Journal of plastic, reconstructive & aesthetic surgery : JPRAS
-
J Plast Reconstr Aesthet Surg · Jan 2015
Reconstruction of volar skin and soft tissue defects of the digits including the pulp: experience with the free SUPBRA flap.
The ideal flap for volar defects on the digits should provide glabrous skin, maintain length, be sensate and supple enough to allow unimpeded motion of the joints. When local flap options are either inadequate or unavailable, this constitutes a challenge that usually requires free tissue transfer. We describe our experience of the use of the free transfer of glabrous skin based on the superficial palmar branch of the radial artery (SUPBRA) for digital (volar) reconstruction. ⋯ The free SUPBRA flap has many advantages, approaching ideal replacement for the volar tissues of the fingers, excellent tissue match, minimal donor site morbidity with an excellent camouflaged scar in the mid palmar crease, one operation field, non sacrifice of a major vessel, can be made 'sensory', neurotises well and offers a single site for rehabilitation. We believe that the free SUPBRA flap is a very reliable and useful option in the armoury of the reconstructive hand surgeon.
-
J Plast Reconstr Aesthet Surg · Jan 2015
Multicenter StudyPrognostic factors for outcome after median, ulnar, and combined median-ulnar nerve injuries: a prospective study.
A major problem in the surgical treatment of peripheral nerve injuries of the upper extremities is the unpredictable final outcome. More insight and understanding of the prognostic factors is necessary to improve functional outcome after repair of the peripheral nerves. The objective of this study was to identify prognostic factors for the functional recovery of peripheral nerve injury of the forearm and their independent contribution in the outcome in the first year after reconstruction. ⋯ Our prospective analysis of prognostic factors shows several factors to be predictive for the functional recovery after peripheral nerve injuries of the median and/or ulnar nerve of the forearm. Sensibility of the hand, power grip, and DASH score (DASH, Disabilities of Arm, Shoulder and Hand) have proven to be the three best prognostic factors in this study. Of these prognostic factors, only posttraumatic stress can be influenced to optimize functional outcome.
-
J Plast Reconstr Aesthet Surg · Jan 2015
Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction.
The posterior interosseous artery (PIA) perforator flap can be used for reconstruction of soft-tissue defects of fingers. Based on the multiple perforators from the posterior interosseous artery, we describe a technique to reconstruct the multi-finger defect in the use of the free multilobed PIA perforator flap. ⋯ Therapeutic, Ⅳ.
-
J Plast Reconstr Aesthet Surg · Dec 2014
ReviewPretibial lacerations: experience from a lower limb trauma centre and systematic review.
Pretibial lacerations are an important and neglected problem among the elderly. Poor management leads to prolonged hospitalisation and terminal decline. This study summarises our experience and evidence from the literature to ascertain an evidence-based rationale for referral and management. ⋯ Admissions expose the elderly to physical/functional decline and death. Our findings support a change of practice, minimising admissions for minor (Dunkin type I/II) injuries and rapid, protocol-driven surgical intervention and discharge for Dunkin type III/IV injuries with avoidance of negative pressure wound therapy in all but selected cases.
-
J Plast Reconstr Aesthet Surg · Dec 2014
Locating recipient perforators for perforator-to-perforator anastomosis using color Doppler ultrasonography.
The authors investigated the efficacy of color Doppler ultrasonography (US) to locate perforators prior to performing perforator-to-perforator anastomosis in free flap reconstruction. ⋯ By using color Doppler US as a preoperative examination technique, we can locate perforators in the lower extremity efficiently to perform perforator-to-perforator anastomosis, with shorter time, less invasiveness, lower cost, and no risk of radiation exposure.