1/17. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/17. brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap.Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter. Common complications recorded in literatures are hematoma and muscle atrophy due to a compartment syndrome. We treated a patient with soft tissue avulsion at forearm using free latissimus dorsi muscle transfer for soft tissue coverage in our hospital. Unfortunately during the transfer the patient's brachial plexus was injured. After timely treatment, he recovered completely.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/17. Vascularized bone grafts to the upper extremity. Indications and technique.Massive autogenous bone grafts with an intact vascular pedicle decrease the time to bony union and immobilization required for treatment of segmental bony defects. These techniques have been shown to be effective in treatment of segmental defects of more than 6 cm after trauma or tumor resection in relatively avascular beds. Additionally, in the upper extremity, the free vascularized bone graft is in the developmental phase for employment in the reconstruction of epiphyseal arrest and congenital radial club hand. There are disadvantages to free vascularized bone transfers compared with conventional techniques. For example, a free vascularized fibular transfer requires a team skilled in microvascular technique, a long operative time (6 to 10 hours), and the sacrifice of a major vessel to the lower extremity. If the anastomosis fails, however, the free vascularized fibula will act as a conventional bone graft, thereby minimizing adverse effects. We think that by proper patient selection, appropriate evaluation and preparation of the bony defect, meticulous microvascular anastomosis, and correct fixation and immobilization of the graft a good outcome can be achieved in those patients with large bony defects that defy the use of conventional methods.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/17. The perforator-based conjoint (chimeric) medial Sural(MEDIAL GASTROCNEMIUS) free flap.The prototypical conjoint or so-called "chimeric" free flap heretofore has been composed of several large independent flaps, each supplied by a separate major branch, that ultimately arise from a common source vessel. The perforator-based type of chimeric flap is a relatively new concept, usually involving multiple muscle perforator flaps each based on a solitary musculocutaneous perforator, but still arising from the same "mother" vessel. This principle of split cutaneous perforator flaps has been now successfully adapted to the medial suralMEDIAL GASTROCNEMIUS perforator free flap on 2 separate occasions. As a chimeric flap, there was greater flexibility in insetting, and overall flap width may be larger but still narrow enough to allow primary donor site closure; and yet, by definition, only a single recipient site was needed for any microanastomoses. This is further proof that the perforator-based chimeric free flap may be an option for any muscle perforator flap donor site, so that potential donor territories for conjoint flaps have become virtually unlimited.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/17. Lethal injuries occurring during illegal break-ins.Individuals who undertake criminal activity are often at risk of injury for a variety of reasons. Two cases are reported where individuals who were engaged in illegal breaking and entering activities sustained stab wounds from broken window glass and died of exsanguination. The cases both involved young males who were under the influence of alcohol and/or drugs and who sustained relatively minor tissue damage that had fatal consequences due to a variety of coincident factors. Critical location of wound sites over major vessels resulted in rapid bleeding that was enhanced by vasodilator effects of alcohol and stimulant effects of amphetamines. In addition, adrenergic effects of being engaged in illegal activities, and the subsequent pain from the wounds, may also have contributed to accelerated heart rate and blood loss. Failure to appreciate the potential effects of such wounds, which may initially have appeared relatively minor based on their small size, added to an impaired ability to apply first aid or seek appropriate medical assistance, may also have been due to the combined effects of drugs, alcohol, and concerns regarding the illegal nature of the underlying activity. Such a scenario constitutes a specific subgroup of offender injury that could be termed the break, enter, and die syndrome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/17. Use of the lateral intercostal perforator-based pedicled abdominal flap for upper-limb wounds from severe electrical injury.BACKGROUND: Upper-extremity wounds can be covered with a variety of flaps. However, pedicled distant flaps still have a place in treatment, especially in the early stages of wound restoration after a severe electrical injury. The purpose of this clinical study was to present the use of the pedicled abdominal flap, using the blood supply of the lateral intercostal perforator vessel, to cover defects caused by severe electrical injury. methods: Between 2003 and 2005, 6 cases of deep burn wounds were treated with a lateral intercostal perforator-based pedicled abdominal cutaneous flap, with the blood supply originating from the lateral perforator branches of the seventh to 10th intercostal arteries. This flap was used to repair deep burn wounds on the elbow, forearms, and hands that were the result of severe electrical injuries. RESULTS: Flaps were harvested in sizes ranging from 16 cm x 12 cm to 9 cm x 7 cm. The pedicle was separated from 18 to 21 days after the operation. Five flaps survived entirely. The sixth underwent marginal necrosis (1.5 cm x 3 cm) at the distal portion of the flap because flap cutting exceeded the paraumbilical line. Results were cosmetically satisfactory for all patients. CONCLUSIONS: This flap is suitable for covering defects in hands, forearms, and elbows. The procedure was performed easily, safely, and reliably, and the flap has several advantages over other commonly used techniques for upper-limb wounds from severe electrical injury. We recommend this flap as the treatment of choice.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/17. Use of a cross-leg free muscle flap to reconstruct an extensive burn wound involving a lower extremity.A young patient sustained a high-voltage burn with extensive destruction of the soft tissue in his left lower extremity. Occlusion of the anterior and posterior tibial arteries, loss of toe extensors and the superficial and deep peroneal nerves were noted, besides the exposure of the lower end of the tibia and metatarsal bones. In the absence of proper recipient vessels, a cross-leg free latissimus dorsi muscle flap with overlying skin and depending on the vessels of the contralateral foot was used successfully for reconstruction of the defect. The pedicle was divided 3 weeks after microvascular anastomosis and the flap survived completely. This technique permits transfer of free flaps to compromised wounds without available recipient vessels, and the latissimus dorsi muscle flap, with its characteristics of large size and copious vascularity, could be split to cover exposed bones in different areas simultaneously.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
8/17. Free tissue transfer for reconstruction of traumatic limb injuries in children.Free tissue transfer was used for the reconstruction of soft tissue defects in 94 children. Of the 127 procedures performed, the latissimus dorsi, scapular skin, lateral arm skin, rectus abdominis, and gracilis were used with the greatest frequency. The microsurgical success rate was 96%. Microsurgical failures were repeated, successfully, and in all cases the limbs were salvaged. Other than having to deal with decreased vessel size and avoiding continuous suture lines, there appears to be little difference in technique or outcome of free tissue transfer when compared to adults.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/17. Arteriovenous shunts in free vascularized tissue transfer for extremity reconstruction.Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself. We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1). There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/17. Immediate amputation stump coverage with forearm free flaps from the same limb.When the traumatic amputation level or the degree of damage to the arm or forearm does not justify reimplantation of the severed part there may be sufficient undamaged skin to be used as a free flap to resurface the arm or the stump. Stump length or the elbow joint may thus be preserved and more durable skin cover for the fitting of a prosthesis may be obtained. A "spare-parts" forearm free flap may be raised on the radial or ulnar vessels or both. Three cases are reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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