1/7. Clinical applications of the posterior rectus sheath-peritoneal free flap.Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article reports the authors' clinical experience with the free posterior rectus sheath-peritoneal flap foil dorsal coverage in three patients. Two patients required dorsal hand coverage; one following acute trauma and another for delayed reconstruction 1 year after near hand replantation. A third patient required dorsal foot coverage for exposed tendons resulting from skin loss secondary to vasculitis. In all three patients, the flap was harvested through a paramedian incision at the lateral border of the anterior rectus sheath. After opening the anterior rectus sheath, the rectus muscle was elevated off of the posterior rectus sheath and peritoneum. When elevating the muscle, the attachments of the inferior epigastric vessels to the posterior rectus sheath and peritoneum were preserved while ligating any branches of these vessels to the muscle. Segmental intercostal innervation to the muscle was preserved. The deep inferior epigastric vessels were then dissected to their origin to maximize pedicle length and diameter. The maximum dimension of the flaps harvested for the selected cases was 16 X 8 cm. The anterior rectus sheath was closed primarily with non-absorbable suture. Mean follow-up was 1 year, and all flaps survived with excellent contour and good function in all three patients. Complications included a postoperative ileus in one patient, which resolved after 5 days with nasogastric tube decompression.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Medial plantar flap based distally on the lateral plantar artery to cover a forefoot skin defect.The authors report a simple, single-step procedure to promote the distal transfer of the instep island flap for coverage of the submetatarsal weight-bearing zone. First described in 1991 by Martin et aI, this procedure remained unknown. As opposed to the medial plantar flap, this technique proposes an instep island flap based on the lateral plantar artery. The inflow and outflow of blood is assured by the anastomosis between the dorsalis pedis and lateral plantar vessels. This approach allows for the transfer of similar tissue and provides adequate coverage of the weight-bearing zone of the distal forefoot.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
3/7. The Doppler probe for planning septofasciocutaneous advancement flaps on the plantar aspect of the foot: anatomical study and clinical applications.A 5-MHz Doppler probe was utilized to identify the perforating septofasciocutaneous vessels on the plantar aspect of the right and left feet of 10 healthy subjects. Each audible perforator was marked, and each foot was photographed, scanned into a personal computer, and standardized to 8 inches high by 4 inches wide. All 20 feet were then stacked together to create a composite average of all markings. Loupe aided (2.5 x magnification) dissection of a latex cast of the perforating septofasciocutaneous vessels from a fresh frozen cadaveric foot revealed similar location and distribution as the composite average described above. The Doppler probe is capable of accurately identifying the septofasciocutaneous perforating vessels, thereby, creating a vascular map of the plantar aspect of the foot useful for precise planning of advancement flap coverage for full thickness defects. Two representative case examples are presented.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Cross-leg pedicled free scapular flap for neuropathic foot ulcer: case report.A case is reported of the treatment of a chronic neuropathic ulcer on the lateral aspect of the foot with osteomyelitis. Extensive debridement and free scapular flap transfer were performed. Because the leg had only one patent vessel, the anterior tibial artery, which was unsuitable for anastomosis, the vascular anastomosis of the flap was performed to the posterior tibial vessel of the contralateral leg, which was used as a termporary carrier. The vascular pedicle was divided after 3 weeks, and the flap survived completely. This case report extends the indications of the cross-leg free flap for complex defects on a single-vessel foot.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. A case of livedoid vasculopathy in a 22-year-old man.A 23-year-old man presented with a 3-year history of painful ulcerations and retiform scarring of his lower extremities. skin biopsy revealed evidence of thrombotic vasculopathy. Livedoid vasculopathy is an uncommon condition presenting as painful lower extremity ulceration and scarring in the form of irregular, ivory-white, stellate plaques. Its pathogenesis is unclear, but it is thought to result from coagulation and fibrinolytic disorders causing occlusion of dermal vessels.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
6/7. A large ulcer and cutaneous small-vessel vasculitis associated with syphilis infection.Cutaneous vasculitis (CV) is a condition with cutaneous manifestations and possible systemic involvement. The causative factors or associated diseases are usually drugs, infection, collagen vascular disease, or malignancy. syphilis as a cause of cutaneous vasculitis is rare. We report the case of a large cutaneous ulcer and small-vessel vasculitis associated with syphilis infection. We suggest that in apparently idiopathic CV or a chronic ulcer refractory to treatment, screening should be performed to detect any underlying infection such as syphilis. It is important to have a rapid and accurate diagnosis because the lesions are very contagious, but may be rapidly and completely cured by early administration of antibiotic treatment.- - - - - - - - - - ranking = 1.6666666666667keywords = vessel (Clic here for more details about this article) |
7/7. Stem cell use in a patient with an ischemic foot ulcer: a case study.stem cell research has been discussed in both the political and popular arenas lately. Some types of stem cell research are controversial; however, not all stem cell research involves harvesting cells from an embryo or an aborted fetus. Another type of stem cell, the adult stem cell, resides within tissues and organs of the body and is responsible for repair after injury. Recent interest has focused on using adult stem cells isolated from a patient's bone marrow to stimulate the development of new blood vessels (a process called angiogenesis) in patients with peripheral vascular disease. These specialized stem cells are referred to as endothelial progenitor cells (EPCs). In laboratory and clinical studies it has been shown that these EPCs are involved in arterial repair and remodeling, as well as angiogenesis. The following case presentation will show how a patient with an ischemic toe ulcer and rest pain, who had no options for conventional revascularization, benefited from the injection of stem cells into her calf muscle. The process of angiogenesis using EPCs will be examined discussing the screening criteria and possible adverse events. The patient's history and progress throughout the recovery period will be reviewed.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |