Single stage functional reconstruction of both peroneal tendons and overlying skin with an anterolateral thigh flap and vascularized fascia lata: A case report.

Reconstruction of complex soft tissue defects in the distal lower leg remains challenging, since anatomical constraints limit the local options available in this area. In this report, we present a case of single stage functional reconstruction of both peroneal tendons and overlying skin with an anterolateral thigh flap and vascularized fascia lata. A 55-year-old patient underwent wide excision of a synovial sarcoma in the distal lower leg, which resulted in a complex defect including the peroneus longus and brevis tendons (10 cm), and the overlying skin (14 × 8 cm). Functional reconstruction was achieved in a single stage with a composite anterolateral thigh flap with vascularized fascia lata of similar dimensions to those of the defect. The fascia lata component of the flap was longitudinally split in two segments. Each of them was rolled up, and that way, two separate vascularized neotendons were created. The neotendons bridged the gap of peroneal tendons, whereas the skin paddle of the flap provided stable soft tissue coverage to the reconstructed tendons. Flap pedicle was anastomosed to the anterior tibial vessels. Early and late postoperative periods were uneventful. Follow up at 1 year postoperatively showed excellent neotendon incorporation, as well as a very good functional and aesthetic outcome. The use of the method described may be a useful alternative in single stage functional reconstruction of composite defects comprising two or even more tendons and the overlying skin.

"Pickaxe" double flap: a useful "tool" for reconstruction of deep large medial canthal defects-5-year experience and brief literature review.

OBJECTIVE: Reconstruction of large, deep medial canthal defects presents a challenge to reconstructive surgeons, since both safe oncologic excision and aesthetically pleasant results should be met. We report our 5-year experience with the use of a double flap technique, which looks like a "pickaxe", in reconstruction of the aforementioned kind of defects. METHODS: The technique is based on the simultaneous use a glabellar and a nasolabial flap designed and raised on either side of the medial canthal defect. The complex of the defect with the flaps looks like a pickaxe. The technique was applied in 17 patients during the last 5 years. RESULTS: No tumour relapses were recorded in our series (mean follow-up period of 24.8 months). Also neither disfiguring scar contractures nor trapdoor deformities were noticed because of the ample tissue provided and the w-plasty outline of the resulting surgical scar. All patients were satisfied with the aesthetic outcome. CONCLUSION: The suggested technique is simple, reliable and provides very good aesthetic results without disfiguring deformities. Most importantly, consistent long-term results with high patient satisfaction and no tumour relapses were achieved. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .