Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Oct 2013
Comparative StudyThe role of the third occipital nerve in surgical treatment of occipital migraine headaches.
The third occipital nerve is often encountered during the occipital migraine surgery, however its contribution to migraine headaches is unclear. The objective of this study was to determine whether removing the third occipital nerve plays any role in the clinical outcomes of occipital migraine surgery. ⋯ Removal of the third occipital nerve did not alter migraine surgery success.
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J Plast Reconstr Aesthet Surg · Oct 2013
Use of a bipedicled nerve flap taken from the dorsum of the digit for reconstruction of neurocutaneous defect in the adjacent finger.
A digital nerve defect complicated by an associated soft-tissue loss poses a reconstructive challenge. This article reports reconstruction of a similar complex injury using a bipedicled nerve flap including a nerve graft from the dorsal branch of the digital nerve. From July 2008 to May 2010, a retrospective study was conducted with nine consecutive patients who had a combination of soft tissue and digital nerve defects. The injured fingers requiring reconstruction included three index, four middle and two ring fingers. The mean size of the soft-tissue losses was 2.8×2.1 cm. The flap is supplied by the digital artery and the venous drainage is by means of a dorsal vein. The mean flap size was 3.1×2.3 cm. The nerve gaps were bridged with the nerve graft attached with the flap. The average length of the nerve grafts was 3.0 cm. All flaps survived completely, and the defects were reconstructed successfully. Venous congestion was not observed in our series. At a mean follow-up period of 23 months, the average scores of static two-point discrimination (2PD) and Semmes-Weinstein monofilament on the finger pulp of the injured side were 7.5 mm and 3.93, respectively. The donor site morbidity was acceptable. According to the Michigan Hand Outcomes Questionnaire, four patients were strongly satisfied and five were satisfied with functional recovery of the injured finger. The bipedicled nerve flap is a safe and effective option for reconstruction of complex digital injury involving soft tissue and nerve defects. Our technique has been shown to provide sufficient sensory recovery. ClinicalTrials.gov ID: NCT01707654. ⋯ Therapeutic IV.
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J Plast Reconstr Aesthet Surg · Oct 2013
Bipedicled flaps in posttraumatic lower-extremity reconstruction.
Complex, lower-extremity, soft-tissue defects pose a significant challenge to the reconstructive surgeon and often require the use of free flaps, which puts significant demands on the patient, the surgeon and the health-care system. Bipedicled flaps are random but receive a blood supply from two pedicles, allowing the surgeon to use local tissue with an augmented nutrient blood flow. They are simple to elevate and economical in operating time. This study describes our experience with lower-extremity wound reconstruction using the bipedicled flap as an alternative to pedicled flaps and free flaps. ⋯ Bipedicled flaps provide a safe, fast and relatively easy alternative for coverage of certain complex open wounds in the lower extremities. Their use does not preclude the use of more traditional options of pedicled muscle or free flap coverage at a later time should they be required. CLINICAL QUESTIONS ADDRESSED/LEVEL OF EVIDENCE: What are alternative strategies for lower-extremity wound reconstruction. Level of Evidence V.