[Use of double flaps in high-voltage electrical injury of scalp and calvaria: case report]. / Saçli deri ve kalvaryumun yüksek voltajli elektrik yaralanmasinda çift flep kullanimi: Olgu sunumu.

A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of 'bipedicled pericranial flap' and 'bipedicled scalp flap'. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.

Reconstruction of distal forefoot burn defect with retrograde medial plantar flap.

Burn reconstruction of forefoot remains as a difficult challenge, because the local flap alternatives are limited. We evaluated the efficiency of distally based medial plantar fasciocutaneous island flap in the coverage of forefoot defects resulting from release of toe contracture and burn debridement. Four patients with toe contractures and two patients with third degree burn in forefoot were treated between June 2004 and February 2006. The mean follow-up period was 10.4 months. The flaps were elevated as with a fasciocutaneous base on the distal medial plantar artery. The dimensions of the flaps ranged from 4cmx3cm to 5cmx4cm. The skin over the pedicle was included as a part of flap in three cases. Concomitant vein of the pedicle was anastomosed with the first plantar digital vein in four cases. In the early postoperative period, one flap used to cover third degree burn due to high-voltage electric injury was lost completely. We concluded that this flap was an appropriate alternative reconstructive option for the forefoot defect. Including skin and subcutaneous tissue over the pedicle to flap protects the pedicle against kinking and compression. Venous supercharging of the flap improves venous drainage.

Repair of chronic mallet finger deformity using Mitek micro arc bone anchor.

Surgical correction of chronic mallet finger caused by terminal tendon disruption was carried out in 22 patients. The distal stump of the tendon was fixed to the base of the distal phalanx with a Mitek micro arc bone anchor. In all patients the mallet finger deformity was corrected. There were 15 patients with excellent results, 5 with good results, and 2 with fair results. None of the patients had a poor result. No further treatment was needed. The Mitek micro arc bone anchor system is a reliable alternative for the treatment of chronic mallet finger deformity without proximal interphalangeal hyperextension.

Various applications of the medial plantar flap to cover the defects of the plantar foot, posterior heel, and ankle.

The medial plantar fasciocutaneous flap provides structurally similar tissue to plantar foot, posterior heel, and ankle defects with its thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue, and plantar fascia. During the past 4 years, 24 patients (20 men, 4 women) with skin and soft-tissue defects over the plantar foot, posterior heel, or ankle were treated. They ranged in age from 20 to 42 years (mean, 24 y). The medial plantar flap was transposed to the defects in four different ways: proximally pedicled sensorial island flaps (N = 18), reverse-flow island flaps (N = 2), free flaps (N = 2), and cross-foot flaps (N = 2). Flap size varied from a width of 2 to 5.5 cm and a length of 5 to 7.5 cm. The follow-up period ranged from 2 to 18 months (mean, 9 mo). Partial flap loss was observed in one free flap and one reverse-flow island flap. Partial skin graft lost in the donor site required regrafting in one patient. Durable, sensate coverage of the defects was achieved in all patients.