RESUMEN
We present a case of a muscle flap of both heads of gastrocnemius on a single vascular pedicle for reconstruction of a tibial defect. The flap was based on the medial sural vessels alone. The vascular supply to the lateral head was achieved through the anastomotic vessels along the gastrocnemial raphe.
Asunto(s)
Músculo Esquelético/trasplante , Osteomielitis/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Tibia/cirugía , Anciano , Desbridamiento , Supervivencia de Injerto , Humanos , MasculinoRESUMEN
Nine patients who presented with fingertip amputations were treated with the dorsal reverse adipofascial flap. The mean age of the patients was 41.3 years and the mean follow-up was 18 months. The flap described here was used only for amputations at the level of the nail fold, from approximately the lunula to the proximal nail matrix. This flap is based on the dorsal arterial branches that originate from the volar digital arteries just distal to the distal interphalangeal joint. The flap uses only the adipofascial tissue over the middle phalanx of the injured finger; it is turned over to cover the fingertip defect and then covered with a split-thickness skin graft. All flaps survived completely, and the patients continue to use their fingertips as before the amputation injury. This one-step operation is easily performed (even in the emergency department), makes no use of the adjacent digits, and provides a pleasing and stable cover for the fingertips.
Asunto(s)
Amputación Traumática/cirugía , Traumatismos de los Dedos/cirugía , Dedos/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodosRESUMEN
The vascular communication between the heads of the biceps femoris muscle has been established after 25 cadaveric dissections. Perfusions of dye through the long or the short head consistently showed 1-2 anastomotic bundles. Outflow of dye opposite to the site of the perfused head was remarkable in most cases. Intramuscular dissections disclosed broad and well structured vascular networks in all short heads, but this was not true for all long heads. Our observations suggest that the anastomotic vessels alone might support the short head which, when released from its profunda femoris vessels, is adequate to cover lateral knee defects. Depending on the level of the anastomotic vessels, the proximal or the distal part of the short head should be used. A pedicled flap may be used as well, whereas transsection of the biceps tendon offers additional mobility.