Reconstruction of massive oncologic defects following extremity amputation: a 10-year experience.

BACKGROUND: Oncologic defects resulting from extremity amputations are often extensive and require substantial soft tissue for reconstruction. METHODS: A review of all patients, who underwent an external hemipelvectomy, forequarter amputation, or hindquarter amputation from 2001 to 2010 at the MD Anderson Cancer Center, was performed. RESULTS: A total of 50 patients were identified; of them, 21 underwent external hemipelvectomy, 22 had forequarter amputation, and 7 had hindquarter amputation. The mean defect size was 644 cm; defects were repaired using fillet flaps (n = 22, 44%), free flaps (n = 4, 8%), or local/regional flaps (n = 24, 48%). Of the fillet flaps, 16 were free flaps and the remaining were pedicled flaps. In all, 29 patients (58%) received preoperative radiation therapy, and 26 patients (52%) received preoperative chemotherapy. Two patients (4%) received postoperative radiation therapy, and 1 patient (2%) received postoperative chemotherapy. Three patients received both pre- and postoperative radiation therapy, and 10 patients were treated with both pre- and postoperative chemotherapy. Patients undergoing free flap reconstruction had significantly fewer complications compared with patients reconstructed using other modalities (2/20 vs. 13/30; P = 0.003). The majority of patients achieved excellent postoperative function, with 73% of upper extremity patients functioning independently and 57% of lower extremity amputees ambulating. CONCLUSIONS: Reconstruction for extensive defects following oncologic extremity amputation is often optimally done using free tissue transfer, particularly by salvaging "spare parts" from the amputated limb for a free fillet flap.

Closed Zone III Rupture of the Flexor Digitorum Profundus Tendons of the Right Index, Long, and Ring Fingers in a Bowler: Gutterball Syndrome.

Zone III flexor tendon injuries are relatively rare in comparison to other flexor tendon injuries in zones I, II, IV, and V. Often, these are open injuries resulting from an electrical device like a saw; however, closed injures are even rarer, and those mid-substance ruptures resulting from bowling with no evidence of underlying tendinopathy from diseases like gout are highly unusual. The principles underlying tendon repair remain the same regardless of the etiology. In this case, we delineate some of the options and stress the guiding principles of the various methods available in this interesting and unusual case.