[Microvascular reconstruction of foot defects using a free femoral periostal flap]. / Mikrovaskuläre Rekonstruktion von Defekten am Fuß durch freien Femur-Periostlappen.

BACKGROUND: The reconstruction of defects in the foot region is a challenge due to the anatomical peculiarities of the soft tissue covering. OBJECTIVE: This article presents the results of the reconstruction of postoperative foot defects using the free femoral periosteal flap (FFPF). MATERIAL AND METHODS: In a patient collective (n = 10) with postoperative wound healing disorders of the foot, the defect zone was covered using a vascularized FFPF from the distal femoral region. The wound healing process was retrospectively analyzed. RESULTS: The mean follow-up time was 20.2 ± 8.22 months (7-35 months). All patients had a soft tissue defect in the foot region with a mean area of 17.9 ± 3.72 cm2 (12-24 cm2). On average, a wound healing disorder occurred 2 weeks after the primary surgery. In the group of patients followed up the vascularized FFPF enabled a stable, definitive and aesthetically pleasing reconstruction and contributed to the bony consolidation. The duration of inpatient care after defect closure was 8-10 days and was significantly less than the duration of wound management prior to transplantation of the FFPF. CONCLUSION: The FFPF is an effective and elegant method for the regenerative reconstruction of defects with accompanying osseous components in the foot region. The FFPF has the advantage of instant thin and pliable tissue coverage in contrast to many other reconstructive methods. The FFPF can promote wound consolidation through the regenerative properties of a vascularized periosteal sheath in the context of a one-step and permanent infection control.

Training program and learning curve in experimental microsurgery during the residency in plastic surgery.

This article presents a comparison of microsurgical training of groups with different background. A protocol based on the rat femoral arterial anastomoses was used to provide an objective representation of the microsurgical skills progress. The performance is assessed by consistent (x4) patency of a standardized anastomosis. Three groups of beginner residents with progressive microsurgical experience and one group of experienced surgeons were observed. The patency curve of the beginner-groups was as an abrupt learning curve, and then a plateau was reached. There was no statistically significant difference in the patency rate between the beginner-groups after their first 32 anastomoses. No statistically significant difference was noted when the patency of the advanced group was compared with beginner-groups after different numbers of anastomoses (inverse proportional with their training experience). A slight or a plateau learning curve was found among the experienced group. The learning curve is a useful adjunct in the assessment of training.