1/9. Anterior tibial aneurysm following inversion injury to the ankle.Arterial injuries in nonpenetrating low-energy injuries to the extremities are rare but can occur when joint injuries put the vessels in traction against their immobile attachments to the long bones. The most common injuries are to the popliteal artery (because of its tethered nature proximal to the popliteal fossa) and the brachial artery (because it is tethered to the humerus proximal to the elbow). The second reported case of an aneurysm of the anterior tibial artery resulting from an inversion injury to the ankle is described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. The sandwich temporoparietal free fascial flap for tendon gliding.Microsurgical transfer of the superficial and deep temporal fascia based on the superficial temporal vessels has been documented. This article analyzes the functional recovery when each layer of this facial flap is placed on either side of reconstructed or repaired tendons, to recreate a gliding environment. This fascial flap also provided a thin, pliable vascular cover in selected defects of the extremities.Six patients (four male and two female) with tendon loss and skin scarring of the hand (three dorsum, one palmar, and one distal forearm) and posttraumatic scarring of the ankle with tendoachilles shortening (one patient) underwent this procedure. No flap loss was witnessed. Good overall functional recovery and tendon excursion were observed. Complication of partial graft loss was observed in two patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. Reverse sural artery flap: caveats for success.Complex open wounds of the distal third of the leg and ankle remain a reconstructive challenge for the plastic surgeon. In many cases, these wounds are best addressed with a free tissue transfer. Although this group has performed more than 400 free flaps to the leg during the past 6 years, free tissue transfer can be an arduous operation that requires a team approach and substantial donor site morbidity for the patient. In recent years, the authors have favored the reverse sural artery fasciocutaneous flap in 11 patients for its ease of dissection, limited morbidity, and preservation of major vessels to the limb. Caveats for successful performance of the reverse sural artery flap include Doppler evidence of patent peroneal perforators, placement of a lazy T-shape skin paddle over the distal gastrocnemius muscle bellies, inclusion of the lesser saphenous vein to augment venous drainage, and, lastly, careful dissection to provide a wide adipofascial pedicle.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/9. Free-flap monitoring using a chimeric sentinel muscle perforator flap.Muscle perforator flaps have become an important resource for the creation of cutaneous flaps based on musculocutaneous perforators, but without inclusion of the involved muscle. As a chimeric flap with or without the muscle, the cutaneous perforator flap can specifically serve as a sentinel or monitoring flap to allow the early detection of anastomotic compromise involving the common source vessel, without the need for direct observation of the major free-flap component. This can be a valuable adjunctive use of muscle perforator flaps for the continuous assessment of free muscle flaps or as an exteriorized flap for the monitoring of buried free flaps.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/9. Delayed supramalleolar flap--an innovative technique for enhanced viability.BACKGROUND: Delaying flap rotation for 48 to 72 hours leads to opening of choke anastomotic vessels linking adjacent vascular territories. This mechanism enhances flap circulation. Lateral supramalleolar flap with larger dimensions or vascular variations can potentially have survival problems. The purpose of this study is to assess the outcome of delayed lateral supramalleolar flap. methods: This descriptive case series was conducted at Aga Khan University Hospital, Karachi from May 1999 to December 2004. Eight cases of delayed lateral supramalleolar flap were identified through medical records maintained through health information management Systems (HIMS). A detailed questionnaire was developed addressing variables of interest. RESULTS: Eight patients required flap delay for 48 hours out of 25 patients, who underwent lateral supramalleolar flap for coverage of foot and ankle soft tissue defects. There were six male (75%) and two female (25%) patients with average age of 31.25 years ranging from 5-52. The reasons for delaying lateral supramalleolar flap were larger flap dimension in four (50%), absent peroneal artery perforator in three (37.5%) and one patient (12.5%) had poor circulation in immediate postoperative period. All the patients required two stage procedure and had excellent coverage of defects. No flap failure occurred subsequent to the delay procedure. CONCLUSIONS: Flap delay enhanced survival and extended the viable dimensions of lateral supramalleolar flap. Compromised circulation in larger flaps and flaps with vascular variations can be improved by delaying flap transfer to the recipient site for 48 hours following its elevation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/9. Massive thrombosis of the superior mesenteric, splenic, and portal veins. Report of a case.A 19-year-old previously healthy youth developed a deep venous thrombosis and a pulmonary embolism in connection with rupture of a ligament of the left ankle. Two months later, while on effective (thrombotest value 21%) oral anticoagulant therapy, the patient had massive thrombosis of the superior mesenteric splenic and portal veins and died. There was no known predisposition to thrombosis, such as tumour, infection, or trauma. A later examination of a 12-year-old brother revealed decreased fibrinolytic activity in the vessel wall as well as a decreased fibrinolytic response to venous occlusion. Since decreased fibrinolytic activity in the vessel wall is sometimes familial, it seems reasonable to suspect that the same defect might have occurred in the patient with the fatal massive thromboembolic disease.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/9. comparative study of reverse flow island flaps in the lower extremities--peroneal, anterior tibial, and posterior tibial island flaps in 25 patients.The reverse flow island flap is one of the most versatile reconstructive procedures in the lower extremity. There are three major arteries, the peroneal, the anterior tibial, and the posterior tibial artery, and a reverse flow island flap pedicled by each vessel and its intermuscular cutaneous perforators is available. Twenty-five reverse flow island flaps were clinically applied for soft tissue defects in the lower leg (10 peroneal, 8 anterior tibial, and 7 posterior tibial flaps). We report a comparative study of the characteristics and indications of the peroneal, anterior tibial, and posterior tibial reverse flow flaps. We conclude that the anterior tibial reverse flow flaps are more likely, without venous anastomosis, to become congested and necrose than the peroneal and posterior tibial flaps.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/9. Combined fasciocutaneous abductor hallucis-medialis pedis transposition flap for defect coverage of the medial ankle.A new method to cover a deep defect of the medial ankle with exposed bone, tendon, or metal implant is presented. In two cases a combined medialis pedis and abductor hallucis muscle flap, each based on separate vessels but linked by the musculocutaneous perforators, was used successfully as an island transposition flap. Among other available options, this flap is, in our opinion, an ideal solution that has superior advantages.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. Microvascular tissue transfer in a pregnant patient.pregnancy is a relative contraindication for elective surgery. The primary concerns are for the safety of the fetus and the mother. However, there are particular problems involving microvascular surgery due to the pregnancy-associated hypercoagulable state. The authors were presented with a 35-year woman, 20 weeks pregnant, with a degloved foot and ankle associated with an open distal tibia/fibula fracture (Gustilo IIIB). Salvage of her leg required a microvascular tissue transfer. Accordingly, a combined latissimus dorsi-serratus anterior free flap was performed with a saphenous vein graft to the popliteal vessels. The patient was hypercoagulable and there were extensive platelet clots. Her consumption of heparin was enormous. Postoperatively, she was treated with intravenous dextran for 5 days and for 17 days with intravenous heparin. After discharge, she was placed on subcutaneous heparin until she delivered a healthy baby. The flap survived and her leg was salvaged. The hypercoagulable state of pregnancy, as well as thromboprophylaxis, are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |