Usefulness of indocyanine green angiography in the intraoperative evaluation of recipient vessels for microsurgical lower extremity reconstruction in ischemic vasculopathy: Report of three cases.

Choosing reliable recipient vessels is crucial for successful free flap reconstruction of lower extremity defects, especially in patients with ischemic vasculopathy. This report describes our experience with the intraoperative use of indocyanine green angiography (ICGA) for selecting recipient vessels in lower extremity free flap reconstruction cases. Three patients with lower extremity defects and ischemic vasculopathy underwent free flap reconstruction. Intraoperatively, the candidate vessels were evaluated using ICGA. In the first case, a 10 × 6 cm defect on the anterior side of the lower third of the leg caused by minor trauma and associated with peripheral arterial occlusive disease was reconstructed using a super-thin anterolateral thigh flap based on one perforator. In the second case, a 12 × 8 cm defect on the posterior side of the right lower leg caused by a dog bite and associated with severe atherosclerosis throughout all three major vessels in the lower leg was reconstructed using a muscle-sparing latissimus dorsi myocutaneous flap. In the third case, a 13.5 × 5.5 cm defect on the right lateral malleolar region, where the peroneus longus tendon was exposed due to Buerger's disease, was reconstructed using a one perforator-based super-thin anterolateral thigh flap. In all cases, ICGA was used to evaluate the functionality of the candidate recipient vessels. In two cases, the candidate vessels showed acceptable blood flow, and the operations proceeded as planned. In the third case, the planned vessels of posterior tibial vessels were not identified to have sufficient blood flow, and one of their branches showing enhancement in ICGA was selected and used as a recipient vessel. All flaps survived completely. No adverse events occurred during the follow-up period of postoperative 3 months. Our results suggest that ICGA may be a valuable diagnostic tool for evaluating the quality of candidate recipient vessels in cases where their functionality cannot be guaranteed with conventional imaging modalities.

Oral Beta-blocker in Problematic Infantile Hemangioma.

One of the most common benign vascular endothelial tumors is infantile hemangioma. These lesions are commonly found in the head and neck, and sometimes it is a challenge to decide the method of treatment if the lesions are problematic hemangiomas, interfering with function or aesthetic appearance. This study reports a case of girl aged 3 years, 7 months, diagnosed with periorbital infantile hemangioma that was successfully treated with oral propranolol in specific doses and gradual tapering off dose. The patient had marked involution of the lesion with no significant side effects after starting her treatment at the age of 4 months, for a total of 13 months with no reported rebound growth after almost 2 years since the termination of treatment. Oral beta-blockers can be used safely in treatment of problematic infantile hemangioma as a single modality, without any surgical intervention.

Non-microvascular Successful Management of Near-total Ear Avulsion.

Traumatic ear avulsion represents a difficult challenge for all reconstructive surgeons; hence, replantation and reattachment will provide the best aesthetic outcome. However, when microsurgery is not possible, the surgeon must choose the most appropriate alternative method to address the concern. We are reporting a case of a near-total right ear external auricle amputation attached only by small skin bridge. The patient was admitted to our institute 22 hours after sustaining an injury during a motor vehicle collision. He was successfully managed by reattaching the external auricle into the anatomical place, with the repair of cartilage. This was followed by applying a daily protocol for venous congestion with the use of subcutaneous and intradermal injection of low-molecular-weight heparin daily for 10 days with gradual tapering of the dose. The external auricle survived with no complications or morbidity. Subcutaneous and intradermal low-molecular-weight heparin can be used effectively in cases of severe venous congestion of avulsed ear with adequate arterial inflow without causing any morbidity.

Abdominoplasty: Pitfalls and Prospects.

Abdominoplasty is the cosmetic surgery of the abdomen that typically involves removing excess skin fat and tightening of abdominal muscles. The procedure is commonly requested to restore pre-pregnancy appearance in women, maintain youthful physique, and lose weight in obese population. Techniques of modern abdominoplasty surgery have been primarily developed in the last 40 years concentrating on the skin and subcutaneous tissue, as well as the muscular abdominal wall for maximum esthetic outcome. Many procedures have been combined and modified to achieve these goals. We present an insight of the development of abdominoplasty considering the pitfalls and advancements improving patient outcomes. The result of this work will provide a deeper perspective to the current research around abdominoplasty in healthcare.