Free-style Approach to the Pedicled Lower Medial Thigh Perforator Flap.

Soft tissue reconstruction around joints such as the knee requires a few additional considerations compared with other regions. The overlying skin must be pliable, with adequate distensibility to maintain the range of motion as a hinge joint, and ideally be replaced with "like-for-like" tissue to restore its delicate contour. The advent of perforator flaps has provided reconstructive surgeons with thin, pliable flaps conferring superior aesthetic results, good preservation of joint range of motion, and less donor site morbidity. Utilizing locoregional options also allows replacement with "like-for-like." We retrospectively reviewed lower medial thigh perforator flaps performed for traumatic and debrided infected knee wounds, using a free-style approach to flap harvest. The described technique was found to be reliable, with consistent anatomy. All flaps survived and successfully covered small- to medium-sized critical defects in healthy individuals and those with multiple comorbidities.

Combination therapy of oxidised regenerated cellulose/collagen/silver dressings with negative pressure wound therapy for coverage of exposed critical structures in complex lower-extremity wounds.

Complex wounds with exposed critical structures such as tendon and bone are a conundrum in wound management, especially in the setting where the patient is not a suitable candidate for flap surgery. While the individual use of negative pressure wound therapy (NPWT) and oxidised regenerated cellulose (ORC)/collagen/silver (PROMOGRAN PRISMA) dressing has been described in the literature, there are little data on the efficacy of their combined use. In this study, we describe a novel technique of combining the use of NPWT and ORC/collagen/silver dressings to manage complex wound beds as an alternative management option for patients not suitable for reconstructive flap surgery. This technique was performed in a series of 37 patients with complex lower-extremity wounds that were not healing with conventional NPWT alone. All patients had open wounds with exposed critical structures that were difficult to manage, such as exposed tendon, bone, deep crevices, and joint. Successful coverage of exposed critical structures was achieved in 89% of patients, and coverage was achieved within 28 days of combination therapy in 82% of these patients, without any complications. The novel technique of combining ORC/collagen/silver dressing and NPWT provides a useful option in the armamentarium of a reconstructive surgeon dealing with difficult complex lower-extremity wounds.