1/26. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/26. 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 = 5keywords = vessel (Clic here for more details about this article) |
3/26. Concomitant double epiphyseal injuries of the tibia with vascular compromise: a case report.A rare case of double epiphyseal injuries in the same tibia is reported. A 4-year-old child was struck by a vehicle and presented with the above fractures and vascular compromise to the extremity. Following localization of the vascular occlusion level by arteriography, popliteal vessel anastomosis was attempted. The vascular repair failed, resulting in disarticulation through the knee. Simultaneous displaced proximal and distal epiphyseal injury in the same tibia has not been previously reported in the literature. The most serious complication of injury to the proximal tibia is vascular compromise. A delay in recognition or intervention in such cases can be devastating.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/26. 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 = 1keywords = vessel (Clic here for more details about this article) |
5/26. 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 = 1keywords = vessel (Clic here for more details about this article) |
6/26. 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 = 1keywords = vessel (Clic here for more details about this article) |
7/26. 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 = 2keywords = vessel (Clic here for more details about this article) |
8/26. Soft-tissue coverage of an open tibial wound in the junction of the middle and distal thirds of the leg with the medial hemisoleus muscle flap.A relatively simple but reliable option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg has never been determined. In this series, the author reports his clinical experience utilizing the medial hemisoleus muscle flap as a local reconstructive option for management of this unique clinical problem. Over the past 2 years, 14 patients underwent a soft-tissue reconstruction of an open tibial wound (4 x 3 to 10 x 5 cm) in the junction of the middle and distal thirds of the leg with the proximally based medial hemisoleus muscle flap. Only the medial half of the soleus muscle was elevated, with attention to preserving critical perforators from the posterior tibial vessels to the flap while allowing adequate arc of flap rotation to cover the exposed fracture site and hardware. All patients were followed for up to 2 years. Only 1 patient developed insignificant distal flap necrosis and was treated with debridement and flap readvancement. All patients had primary healing of their wounds, reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Therefore, the medial hemisoleus muscle flap described by the author can be a reliable local option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg with good outcome and minimal morbidity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/26. Difficult reconstruction of an extensive injury in the lower extremity with a large cross-leg microvascular composite-tissue flap containing fibula.In the absence of proper recipient vessels, a large microvascular composite-tissue flap was transferred successfully for reconstruction of a leg with an extensive crush injury. This was accomplished by using vessels of the normal leg. The microvascular flap containing skin, muscle, and 15 cm of fibula survived well after division of the pedicle. To achieve good bone healing, the leg was protected by a brace while gradually increasing weight bearing. The functional result is satisfactory.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/26. 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) |
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