Microsurgery
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Since the advent of perforator flaps, a wide variety of applications have been documented. This study focuses on free flaps based on musculocutaneous perforators, because they have not been well-described in the literature of upper-limb reconstruction. They can be trimmed to be thin and pliable, and may provide large flaps with multiple components on the same pedicle to facilitate three-dimensional inset of flaps. ⋯ Preservation of the muscles leads to better preservation of donor-site functions. Less requirement of secondary debulking procedures is a great advantage. However, caution should be taken in the presence of wound infection.
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Surgical training is undergoing a rapid transformation, which has been influenced by advances in computer modeling. Increased pressure to reduce the use of animals in technical training has led to a new approach in teaching microsurgery. ⋯ In doing so, we review articles from the latest journals and authenticated Internet websites to compare and contrast these various methods. Finally, we look at the specific technique that has potential impact on the future modeling of microsurgical techniques.
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The fibular free flap is seen as one of the foremost technical options in mandibular reconstruction, especially in those defects where long bone is required. Cases with squamous-cell carcinoma of the floor of the mouth with mandibular spread and subsequent segmentary mandibular removal are the cornerstone examples. A case of squamous-cell carcinoma of the whole floor of the mouth with mandibular invasion is reported. ⋯ The fibular free flap is an excellent technique for mandibular reconstruction. Morphological deviations can modify the design of the flap. Achondroplasia is not a deterrent in successful use of the free fibula flap for reconstruction of the head and neck in adequately selected cases.
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Traumatic brachial plexus injuries in children, excluding birth palsy, are seldom reported. In this study, we report on 11 cases operated upon between 1995-1998, and followed for at least 30 months. All patients were males with an average age of 11 years (range, 3-16 years). ⋯ Harvesting the phrenic nerve and the contralateral C7 root resulted in no residual morbidity. Compared to adults, children have a higher incidence of root avulsion, no deafferentiation pain, a higher incidence of associated skeletal injuries, and the same recovery rate of elbow and shoulder functions following plexus reconstruction, but recovery is faster. Given the frequency of root avulsions, neurotization is often required.
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This study reports results in 12 patients treated with "completely vascularized single-stage approaches," so defined because skin, tendon, and nerve are transferred as a compound flap, and all are vascularized. A free dorsalis pedis cutaneotendinous flap was used in 7 patients, while a radial forearm cutaneotendinous island flap was transposed in 5 patients. A dorsalis pedis flap provides four vascularized extensor tendons (extensor digitorum comunis tendons), and the radial artery flap permits the inclusion of one completely vascularized tendon (palmaris longus) and two "strips" of vascularized tendons (flexor carpi radialis and brachioradialis). ⋯ The dorsalis pedis flap can be employed in the reconstruction of cutaneotendinous defects of the dorsum of the hand which require the use of three or four tendons grafts. We suggest the use of forearm cutaneotendinous flaps in cases of reconstruction of one or two extensor tendons. The "completely vascularized single-stage reconstruction" avoids prolonged hospitalization and results in a rapid restoration of near-normal function and appearance of the hand.