Versatility of Local Fasciocutaneous Island Flaps for Resurfacing Soft Tissue Defects Overlying the Achilles Tendon.

Background: Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. Methods: This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Results: Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Conclusion: Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

Single Stage Reconstruction of Large Calvarial Exposure after Tumor Resection: A 3-Year Experience.

BACKGROUND: We aimed to review the treatment and outcome of patients' undergone reconstruction of large full thickness scalp defects with exposed calvarium after oncologic resection with the combined local flap and split-thickness skin graft (STSG) technique. METHODS: A retrospective review of 45 patients with scalp defects secondary to tumor extirpation was performed at the Plastic Surgery Department, Tanta University Hospital, Tanta, Egypt from Nov 2016 to Nov 2019. Patients, with large (>50 cm2) and full-thickness (exposed calvarium) scalp defects, who underwent scalp reconstruction with the combined local flap and STSG technique and had completed their medical records were enrolled. RESULTS: Only 38 met the inclusion criteria. Thirty-three were male (86.8). The mean age was 61.5 years. The lesions removed were BCC in 30 cases (78.9%) and SCC in 8 cases (21.1%). Defect sizes ranged from 55 to 196 cm2. There was complete survival of all flaps. Complications were noticed in 5 patients (13.2%);2 developed small hematomas, 2 suffered from partial graft losses and one had wound infection. The follow-up period ranged from 6 to 27 months. Overall, 34 patients were satisfied with the functional and cosmetic results (89.5%), while 4 female patients weren't satisfied with the esthetic results (10.5%). CONCLUSION: The combination of local flap and skin graft technique is highly reliable, easy to perform and safe single-stage reconstructive modality of large skull exposed scalp defects, providing durable coverage and favorable esthetic outcome.

Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm.

This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy. METHODS: A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale. RESULTS: The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent. CONCLUSIONS: This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).

Outcome of Thumb Reconstruction Using the First Dorsal Metacarpal Artery Island Flap.

BACKGROUND: Reconstruction of complex soft tissue defects of the thumb, with exposure of tendons, joints or bones, has always been a difficult task. We evaluated the functional and esthetic outcomes of 1st dorsal metacarpal artery island flap in reconstruction of post-traumatic soft tissue defects of the thumb. METHODS: Between January 2012 and June 2014, fifteen patients with complex post-traumatic soft tissue thumb defects underwent 1st dorsal metacarpal artery island flap. Sensory function was evaluated with static 2-point discrimination and cortical reorientation. The mobility of the thumb was tested by the Kapandji score. The esthetic outcome was assessed. Patient's subjective satisfaction was evaluated by the visual analogue scale. RESULTS: The mean flap size was 33.3×17.7 mm. All donor sites were grafted by full-thickness skin grafts from the groin. Fourteen flaps survived completely and one had distal flap necrosis was treated conservatively. The mean static two-point discrimination was 10.4 mm. Cortical reorientation was complete in 40%. The average Kapandji score was 7.1. The esthetic outcome was excellent in six, good in eight and poor in one subject. After a mean follow up period of 18.2 months, the mean subjective satisfaction score was 8.1; most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site. CONCLUSION: First dorsal metacarpal artery flap offers a sensate, pliable and versatile coverage for small to moderate sized thumb defects. Moreover, it provides good functional and esthetic outcomes with minimal donor site morbidity.