Perforator-Based Propeller Flap with Additional Venous Pedicle for Lower Limb Reconstruction.

Propeller flaps are effective reconstructive tools for small-to-medium sized defects of the lower limb and a reasonable alternative to free flaps. A major vessel of the lower limb remains undisturbed while raising the flap and the flap donor and recipient areas are addressed in the same operative field. Perforator-based propeller flaps are based on single perforator arising from a major vessel and during rotation of the larger paddle there is a possibility of kink in the venous component leading to congestion of flap. In our modification, one superficial vein of the lower limb namely the great saphenous or short saphenous vein was included in the flap territory to enhance the retrograde or antegrade venous drainage of the flap. We observed, no flap congestion or necrosis in the postoperative period. Also, the patency of the incorporated vein was confirmed using handheld and color Doppler.

A Rare Anatomical Variation in the Pedicle of Anterolateral Thigh (ALT) Flap.

Free anterolateral thigh (ALT) flap finds its place in the front row among the soft-tissue flaps used for complex reconstruction of various defects. Its versatile tissue component and ease of harvesting with minimal donor site morbidity made it a popular flap. However, its variable vascular anatomy alerts the reconstructive surgeon to remain aware of the common variation and vigilant with regard to unusual variation. Commonly described variations are about the origin and course of pedicle and perforators. There are rare reports regarding the presence of double arteries and single vein in the flap pedicle. Here, the authors describe these unusual anatomical variations in the pedicle of ALT flap, with two arteries and one vein, and discuss the surgical implication of the same.

Pedicled anterolateral thigh flap: A versatile flap for complex regional defect reconstruction.

Objectives: Soft-tissue defects of the lower abdomen, perineum, groin, and trochanteric area often involve the loss of composite tissue components and are technically challenging to reconstruct. The goals of reconstruction should include the replacement of the defect with a suitable soft-tissue flap that provides stable coverage while protecting important exposed structures. However, there are limited locations in this region for the creation of pedicled flaps for complex defect reconstruction. The pedicled anterolateral thigh (ALT) flap is considered superior to other comparable flaps due to its varying soft-tissue components and long pedicle with consistent anatomy that allow the reconstruction of locations that are difficult to reach without significant flap donor site morbidity. Herein, we present a case series of our experience of using a pedicled ALT flap to reconstruct regional defects over a range of locations. Methods: The present study comprised ten patients who underwent surgical reconstruction of soft-tissue defects of the lower abdomen, groin, trochanteric, scrotal, and penoscrotal defects using a pedicled ALT flap over a two-year period. The flap was customized according to the defect when required. Results: In our case series, flap loss was not observed with only a few minor complications. All patients accepted the aesthetic appearance of the flap recipient site area without requesting revision surgery. The donor site was closed primarily in half of all cases, with split skin grafting applied in the remaining patients. Graft take at the flap donor site was satisfactory in all cases. Conclusion: A pedicled ALT flap is a reliable and suitable option for complex soft-tissue reconstruction for regional soft-tissue defects of the lower abdomen and perineum.

Adamantinoma of tibia: excision and reconstruction with free vascularized fibula flap: a case report and review of literature.

Adamantinoma is a rare malignant tumour usually affecting the diaphysis of long bones. The tumour most commonly affects the tibia. Conventional management involves excision with a wide margin, reconstruction and sometimes amputation. Multiple options are available, but reconstruction depends upon the size of the bony defect and available resources. None has proved to be the favourable one. We have analysed the advantages and shortcomings of various methods used. In our case, a 33-year-old male patient presented with a large adamantinoma of the midtibial region of the left leg, which was managed with excision and reconstruction of long segment bony defect with free vascularized osteocutaneous fibula flap. There are osseointegration and hypertrophy of the vascularized bone with good functional gain in long term follow-up. Autologous bone reconstruction after adamantinoma excision with microvascular free fibula flap in large bone segment defects salvage the limb with satisfactory functional outcome.

Management of a Late Presentation of Bear Mauling with a Complex Maxillofacial Defect in a Tertiary Care Hospital - A Case Report.

Rationale: Bear mauling is the most common wild animal-inflicted injury in India. Ideally, these injuries should be managed early with fracture fixation, wound debridement, and appropriate coverage. Delay may lead to devascularization and a more severe deformity, which needs complex and multi-staged procedures for optimal outcome. Patient Concerns: Facial deformity in bear mauling is upsetting to the patient. Apart from facial aesthetics, the victim has difficulties in speech, eating, and respiration when the midface is involved. Diagnosis and Treatment: Patients require proper assessment of the soft tissue and bony defects by clinical assessment and imaging before planning any reconstruction. Outcome: The complex defect was managed in stages by both microsurgical and nonmicrosurgical methods including debridement, fracture fixation, local flaps, free flap, and prosthesis. Take-away Lessons: Systematic approach in categorizing each component of the problem, finding the best possible solution for each of them, and inter-departmental collaboration are important.

Isolated hexadactylia: A rare case of central polydactyly of the foot.

BACKGROUND: Central polydactyly of foot is uncommon form of polydactyly but it usually causes intermetatarsal widening because of metatarsal bifurcation. Central polydactyly associated with T shaped bifurcation of metatarsal in vertical plane has not been reported yet. CASE: We present a 4 year male child with extra toe on the dorsal aspect of right foot with complains of difficulty in wearing footwear and poor cosmesis. The extra digit was fully developed with bifurcation of 2nd metatarsal bone proximal to the head without any intermetatarsal widening. The angular deviation was 45° to the longitudinal axis of foot and in a plane vertical to the transverse arch of foot. The child was operated with excision of extra toe without any residual bony deformity. CONCLUSION: The central polydactyly is rare type of polydactyly of foot. Central polydactyly with metatarsal extension causing intermetatarsal widening has been well described entity. But the previous classifications need to be modified to include central polydactyly with vertical oriented T bifurcation of metatarsal bone without intermetatarsal widening.