft Tissue Defect of Hand

Background: Distant pedicle flaps like groin flaps are still considered workhorse flaps for the coverage of soft tissue defects of the hand. In the era of free flaps pedicle flaps are still considered as primary flaps by many surgeons. Pedicle flaps are easy to raise, require less experience and microsurgical facility. Methods: In this retrospective descriptive study, patients in whom groin flap was done for reconstruction of hand soft tissue defects were included from April 2017 to April 2022. Results: Thirty-three flaps were included in this study with an average patients’ age of 34.6 years. There were 24 males and 9 females. All flaps survived and served the purpose of covering wounds. Complications like finger and shoulder stiffness were seen in 18 (54.5%), partial necrosis was seen in 4 (12.1%), marginal necrosis in 2 (6%), and infection was seen in 5 (15.2%) patients. Donor sites were healthy after insetting of the flap and did not show any sign of morbidities like infection or bad scarring. Conclusion:Groin flaps are versatile flaps. Where microvascular free flaps are not possible due to severity of injury or due to unavailability of the facility for microvascular free flap groin flap is an excellent option. With less complication, those flaps can be executed easily.

How We Do It: Shark Island Pedicle Flap for Alar Crease Defects.

How We Do It: Shark Island Pedicle Flap for Alar Crease Defects.

Preoperative sleep-disordered breathing and craniofacial abnormalities are risk factors for postoperative sleep-disordered breathing in patients undergoing skin-flap oropharyngeal reconstruction surgery for oral cavity cancer: a prospective case-control study.

After oropharyngeal reconstruction surgery, excessive flap volume within the oral cavity may increase the risk of pharyngeal obstruction during sleep. This prospective observational study aimed to test a hypothesis that the skin-flap oropharyngeal reconstructive surgery increases nocturnal apnea-hypopnea index (nAHI, primary variable) after surgery. Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery. In 15 patients, apostoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour-1, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15). Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors. UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.

Reconstruction of Total Maxillectomy Defects Using Coronoid-Temporalis Pedicled Flap, Titanium Mesh, and Free Flap.

The maxilla plays a crucial role in maintaining midfacial contour, supporting the globe and dentition and separating the oral and nasal cavity. Reconstruction of total maxillectomy defects has always been a challenge in head and neck surgery. In recent years, on the basis of existing methods, we have used the coronoid-temporalis pedicled flap combined with personalized titanium mesh and free flap to reconstruct total maxillectomy defects. This combination of multiple methods can restore the functional subunits of the maxilla. In this report, we introduce our surgical procedures in detail and assess the postoperative effects. Postoperative facial aesthetic outcomes were satisfactory in all 8 patients. None of the patients showed diplopia, oral-nasal reflux, hypernasality, titanium mesh exposure, or trismus. This new surgical procedure may be a simple and feasible option for the reconstruction of total maxillectomy defects.

Identifying risk factors and analyzing reconstructive outcomes in patients with lower-extremity soft-tissue sarcoma

Reconstructing defects after resecting soft-tissue sarcoma (STS) can be challenging. The aim of this retrospective study was to analyze the reconstructive outcomes and identify the potential risk factors in patients undergoing reconstruction after excision of lower-extremity STS. Patients with lower-extremity STS were included. This database was compiled of patients from a single, large National Cancer Institute-accredited academic hospital. In total, 302 patients were included between January 2016 to January 2022. Univariate and multivariate analyses were performed to calculate odds ratios (ORs) for developing complications for each patient and surgical characteristic. The following factors were independent predictors of any complication: benign pulmonary disease (OR=4.2; p=0.02), preoperative radiotherapy (RT; OR=2.5; p=0.047), a tumor in the medial thigh (OR=1.9; p=0.03), body mass index (BMI)>30kg/m2 (OR=1.05; p=0.037), and full-thickness skin graft (OR=5.4; p=0.01). In the preoperative RT subgroup, reconstructing a defect via undermining and layered closure alone was an independent predictor of dehiscence (OR=2.1; p=0.02) and seroma (OR=3.1; p=0.02), whereas pedicled flaps (OR=0.08; p=0.001) and free flaps (OR=0.05; p=0.001) were independent protectors against any complication. Information derived from this analysis will assist with accurate preoperative patient counseling, which is crucial for informed decision-making and expectation management in lower-extremity STS. BMI and pulmonary function should be optimized to the extent possible to reduce postoperative complications. Patients treated preoperatively with RT should be reconstructed with a pedicled or free flap to optimize recovery.

Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet

To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Between July 2017 and January 2023, 35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue (13 pedicled flaps and 22 free flaps). There were 18 males and 17 females, with an average age of 38.8 years (range, 8-56 years). Thirty cases of defects were caused by trauma, and the interval between injury and admission ranged from 2 to 6 hours (mean, 3.3 hours). Three cases were ulcer wounds with a course of 3.0, 3.8, and 7.0 months, respectively. Two cases were malignant melanoma. Eight cases of wounds located in the fingers, 13 cases in the palm, 12 cases in the heel, and 2 cases in the distal foot. The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm, and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm. The donor sites were repaired with skin grafts. All flaps were survived and the wounds healed by first intention after operation. The partial necrosis at the edge of the skin graft occurred in 1 case, which healed after dressing change; the other skin grafts survived successfully. All patients were followed up 6-24 months (mean, 18 months). The flaps exhibited similar color and thickness to the surrounding hand and foot skin. Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm. The donor sites had no painful scars or sensory abnormalities. Foot and ankle functions were good and gaits were normal. Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape, high survival rate of skin graft at the donor site, and no obvious complications.

Reconstruction mammaire secondaire unilatérale par lambeau dorsal pédiculé épargnant le muscle grand dorsal (TDAP et MSLD) chez les patientes aux antécédents de mastectomie totale pour cancer du sein. Étude observationnelle monocentrique

The use of pedicled dorsal flaps sparing the latissimus dorsi muscle (TDAP and MSLD flap) is a well-described reconstruction method in breast reconstruction after breast cancer. However, little data exists regarding patient satisfaction after this surgery. The main objective of this study was to evaluate patient satisfaction after unilateral total secondary breast reconstruction using a TDAP or MSLD flap. The secondary objectives corresponded to the evaluation of postoperative complications following this surgery, the evaluation of the duration of the reconstruction and the nature of additional interventions, the evaluation of the functional after-effects, and the evaluation of the chest size when the reconstruction is completed. This is a monocentric, retrospective cohort study, including 22 patients who underwent unilateral secondary total breast reconstruction using a TDAP or MSLD flap between January 1, 2018 and December 31, 2022. Patient satisfaction was assessed using three questionnaires validated in breast reconstruction: the Reconstruction module of the BREAST-Q, the MBROS-S and the MBROS-BI. The MBROS-S satisfaction score is 71.4%. The MBROS-BI body image score is 62%. With the BREAST-Q, the Satisfaction with Breast score is estimated at 53.1; the Satisfaction with Back score is estimated at 75.5; the physical well-being score regarding the chest is evaluated at 71.7; the physical well-being score concerning the shoulder and back is evaluated at 67.4; the psychosocial well-being score is assessed at 67.4; the sexual well-being score is estimated at 48.7; and for women who have benefited from reconstruction associated with a prosthesis, the satisfaction score regarding the implant is 71.6. Unilateral total secondary breast reconstruction with a dorsal pedicled flap sparing the latissimus dorsi muscle is an elegant, reliable, and respectful way to reconstruct a breast, and appears to give high levels of satisfaction.

Pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest for salvage mandibular reconstruction: Case and technique.

In the era of free flap reconstruction, mandibular defects are routinely reconstructed with osseous free flaps, and non-free flap bony reconstruction options are limited. A patient with T4N0 mandibular squamous cell carcinoma underwent resection with fibula free flap reconstruction of a parasymphyseal to angle defect. After free flap failure due to venous congestion, the flap was explanted. He declined additional free flap reconstruction and elected to proceed with pedicled osteomyocutaneous pectoralis major with rib. In this case presentation, we discuss the technical details of harvest of this flap using the 6th rib. The pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest, which is infrequently described in the literature, remains a viable option for bony reconstruction, particularly in the salvage setting.

Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction.

The vertical rectus abdominis myocutaneous (VRAM) flap has emerged as the workhorse flap for perineal and pelvic reconstruction. We aimed to evaluate outcomes of VRAM flap over a 20-year period and the role of mesh abdominal wall reinforcement following VRAM flap-based reconstruction. We conducted a retrospective review of all consecutive patients who underwent pelvic reconstruction with a VRAM flap between January 2001 and March 2021. Our primary outcome measure included recipient and donor surgical site occurrences (SSOs). We identified a total of 546 patients (55% females) with a mean age was 58 years and mean BMI was 27 kg/m 2. Mesh was used at the time of VRAM reconstruction to reinforce the abdominal donor site in 36% of patients. Recipient-site SSOs occurred in 38% of patients while donor-site SSOs occurred in 17% of patients. Hernia was identified in 9.9% of patients while bulge developed in 6.4% of patients. Cox proportional hazards regression model for hernia occurrence identified age, BMI, tobacco use (HR 2.03, 95% CI [1.02 - 4.04]) and use as an extended VRAM (HR 2.13, 95% CI [1.04 - 4.36]). The use of mesh or component separation were not independent protective factors for hernia occurrence. The pedicled VRAM flap is versatile and is our preferred flap for reconstruction of pelvic and perineal defects. The use of mesh/component separation to allow for fascial closure was not shown to reduce donor site hernia occurrence.

Three cases of uncommon medication‐associated osteonecrosis of temporal bone

AbstractIntroductionMedication‐related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti‐resorptive and biologic agents. Here, we present the first case of tyrosine‐kinase inhibitor‐related external auditory canal (EAC) osteonecrosis as well as two cases related to anti‐resorptive therapies.MethodsA retrospective case series.ResultsCase one: an 84‐year‐old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally. She had a history of osteoporosis treated with denosumab and risedronic acid. She successfully underwent left EAC reconstruction using an inferiorly‐based pedicle periosteal flap while the right ear canal was managed conservatively. Case two: a 69‐year‐old male presented with osteonecrosis of the right EAC. He had a history of osteoporosis treated with alendronic acid and zoledronic acid. His osteonecrosis is conservatively managed with local debridement and antibiotic application. Case three: a 60‐year‐old male presented with osteonecrosis of the right inferior EAC. He had a history of chronic myelogenous leukemia treated with a tyrosine‐kinase inhibitor, imatinib. After failing conservative therapy, he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.ConclusionAnti‐resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis. When a local debridement and antibiotic therapy fail, definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.

Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review.

The Clagett procedure is one of the last treatment options for chronic stage pleural empyema. It involves the formation of an open-window in the thoracic wall to allow for continuous drainage and irrigation of the pleural cavity. Once the empyema has been resolved, reconstruction of the chest wall is sometimes challenging. This review aims to identify and summarize the options for reconstructing soft tissue defects of the chest wall following the Clagett procedure and other types of open-window thoracostomy. A narrative review was performed of the literature on PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar, including all relevant studies published until January 2023. This review contains an overview of the reconstruction methods and the outcomes of the included studies on reconstructive options after the Clagett procedure and other types of open-window thoracostomy. A subdivision was made based on reconstruction type: pedicled flaps, free flaps, and the use of a vacuum-assisted closure (VAC) device. The advantages of pedicled flaps are reliable vascularization, better tissue match, reduced scarring, and shorter operation time compared to free flaps. However, when pedicled flaps are not available due to damage during previous surgeries or offer insufficient volume to obliterate the cavity, free flaps might be a solution. In cases where an open-window thoracostomy necessitates chest wall reconstruction, a pedicled flap is the preferred choice, followed by free flaps. Additionally, vacuum-assisted negative pressure wound therapy (VANPWT) techniques have shown potentially promising results (as an adjunct to surgical treatment).

The Pedicled Sensate Osteocutaneous Groin Flap for Reconstruction of the Forearm and Hand

Background The groin flap is axial pedicled and versatile. Until now, this flap has been used with many modifications for the reconstruction of forearm and hand defects. However, this flap has not been used in forearm, hand, and thumb reconstruction as a pedicled sensate osteocutaneous flap. In this study, a pedicled sensate osteocutaneous groin flap was used for the reconstruction of composite tissue defects on the forearm, hand, and thumb. Patients and Methods A pedicled sensate osteocutaneous groin flap was used to reconstruction composite tissue defects on the forearm, hand, and thumb in 7 patients. The mean age of the patients was 42 years. The defects were located on the dorsal surface of the forearm and hand in 2 patients, the dorsal surface of the hand and finger in 2 patients, and the thumb in 3 patients. The dimensions of the flap skin paddle ranged from 7 × 11 cm to 8 × 23 cm, and the dimensions of the bone component ranged from 1 × 1.5 × 3.5 cm to 1 × 1.5 × 5 cm. The mean follow-up duration was 26 months. Results All the flaps survived. Flap debulking was performed using 3 flaps. Sensory recovery in the flaps was completed approximately 18 months after the first operation. When the results of static 2-point discrimination test and Semmes-Weinstein monofilament test were evaluated at 18 months postoperatively, it showed that protective sensation was obtained. Except for 1 patient, motion restriction did not develop in the wrist, elbow, or shoulder joints. An acceptable aesthetic result, minimal donor site deformity, and protective sensation were obtained in all patients. Conclusions The pedicled sensate osteocutaneous groin flap can be safely used in the reconstruction of forearm and hand composite tissue defects that do not have available vascular structures for free flaps in the recipient area and in thumb reconstruction where toe transfer and pollicization cannot be performed.

Determining Degree of Hypertrophy and Extent of Resection in Aesthetic Labia Minora Reduction: Technical Highlights and Step-by-Step Video Guide.

Advances in aesthetic labia minora (LM) procedures have led to better results and fewer complications. Edge trim or wedge approaches are used, both of which use hidden incisions and preserve the edges of the LM. Since 1998, we have been performing a simple and reliable technique based on inferior wedge LM resection and superior pedicle flap reconstruction. Although details of aesthetic LM reduction have been amply published, previous technical videos have not presented a detailed step-by-step description, and few studies specifically address how to estimate the amount of tissue to resect according to the degree of hypertrophy. This article and the accompanying videos provide a detailed guide that clearly outlines the senior author's (A.M.M.) technique for aesthetic LM reduction. The authors' experience demonstrates that superior pedicle flap reconstruction is a reliable and reproducible technique. The success of the procedure depends on patient selection, careful preoperative planning, and adequate intraoperative management.

Treatment of recalcitrant femur nonunion with pedicled corticoperiosteal medial femoral condyle flap

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn’t any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

Repair of cervicothoracic skin defects with extra-long transverse cervical flaps by stepwise pressure packing in children: a technical innovation

ObjectiveTo investigate the clinical effect of prolonging predilated transverse cervical flap with stepwise pressure packing for neck and chest lesions in children.MethodsA retrospective review of children with large cervicothoracic lesions admitted to our department from January 2011 to June 2021 was conducted to compare stepwise pressure packing with normal dressing in the surgical method of transverse cervical pedicled flaps after expansion. Among 58 included children, 22 (14 males and 8 females) were allocated to the extended and expanded transverse cervical flap with stepwise compression dressing group, and 36 (19 males and 17 females) to the transverse cervical flap group. The causes of skin defects were: scars (37 cases) and giant nevus (21 cases). The course of the disease ranged from 0.5 to 8 years. The two groups were compared in terms of child satisfaction, the occurrence of infection, recurrence of the contracture, secondary operation, and repaired area.ResultsIn 22 cases of extended transverse cervical flaps, 8 cases were embedded with two expanders, resulting in a total of 30 expanded flaps, which were successfully transferred to the neck and chest without necrosis at the distal end of compression, with good effect. Comparison of pedicled transverse cervical flaps with stepwise pressure packing and pedicled transverse cervical flaps alone revealed no significant difference in child satisfaction, the occurrence of infection, recurrence of the contracture, and secondary surgery (all P &amp;gt; 0.05). Yet, there was a significant difference in the repair area between two groups (P &amp;lt; 0.05).ConclusionProlongation of pedicled cervical flaps after expansion with stepwise pressure packing resulted in an effective method for repairing the large skin defect of children's face and neck caused by various diseases. In terms of increasing neck repair area, the operation with stepwise pressure dressing was significantly superior to the simple packing.

Application of Staged Negative Pressure Wound Therapy and Flap Surgery for Infection Control After Patellar Internal Fixation Surgery.

The anatomic position of the patella is superficial, making it vulnerable to injuries. Treatment of patella infection after internal fixation surgery remains a big challenge due to minimal soft tissue coverage and vital tissue exposure. Forty-two patients aged 10 to 59 years were admitted to the institution's burn unit between January 2010 and December 2019. Each presented with infection after patellar fracture surgery. Twenty-seven infections were superficial, whereas 15 were deep with pyogenous arthritis of the knee. Negative pressure wound therapy (NPWT) was applied after radical debridement to remove necrotic subcutaneous tissues and internal fixation devices. In addition, cases with septic arthritis were irrigated continuously with normal saline. After 5 to 10 days of NPWT treatment and irrigation, wound infection was well controlled. Afterward, 42 wounds were resurfaced with pedicled flaps, the 42 patients received 17 reverse-flow anterolateral thigh (ALT) perforator flap, 12 medial sural artery perforator flaps, 7 gastrocnemius musculocutaneous flaps, as well as 6 saphenous artery flaps. Thirty-seven flaps survived uneventfully. However, 3 flaps developed venous congestion in the distal end. Two flaps developed tip necrosis. All patients were followed up between 3 and 48 months. Infection beneath the flap occurred in 3 patients and healed after an additional debridement surgery. The staged NPWT and flap surgery strategy focus on thorough debridement and immediate internal fixation devices removal, effective fracture fixation, efficient NPWT application, targeted administration of antibiotics, and adequate soft tissue coverage. This study established that the procedure was effective in infection control after patellar internal fixation surgery.

Hook nail deformity in a child – treatment option with bone graft and thenar flap. Case study with pros and cons

Introduction. Hook nail deformity is a common complication following fingertip amputations. Loss of distal bone support and palmar pulp tissue, results in the volar curving of the nailbed, which may cause pain, and aesthetic and functional problems. A few procedures have been described to address nail deformity, including flaps, skin and bone grafts, and microsurgical transfer. Unfortunately, none of the techniques provides reliably good and persistent correction. Case report. An 8-year-old boy sustained amputation of the distal phalanx of the middle finger and underwent surgical closure of the wound. After 4 years, the patient was admitted to our Department due to a deformed hook nail, which was aesthetically distressing. The hook nail was curved volarly and obliquely. The radiographs showed the lack of a significant part of the distal phalanx. Treatment. Surgical reconstruction of deficient distal phalanx was performed. The iliac bone graft, inserted into the distal phalanx, was stabilized with two K wires. A Pedicled flap of full-thickness from the thenar was used to cover skin loss over the fingertip. Pedicle division was performed at around 4 weeks. “K” wires were removed after 4 months. Results. The procedure was well-tolerated by the patient, and no complications occurred. Bone graft provided solid support for the nail bed during healing. Adequate growth and aesthetics of the hook nail were achieved. At 2 years follow-up, slight rotation of the nail was observed, which could have resulted from partial graft resorption and growth of the patient. The patient was satisfied with the treatment. Conclusions. Although perfect restoration of the nail bed length and pulp contour remains unobtainable, our result showed stable correction of the hook nail deformity.