1/55. Amputated lower limbs as a bank of organs for other organ salvage.Aggressive modern technologies have made it possible to attempt limb salvage in even the most extreme cases. However, it is imperative to remember that prolonged salvage attempts may lead to devastating complications. The decision-making is more problematic in patients with bilateral severely injured mangled lower limbs. In such a case, protocols like the MESS are no longer valid because of the implications of bilateral amputation. In these rare cases, we use a multi-team approach and modern micro-surgical reconstructive techniques in attempting to salvage at least one of the lower limbs. We present here our experience in six patients with bilateral mangled lower limbs where an amputated limb was the source of "spare parts" for the salvage of the contralateral limb. In each of the cases, after evaluation and planning, the harvesting of the required tissues (including skin, muscle, bone, nerve and blood vessels) from the amputated leg was performed and simultaneously, a reconstruction of the contralateral severely injured limb was done. These cases emphasize the importance of modern trauma care, not only the ability to treat multiply traumatized patients, but also the capability to execute sophisticated techniques during the acute phase of treatment with maximal cooperation between teams from different disciplines.- - - - - - - - - - ranking = 1keywords = blood vessel, vessel (Clic here for more details about this article) |
2/55. Free flap to the arteria peronea magna for lower limb salvage.A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
3/55. Successful free flap transfer and salvage in sickle cell trait.The presence of sickle cell haemoglobin is generally regarded as a contraindication to free tissue transfer. We present the case of a 42-year-old male with sickle cell trait who had free transfer of a latissimus dorsi flap to cover a gunshot wound to his thigh. His initial haemoglobin S was 36%. Early flap failure from venous thrombosis was successfully salvaged by re-anastomosis to alternative vessels.- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
4/55. Pedicled foot fillet flap based on the tibialis anterior vessels: case report.A case of an 18-year-old male with extensive posterior and lateral soft-tissue loss of the lower leg is reported. There was a segmental defect of 20 cm in the tibialis posterior neurovascular bundle, and the injury was not considered reconstructable. There was extensive soft-tissue trauma to the posterior compartments of the leg, with an intact and well-perfused foot. A primary amputation was indicated. The foot was used as a fillet flap for tibial length preservation and optimal stump coverage. The foot fillet flap was pedicled on the tibialis anterior vessels, preserving the deep plantar, first dorsal metatarsal, and anterior communicating vessels. The postoperative evolution was uneventful, with successful prosthetic adaptation.- - - - - - - - - - ranking = 2.8867638689345keywords = vessel (Clic here for more details about this article) |
5/55. 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 = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
6/55. Distally-based neurofasciocutaneous flaps in electrical burns.Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
7/55. Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients.Free tissue transfer has become the most important means of limb salvage treatment after severe trauma. This one-step procedure shortens healing and hospitalization time and minimizes the danger of infection. However, very few studies have considered the use of free tissue transfer for the reconstruction of traumatic limb injuries in children. This study reports 22 such cases treated in the authors' unit between 1993 and 2000 (17 boys and 5 girls; mean age, 8.9 years; age range, 18 months-15 years; 16 lower and 6 upper limbs). All flaps were indicated for repair of acute traumatic defects (20-500 cm2). Five different flaps were used: 12 scapular, 4 latissimus dorsi, 4 serratus anterior, 1 groin, and 1 temporalis fascia. All were successful, except for partial necrosis with the free groin flap. Three flaps requiring reexploration for venous insufficiency had a successful outcome. The microsurgical success rate in this pediatric population is very high, and the state and size of the donor site and recipient vessels have caused no problems. No long-term complications have been noted (mean follow-up, 3.8 years).- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
8/55. Versatility of rectus abdominis free flap for reconstruction of soft-tissue defects in extremities.rectus abdominis flaps, whose blood supply is mainly provided by superior and deep inferior epigastric vessels, are suitable not only for local transfer but also as free flaps. Based on abundant anastomoses of deep inferior epigastric vessels with other vessels such as superior epigastric vessels, lower intercostal vessels, subcostal vessels, lumbar vessels, superficial epigastric vessels, and superficial and deep iliac circumflex vessels, the rectus abdominis flap may be designed as a vertical flap, transverse flap, or oblique flap. From September 1995-October 2002, 42 free rectus abdominis flaps were transferred to reconstruct a variety of soft-tissue defects. The size of rectus abdominis flaps ranged from 6-25 cm in length and 5-12 cm in width. The overall success rate was 100% (42 of 42). The donor area was closed directly in 8-10-cm-wide flaps, leaving an inconspicuous scar. Larger flaps required skin grafting. After a mean 7-month (range, 3 weeks-18 months) follow-up, all flaps have healed uneventfully, and donor abdominal morbidity is minimal.- - - - - - - - - - ranking = 4.3301458034018keywords = vessel (Clic here for more details about this article) |
9/55. Antiphospholipid antibody thrombosis. Another source of chronic wounds.Antiphospholipid antibody thrombosis syndrome is currently not well known and probably underdiagnosed. The risk it presents for recurrent thromboembolism is both life threatening and chronic. Because patients often develop long-standing wounds, it is important for the wound care nurse to identify clients suspect for the disease. Several theories exist speculating on the mechanism of thrombosis involving antiphospholipid antibodies, and each focuses on changes at the interface between the vessel, cell wall membrane, and its interaction with circulating antibodies. As wound care nurses, we should consider antiphospholipid antibody thromboses whenever encountering a recalcitrant wound without obvious underlying cause. Thrombosis can occur anywhere, although 41% of presentations are cutaneous. Recurrent deep vein thrombosis with coexisting venous insufficiency can lead to a missed diagnosis of antiphospholipid thrombosis syndrome, despite evidence of pain and tissue necrosis that is typical of the disease. In any event, long-standing nonhealing wounds are always a signal to revise a diagnosis and seek alternative causes for failure of healing.- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
10/55. Microvascular anastomosis through the tibial tunnel: a new technique in free-tissue transfer to the leg.Free-tissue transfer to a severely traumatized leg has a high rate of vascular complications. We present three successful cases using a new technique of microvascular anastomosis through the tibial tunnel. Because of the unavailability of anterior tibial artery due to posttraumatic vascular disease, donor vascular pedicles were passed posterior to the tibia through the tibial tunnel and anastomosed to the posterior tibial artery or its branch in an end-to-end fashion. The flaps survived perfectly, without any vascular complication. This technique represents a safe route, and the shortest route, to an expected anastomosis point. Our technique is indicated especially in cases with a single-vessel leg.- - - - - - - - - - ranking = 0.48112731148909keywords = vessel (Clic here for more details about this article) |
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