1/17. Successful free flap transfer following venous thrombectomy in recipient vessel.We report the case of a 53-year-old male patient who suffered a high velocity multiple trauma with bilateral open tibial fractures. At definitive orthopaedic and plastic surgical reconstruction 5 days post initial trauma, he was found peroperatively to have an existing deep venous thrombosis in his popliteal vein on one side. He underwent venous thrombectomy and had subsequent successful latissimus dorsi flap transfer using the unblocked popliteal vein as a recipient vessel.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/17. Clinical applications of free soleus and peroneal perforator flaps.Clinical applications of two free lateral leg perforator flaps are described: a free soleus perforator flap that is based on the musculocutaneous perforator vessels from one of the three main arteries in the proximal lateral lower leg, and a free peroneal perforator flap that is based on the septocutaneous or direct skin perforator vessels from the peroneal artery in the distal and middle thirds of the lateral lower leg. The authors applied free soleus perforator flaps to 18 patients and free peroneal perforator flaps to five patients with soft-tissue defects. The recipient site was the great toe in 14 patients, the hand and fingers in five patients, the leg in two patients, and the upper arm and the jaw in one patient each. The largest soleus perforator flap was 15 x 9 cm, and the largest peroneal perforator flap was 9 x 4 cm. Vascular pedicle lengths ranged from 6.5 to 10 cm in soleus perforator flaps and from 4 to 6 cm in peroneal perforator flaps. All flaps, except for the flap in one patient in the peroneal perforator flap series, survived completely. Advantages of these flaps are that there is no need to sacrifice any main artery in the lower leg, and there is minimal morbidity at the donor site. For patients with a small to medium soft-tissue defect, these free perforator flaps are useful.- - - - - - - - - - ranking = 0.4keywords = vessel (Clic here for more details about this article) |
3/17. Locally applied hypothermia and microvascular muscle flap transfers.The success rate for wound closure of grade III open tibia-fibula fractures with free muscle flaps is approximately 90%. Complications and loss of free flaps are due mainly to anastomotic problems, local anatomical considerations, or recipient vessel injuries, which prolong the ischemic time of the transferred free muscle tissue. We present the techniques used at the shock Trauma Center of The maryland Institute for emergency medical services Systems (MIEMSS), which has allowed us a 100% success rate for the last 80 free muscle transfers performed. This surgical technique involves the use of locally applied hypothermia to decrease muscle metabolism and no-reflow phenomena. Representative cases are illustrated, which could have been failures because of increased ischemic time.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
4/17. Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.BACKGROUND: Soft-tissue coverage in the lower extremity usually requires a flap with a long pedicle, low donor-site morbidity, and versatility in terms of shape and volume. The extended-pedicle free vastus lateralis muscle flap has previously been described for head and neck cancer, and it fulfills these requirements. methods: Twelve patients with lower extremity defects underwent reconstruction with an ipsilateral free vastus lateralis muscle flap. The flap included a segment of the distalmost part of the muscle, distal to the entry point of the motor nerve to the vastus lateralis, based on the descending branch of the lateral femoral circumflex vessels. Up to 20 cm of vascular pedicle with a large caliber was obtained. In three cases, a combined distal vastus lateralis and anterolateral thigh flap was used as a chimeric flap. RESULTS: All flaps were successful. infection developed in two cases and required flap reelevation and new wound debridement. There was no substantial subjective donor-site morbidity. CONCLUSIONS: Elevation of the flap can be performed with the patient in the supine position and is extremely fast and straightforward, without the added difficulty of anatomical variation or extensive intramuscular vascular dissection. The pedicle is long and of large caliber. Although the series is short, the authors conclude that this is a useful free flap for lower extremity reconstruction.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
5/17. 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 = 0.2keywords = vessel (Clic here for more details about this article) |
6/17. Supracondylar femur nonunion associated with previous vascular repair: importance of vascular exam in preoperative planning of nonunion repair.One case of a Gustilo type 3C open OTA 33A-1 supracondylar femur fracture with superficial femoral artery injury that underwent reverse saphenous vein graft repair and open reduction and internal fixation with a retrograde femoral nail is reviewed. The fracture progressed to a hypertrophic nonunion despite 2 bone-grafting procedures and a nail dynamization. Upon referral for revision of the nonunion, a vascular examination revealed a well-perfused extremity with slightly diminished pedal pulses. An arteriogram was ordered that revealed an intraosseous aneurysm associated with the nonunion site and vascular repair. In a joint procedure with vascular and orthopedic surgeons, the previous vessel repair was mobilized, the aneurysmal feeder vessels were ligated, and the nonunion was revised with bridge plating and iliac crest autograft. The nonunion healed uneventfully, and the patient shows no signs of vascular compromise at the 2-year follow-up. The importance of the preoperative vascular assessment is emphasized, and the literature is reviewed.- - - - - - - - - - ranking = 0.4keywords = vessel (Clic here for more details about this article) |
7/17. Free ascending scapular flap.Four patients with free tissue transfer using ascending cutaneous branches of circumflex scapular vessels are herein presented. The free ascending scapular flap is located on the superior vertical axis, differentiated with the scapular flap horizontally and the parascapular flap vertically designed. The flap is an excellent choice because of easy dissection, a constant artery and venous system, 2- to 3-mm-diameter vessels, and sufficient length of the vascular pedicle. All flaps survived completely with a fairly thin skin. The shoulder donor site could be closed primarily. No functional deficit of the shoulder was observed.- - - - - - - - - - ranking = 0.4keywords = vessel (Clic here for more details about this article) |
8/17. Free vascularized bone grafts in surgery of the upper extremity.Free vascularized fibular grafts were employed in five patients with segmental bone defects following trauma or resection of tumors of the upper extremity with excellent results in three patients and satisfactory results in two. No donor site morbidity was experienced. A comparison with rib and iliac crest grafts indicates that the fibula is more suitable for reconstruction of long bone defects. The advantages of this technique are stability without sacrificing viability and a shorter immobilization period with more rapid incorporation and hypertrophy of the graft. The disadvantages are prolonged operating time, difficulty in assessing patency of anastamoses in the immediate postoperative period, and sacrifice of a major vessel in the lower extremity.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
9/17. Microvascular osteocutaneous groin flap in the treatment of an ununited tibial fracture with chronic osteitis. A case report.A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. The bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
10/17. Bilateral arterial injury in the lower limbs associated with open pelvic fractures: a case report.The complications of pelvic fracture include blood loss, urinary tract injury, nerve injury and orthopaedic disability. Bleeding is quoted as the cause of death in 65 per cent of patients dying with a fractured pelvis (Rothenberger et al., 1978a). In a fifth of these patients disruption of the iliac or femoral vessels is the major source of bleeding. However, the incidence of major vessel injury in pelvic fractures is only 1 per cent. Arterial injury in both lower limbs is reported here, in association with an open fracture of the pelvis.- - - - - - - - - - ranking = 0.4keywords = vessel (Clic here for more details about this article) |
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