Journal of plastic, reconstructive & aesthetic surgery : JPRAS
-
J Plast Reconstr Aesthet Surg · Dec 2009
Case ReportsFree myocutaneous latissimus dorsi flap transfer in total knee arthroplasty.
The purpose of this article is to present our experience with free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty in case of insufficient soft tissue prior to operation ('prophylactic indication'). Fourteen patients who underwent simultaneous flap surgery in the context of total knee arthroplasty because of insufficient soft tissue are reviewed in a retrospective clinical study. The following criteria were examined: (1) aetiology of the soft-tissue defect, (2) number of previous operations, (3) status of the knee extensor mechanism classified as complete, partial or missing, (4) primary wound healing, (5) complications and (6) active range of motion (ROM). ⋯ A free myocutaneous latissimus dorsi flap transfer is rarely indicated in total knee arthroplasty and should only be considered for defects which cannot be covered by a pedicled (medial gastrocnemius) flap. Free latissimus dorsi transfer makes prosthesis implantation possible, prevents postoperative knee stiffness because of soft tissue and/or scar constriction and shows a low rate of severe complications in patients with a high risk of wound-healing problems. Moreover, transfer of well-vascularised tissue will improve trophicity in the knee region, and thus make future operations in this region easier.
-
J Plast Reconstr Aesthet Surg · Dec 2009
Case ReportsDermal vascularity of the auricle: implications for novel composite grafts.
Auricular composite grafts represent a well-established technique in facial reconstruction surgery, with several advantages including high survival rate as well as less contraction and good colour match. Although the revascularisation of composite grafts reportedly occurs by inosculation and angiogenesis through both the dermal-dermal connections and the wound bed, we hypothesised that the auricular dermis might have a distinct vascular profile as compared with other regions, that might contribute to the high survival rate of auricular composite grafts. To elucidate this hypothesis, we investigated the dermal vascular profiles of several regions in fresh cadavers using a von-Willebrand factor antibody-binding technique. ⋯ Unexpectedly, the cheek dermis, which is just adjacent to the auricular region, had a poor vascular profile. Because of its rapid and reliable revascularisation through dermal-dermal connections, the auricular composite graft should be more widely used in reconstructive surgery. It offers an especially good alternative in treating intractable ulcers and in tracheal reconstruction.
-
J Plast Reconstr Aesthet Surg · Dec 2009
Letter Case ReportsIs it a chemical burn or an irritant contact dermatitis?