Bilateral Gastrocnemius Muscle Flap for Bilateral Defects of Knee Joint in Schatzker Type V & VI Proximal Tibial Condyle Fractures.

Bilateral defects around the knee joint following fracture of the proximal tibia (Schatzker type V & VI) are difficult to reconstruct because of the unavailability of local tissue. A bicondylar proximal tibial fracture requires a bilateral approach and dual plates for fracture fixation. Because of extensive dissection during plating and extended zone of trauma, the suture lines occasionally dehisce resulting in soft tissue defects on both sides of the proximal tibia. Because of its bilateral nature, the defect requires 2 flaps. We are reporting 2 cases of suture dehiscence after fixation of bicondylar fracture of the proximal tibia which required reconstruction with bilateral gastrocnemius flaps. This reconstruction is a simple option that helps in providing stable coverage. The first case was followed up for a period of 5 years and the second case was followed up for a minimum period of 6 months. Both cases demonstrated well-healed flaps, united bone and no donor side morbidity. Bilateral gastrocnemius muscle flaps can be used simultaneously for 2 separate defects on both sides of the knee without significant donor site morbidly. This reconstructive option provides stable coverage, reduces the infection and promotes bony union thus helping in early ambulation.

Il est difficile de reconstruire des anomalies bilatérales autour de l'articulation du genou après une fracture du tibia proximal (classification de Schatzker de types V et VI) à cause de l'absence de tissus locaux. Il faut une approche bilatérale pour soigner une fracture des plateaux du tibia proximal et deux plaques pour fixer la fracture. En raison de la dissection importante pendant l'installation des plaques et de la zone étendue du traumatisme, il arrive que les lignes de suture s'ouvrent, ce qui entraîne des anomalies des tissus mous des deux côtés du tibia proximal. Parce qu'elle est bilatérale, l'anomalie doit être corrigée par deux lambeaux. Les chercheurs rendent compte de deux cas de déhiscence des sutures après la fixation d'une fracture des plateaux du tibia proximal qui a dû être reconstruite par des lambeaux bilatéraux du muscle gastrocnémien. Cette reconstruction est une option simple qui contribue à une couverture stable. Le premier cas a été suivi pendant une période de cinq ans et le deuxième, pendant une période minimale de six mois. Dans les deux cas, les lambeaux ont bien guéri, l'os s'est uni et il n'y avait pas de morbidité au site du donneur. Il est possible d'utiliser simultanément les lambeaux bilatéraux du muscle gastrocnémien pour corriger deux anomalies distinctes des deux côtés du genou sans provoquer de morbidité importante au site du donneur. Cette possibilité reconstructive assure une couverture stable, réduit l'infection, favorise l'union osseuse et contribue donc à une ambulation précoce.

Don't Play It by Ear: Technical Considerations to Optimize Outcome and Procedural Safety of Congenital Microtia Reconstruction in a Dextrocardia Patient With Situs Inversus Totalis, Butterfly Vertebra, and Hemivertebra.

Background: Microtia can occur as a standalone condition or as part of a genetic syndrome. We report the first case of microtia presenting in a patient with dextrocardia, situs inversus totalis, butterfly vertebra, and hemivertebra, and we present technical recommendations for optimizing anaesthetic and surgical harmony in this extraordinary case.Patients with situs inversus dextrocardia should be checked for signs of Kartagener syndrome. Dextrocardia requires mirroring the placement of electrocardiogram (ECG) leads and the use of shocking paddles for cardiopulmonary resuscitation. Central venous access should be performed under ultrasound guidance because of varied course. Cervical vertebral deformities necessitate a thorough airway assessment since neck mobility may be limited due to pain or aberrant curvature. Conclusions: In this case, Brent's approach was used to treat the microtia, but rib cartilage was harvested from the ipsilateral side to lessen the chance of damaging the pericardium due to unfamiliar anatomy. These factors must be taken into account to perform a safe surgery on such patients.

Revisiting the Trapezius Flap as a Reconstructive Option for Cervico-Occipital and Thoracic Spine Regions.

Introduction Reconstruction of complex soft tissue defects around the cervico-occipital and thoracic spine regions is a challenging task. We want to share our experience with trapezius flap for the reconstruction of these complex cases. Materials and Methods A retrospective analysis of patients who underwent reconstruction using trapezius flaps from January 2016 to June 2019 was performed. The indications, technique, complications, and outcomes were analyzed and presented. Results Six patients (three males and three females, >10 years of age) underwent seven reconstructions using trapezius flaps (one of the patients underwent reconstruction using a bilateral trapezius flap). Trapezius flap was used to resurface the parieto-occipital ( n = 2), cervico-occipital ( n = 2), cervicothoracic ( n = 1), and thoracic ( n = 1) regions. All flaps showed successful outcomes; one patient had wound dehiscence, and one patient had partial skin graft loss. Conclusion Trapezius flap is a reliable and good alternative to free flaps for the coverage of complex cervical-occipital and upper thoracic soft tissue defects.