Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: patient selection and surgical refinement.

In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. The patient selection and surgical refinement are discussed. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at the Chang Gung Memorial Hospital. The defects were located at the ankle (three cases), foot (two cases), and heel (six cases). Particular attention was paid to precise patient selection and surgical refinements. Patient selection was based on the lower limb vascular status by palpable distal pedal pulses and ankle brachial index ranging from 0.9 to 1.2. Surgical techniques were refined as precisely locating the perforators of peroneal artery, placing the skin paddle in upper third of leg for a distal region coverage, designing a 7-cm-wide adipofascial pedicle with a 2 cm skin paddle on it, preserving the mesentery structure of sural nerve and concomitant artery with or without including gastrocnemius muscles cuff, no tunneling when inset this flap and supercharging with lesser saphenous vein whenever needed. All the flaps survived completely. Only one patient required immediate anastomosis of lesser saphenous vein to local vein around defect in order to relieve the venous congestion during operation. Patients felt diminished but adequate recovery of sense of touch and temperature at the flap. Following the precise patient selection and surgical refinements, the modified reverse sural flap seemed to be a reliable and effective local flap for reconstruction of the soft tissue defects on ankle and foot.

Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports.

Soft tissue reconstruction of the distal forefoot and toes poses a difficult problem. Skin grafts are not suitable when deep structures are exposed. Local flaps are not available, particularly for defects of the toes. Free flaps are spared for larger defects. Medial plantar flap has been widely used for plantar defects, especially weight-bearing surface of the heel. Distally based retrograde-flow design of this flap allows the transfer of the pedicled flap distally and provides coverage of soft tissue over the metatarsal heads. In this report, we further modified the retrograde-flow medial plantar island flap to extend its use for distal dorsal forefoot defects. The technique and outcomes of two patients are presented.

A safe and efficient method for intra-operative digital photography using a waterproof case.

BACKGROUND: Intra-operative photography provides valuable information for photo-documentation. In order to improve quality of photographs and avoid additional contamination, we applied a sterilised waterproof case to adapt a digital camera that allowed the operating surgeon himself to obtain his own ideal images. A prospective study was designed to investigate the efficacy and safety of this technique. MATERIALS AND METHODS: A total of 46 patients were enrolled in this study. The Fujifilm FinePix F30 digital camera encased in Fuji WP-FXF30 waterproof case was used in this study. Microbiological swabs were taken from the case's surface immediately after sealing the digital camera and at the end of surgery. In addition, intra-operative wound swabs were taken for correlation. The patients were followed up to record the possibility of any additional wound infections. RESULTS: None of the swab results on the waterproof case were positive before use. Overall, 11 patients had positive results of bacteria growth from intra-operative wound cultures. Eight of them also revealed positive microorganisms cultured from the case surface after use, in which the bacteria strains were correlated with the intra-operative wound cultures. However, no additional bacteria growth was noted from the culture of case surface. CONCLUSION: A digital camera encased in a sterilised waterproof case met the strict requirements for sterility in our series and demonstrated no added increase in infection rate. Safe use of this technique for obtaining intra-operative photographs with high image quality can be achieved.

Eikenella corrodens discitis in a habitual betel quid chewer: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe the case of a patient who habitually chewed betel quid and presented with intractable lower back pain owing to L4-L5 discitis caused by Eikenella corrodens. SUMMARY OF BACKGROUND DATA: E. corrodens is a normal inhabitant of mucosal surfaces in humans, particularly the oral cavity. Vertebral discitis due to E. corrodens is extremely rare. Discitis caused by E. corrodens in a habitual betel quid chewer has not been reported thus far. METHODS: A 52-year-old man had suffered from lower back pain for many years, and it worsened 3 months before admission. He had had severe periodontitis because of habitual betel quid chewing for over 10 years. RESULTS: The patient underwent staged spine surgeries because of the coexistence of L4-L5 discitis and isthmic spondylolisthesis. Tissue culture revealed the presence of E. corrodens. One and half years after the operation, the patient was fully ambulatory but demonstrated mild atrophy in the right thigh compared with the left thigh. CONCLUSION: E. corrodens discitis is extremely rare. We hypothesize that E. corrodens is a potential causative organism of discitis in patients who habitually chew betel quid.