1/26. Salvage of the distal foot using the distally based sural island flap.The authors describe their additional experience with the distally based sural island flap for reconstruction of the whole foot, including the forefoot area in 8 patients. The flap is vascularized by the lowermost perforating branches of the peroneal artery. The skin flap can be elevated, based on the lesser saphenous vein and its accompanying arteries, in all parts of the sural region. This modification allows a farther reach of the flap for coverage of the distal foot and sole. All flaps, innervated by the lateral sural cutaneous nerves, were able to provide protective sensation in the distal soles. In 7 patients the flaps survived completely, and only 1 patient had partial necrosis of the flap. The advantage of this flap is its constant and reliable blood supply without sacrifice of the major artery. Elevation of the flap is simple and rapid. This flap is a versatile alternative that should be considered prior to a free flap transfer.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/26. replantation of an avulsive amputation of a foot after recovering the foot from the sea.A foot avulsion case, with the dismembered body part submerged in sea water for 1 hour, is presented. This report is unique in that it is the first to document the reattachment of a body part that had been submerged in sea water. It was not known how salt-water exposure would affect wound management. Differences in osmolarity and bacterial flora between the sea water and foot tissues have not caused any problems, and the patient has not suffered any vascular or infectious complications after replantation. Neurotization of the plantar surface by the tibial nerve, which was stripped off during amputation and replaced in its original traces, was the most critical part of convalescence. After management of such an interesting case, we conclude that exposure to sea water of the dismembered part should not be a contraindication for replantation surgery.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/26. The distally based superficial sural flap: our experience in reconstructing the lower leg and foot.The treatment of soft-tissue defects of the lower third of the leg and foot is often an awkward problem to tackle because of the frequent involvement of muscle, tendon, and bone, which is caused by the thinness and poor circulation of the skin covering them and by the small quantity of local tissue available for reconstruction. The authors present their experience with the use of sural flaps for the treatment of small- and medium-size defects of the distal region of the lower limb. The flap used was a distally based fasciocutaneous flap raised in the posterior region of the lower two thirds of the leg. Vascularization was ensured by the superficial sural artery, which accompanies the sural nerve together with the short saphenous vein. The authors treated 18 patients (12 men and 6 women) from May 1997 to August 1999 at the Division of Plastic Surgery, University of Turin, italy. Superficial necrosis without involvement of the deep fascia (which was grafted 1 month later) occurred in 1 patient of the 18 treated. In another 2 patients, defects were found in the flap margins, but no additional surgical revision was necessary, and recovery occurred by secondary intention. In every patient the sural flaps provided good coverage of the defects, both from a functional and an aesthetic point of view. The major advantages of this flap are its easy and quick dissection. Because the major arterial axis is not sacrificed, this flap can be used in a traumatic leg with damaged major arteries.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/26. Reconstruction of a painful post-traumatic medial plantar neuroma with a bioabsorbable nerve conduit: a case report.Although nerve injuries to feet may be common, primary repair of a damaged nerve in the foot is rare. Secondary digital nerve reconstruction in the foot has not been previously reported. This report describes a patient with post-traumatic neuroma of medial plantar nerve who was treated by neuroma resection; the nerve defect was reconstructed with bioabsorbable nerve conduit. This case illustrates successful, secondary reconstruction of nerve injury in the foot using a new surgical technique. A bioabsorbable polyglycolic acid nerve conduit eliminated the need for a short nerve graft and was effective in relieving the neuroma pain by providing an appropriate distal site for neural regeneration.- - - - - - - - - - ranking = 13keywords = nerve (Clic here for more details about this article) |
5/26. Use 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 advantages of these flaps are easy and quick dissection (hence a time-saving operation), acceptable donor site morbidity, and preservation of major arteries of the leg. 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.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/26. lacerations of the plantar aspect of the foot.The absence of any known reference in the medical literature to lacerations of the plantar aspect of the foot prompted the author to send an questionnaire to members of the American Orthopaedic foot Society and association of Bone and Joint Surgeons asking each one to outline his treatment for various combinations of lacerations of the flexor tendons and plantar nerves in a group of patients with varied ages and occupations. To simplify results, only clean wounds satisfactory for immediate surgery were considered. A majority of surgeons preferred primary repair of a lacerated flexor hallucis longus tendon or extensive laceration of all flexor tendons and nerves but were equally divided between repair and non-repair of flexor tendons and plantar nerves of the middle three toes. A majority of surgeons preferred not to repair isolated lacerations of flexor tendons other than the flexor hallucis longus. Most surgeons electing to repair the structures preferred to approach them through the original plantar laceration rather than through an accessory incision in the non weight-bearing portion of the foot.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
7/26. Free medial sural artery perforator flap for resurfacing distal limb defects.BACKGROUND: The need for thin flap coverage has increased, especially for contouring or covering shallow defects of distal limbs. The free medial sural artery perforator flap harvested from the medial aspect of the upper calf can be useful for this purpose. methods: Between January 2002 and February 2003, we used the free medial sural artery perforator flap for distal limb reconstruction in 11 clinical cases, including four hands and seven feet. This perforator flap is based on the proximal major perforator of the medial sural artery, which can be identified along the axis of the medial sural artery and usually emerges in an area between 6 and 10 cm from the popliteal crease and approximately 5 cm from the posterior midline of the leg. RESULTS: Most of the flaps were safely raised with a single perforator. One flap developed venous congestion during the postoperative course and finally underwent total necrosis. CONCLUSION: The main advantage of the medial sural artery perforator flap is that it only requires cutaneous tissue to achieve better accuracy in reconstructive site, and it preserves the medial gastrocnemius muscle and motor nerve to minimize donor-site morbidity. However, the tedious process of intramuscular retrograde dissection of the perforator and the unsightly scar of the donor region are the major concerns.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/26. The compound thoracodorsal perforator flap in the treatment of combined soft-tissue defects of sole and dorsum of the foot.Nine cases of massive soft-tissue loss of the foot were reconstructed by means of a compound (chimera) thoracodorsal artery perforator (TAP) flap, which reconstituted the different functional units (dorsum, heel, instep, weight-bearing surface). In each case, the flap consisted of a skin component isolated on its perforator in combination with a portion of latissimus dorsi muscle and/or serratus fascia, all pedicled on the thoracodorsal vessels. The pedicle length allows up to 4-6 cm of independent mobility of the skin island. The mobility of the various flap components allows the various functional units of the foot to be reconstructed without relying on multiple flaps or anastomoses. The pedicle length was sufficient to be able to perform the anastomosis out of the zone of injury. In some cases the skin island was harvested along with intercostal nerve branches, this gave us the potential to develop a sensate flap. The indications and advantages of this reconstructive method are discussed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/26. Timing of management of severe injuries of the lower extremity by free flap transfer.Covering defects by free-tissue transfers enable surgeons to reconstruct or salvage the lower extremity injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerve. The timing of the reconstruction using flap techniques is extremely important. It can be divided into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days). Our treatment of choice in an isolated complex injury of a lower extremity with a soft tissue defect is "primary free flap closure" providing improved funcional and aesthetic results, and psychologically benefit through lowered morbidity of the patient.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/26. Ruptured plantar epidermal inclusion cyst with foreign body giant cell reaction.The case of a ruptured, multilobular, plantar epidermal inclusion cyst is presented. The case is notable because the lesion involved the fourth common digital nerve. Magnetic resonance images of the foot are demonstrated. Treatment consisted of surgical excision without recurrence.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
| | Next -> |