Annals of plastic surgery
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Subjective outcome was assessed in 100 patients with cubital tunnel syndrome at least 2 years after anterior transmuscular transposition of the ulnar nerve. The mean time from surgery was 37 months (standard deviation, 10 months). The patient sample of 119 operated cases included 81 unilateral procedures and 19 patients had bilateral procedures. ⋯ Postoperatively symptoms were significantly less than those preoperatively: pain, p = 0.001; cold sensitivity, p = 0.001; tingling, p = 0.05; and numbness p = 0.08. In 51 cases, patients reported normal sensation and in 45 cases patients reported normal strength. Reported outcome was significantly better in nonsmokers than in smokers (p = 0.02) but was not significantly different in patients with workers' compensation/litigation (p = 0.51), obesity (p = 0.16), abnormal preoperative nerve conduction studies (p = 0.21), concomitant carpal tunnel syndrome (p = 0.95), or brachial plexus nerve compression (p = 0.35).
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Annals of plastic surgery · Jan 2002
Management of neuromas in continuity of the median nerve with the pronator quadratus muscle flap.
Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challenging problem. Nine median nerve neuromas were covered with the pronator quadratus muscle preelevated as an island flap. ⋯ Results showed a marked improvement in terms of symptoms in all patients. In particular, 6 patients had complete pain relief and 3 patients complained of mild intermittent pain.
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Annals of plastic surgery · Nov 2001
Case ReportsUse of distally based saphenous neurofasciocutaneous and musculofasciocutaneous cross-leg flaps in limb salvage.
Neurocutaneous island flaps have been very popular in soft-tissue coverage of the lower extremities. These flaps are based on the arterial network around the superficial sensory nerves. ⋯ The authors used five neurofasciocutaneous and three musculofasciocutaneous flaps successfully as cross-leg flaps for the coverage of relatively large defects of the lower two thirds of the leg and foot in 8 patients. They conclude that reverse saphenous neurofasciocutaneous and musculofasciocutaneous flaps as a cross-leg flap in patients who cannot be reconstructed with other flap alternatives have many advantages over traditional cross-leg procedures, such as short vascularization time, minimal patient discomfort, wide arc of rotation and great versatility, and a safe vascular pattern.
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Annals of plastic surgery · Oct 2001
Case ReportsSensate sole-to-sole reconstruction using the combined medial plantar and medialis pedis free flap.
The coverage of soft-tissue defects of the sole needs special consideration because of the forces of weight bearing on the reconstruction. A variety of free tissue transfers have been advocated for soft-tissue replacement of the weight-bearing portions. ⋯ The authors present a case of reconstructing the sole with the combined medial plantar and medialis pedis free flap that involves approximately 70% of the weight-bearing portion. This contralateral, combined fasciocutaneous free flap based on the posterior tibial-medial plantar vascular system is a good alternative in covering extensive sole injuries.
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Annals of plastic surgery · Aug 2001
Case ReportsCross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.
When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. ⋯ Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.