Microsurgery
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Comparative Study
The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases.
Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique. ⋯ The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks.
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Extensive defect coverage of the palm and anatomical reconstruction of its unique functional capacity remains difficult. In manual laborers, reconstruction of sensation, range of motion, grip strength but also mechanical stability is required. Sensate musculo-/fasciocutaneous flaps bear disadvantages of tissue mobility with shifting/bulkiness under stress. ⋯ Defect coverage of the palm should not consist of merely providing sensate vascularized tissue. The most appropriate procedure should be derived from careful defect analysis to achieve near to anatomical reconstruction. In laborers, defect related demands need close correlation with sensation and mechanical stability to be expected.
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The upper brachial plexus injury leads to paralysis of muscles innervated by C5 and C6 nerve roots. In this report, we present our experience on the use of the combined nerve transfers for reconstruction of the upper brachial plexus injury. Nine male patients with the upper brachial plexus injury were treated with combined nerve transfers. ⋯ Six out of nine patients were able to perform the normal range of shoulder abduction with the strength degraded to M3 or M4. These results showed that the technique of the combined nerve transfers, specifically the SAN to the SSN and triceps branches to the axillary nerve through a posterior approach, may be a valuable alternative in the repair of the upper brachial plexus injury. Further evaluations of this technique are necessary.