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.

A Prospective Study of Graft Repositioning over Flap Technique for Reconstruction of Fingertip Amputation.

Background: Replantation of digital tip amputations, especially Allen III and IV, is challenging for hand surgeons as it requires a high level of microsurgical expertise and fine instruments. The graft repositioning over flap (GRF) technique is a simple and reliable procedure that provides length, sensation and nail growth and GRF has become popular in the last few years. The aim of this study is to report the short-term outcomes of the GRF technique. Methods: This is a prospective study of all patients who underwent a GRF reconstruction for Allen III and IV digital amputations at our hospital over a 12-month period. In addition to demographic data and injury details, we collected outcomes data with regard to flap and nailbed graft survival, capillary refill time, nail growth, sensation (2-point discrimination), bone union and gain in length of digit compared to length at injury. Results: Twenty patients underwent GRF reconstruction of digital amputation. They included 18 men and 2 women with an average age of 29 years. The thumb was the most frequently injured digit (n = 7). Electric saws (n = 5) and industrial machines (n = 5) accounted for 50% of injuries. Twelve amputations were Allen IV. Five patients were lost to follow-up and outcomes data was available for 15 patients. There was loss of flap and nail bed in three patients. There was no growth of nail in three patients. The distal phalanx graft was lost in six patients and united in the remaining nine patients. Conclusions: The GRF technique is a simple and reliable option in patients in whom replantation is not possible. It restores length, provides sensation and nail growth in the reconstructed fingers. Level of Evidence: Level IV (Therapeutic).

Management of Post-Electric Burn Microstomia by Free Radial Artery Forearm Flap in a 1-Year-Old Child.

Management of post-electric burn microstomia is a challenging task, especially in children, as it causes difficulty in feeding and airway problems (secondary to nasal airway blockage). The recreated defect is often full thickness and requires full-thickness tissue for reconstruction. The free flap can provide adequate normal tissue for the restoration of functions and aesthesis of the perioral region. However, performing free flaps in children is equally demanding due to small-diameter vessel anastomosis and postoperative monitoring. We present a case of postburn microstomia that was managed by contracture release and reconstruction by free radial artery forearm flap in a 1-year-old child. Postoperatively, at 6 months of follow-up, the flap settled well and the child was able to open his mouth fully with good aesthetic outcome. The free flap can be considered a good and safe option for perioral contracture release and reconstruction for better functional and aesthetic outcomes.

Closed-chamber Suction-assisted Fat Harvest: An Innovative Technique in Resource-limited Settings.

Autologous fat grafting is one of the most commonly performed procedures, not only for cosmetic reasons, but in a variety of reconstructive procedures like correction of contour deformities and treatment of scars. The Coleman technique has been traditionally described as one of the efficient methods of fat harvest, where 10 mL syringes connected with a liposuction cannula are used for the manual harvest of fat; although it is a widely used technique, it becomes time-consuming and tiring when a large amount of fat has to be harvested. To overcome this issue, we have devised a simple, cost-effective, quicker method in resource-limited settings by using a 500-mL normal saline bottle as a closed chamber, which is in turn connected to a suction tube. The liposuction cannula is connected to a tube that is inserted into this closed chamber, where fat is aspirated and collected. Using this technique, a large amount of fat can be easily harvested in less time and with less effort, without damaging the adipocytes.

Distally Based Sural Artery Peroneus Flap (DBSPF) for Foot and Ankle Reconstruction.

BACKGROUND: Reconstruction of soft-tissue defects in lower third of leg, ankle, and foot has been a challenge and reconstructive surgeons have been trying to innovate different flaps. To solve this issue, we propose a distally based sural artery peroneus flap (DBSPF) in which we include superficial portion of the peroneus brevis muscle and its blood supply with the peroneal artery distally. The aim of this study was to evaluate the functional outcome and its usefulness over conventional distal sural artery flap or other local options available. METHODS: This is a case series of 20 patients that include a DBSPF that was done for defects around ankle, distal leg, and foot caused by trauma or tumor ablation within the period of June 2013 to March 2015 in Kasralainy Hospital, Cairo. All cases were evaluated according to flap vascularity, distal reach of flap, aesthetic outcome, and donor-site morbidity. RESULTS: All flaps survived. One flap developed venous congestion that subsided spontaneously with limb elevation. The flap dimension ranged from 42 cm to 442 cm2, and it reached the midfoot easily. The pivot point was kept as low as 2-6 cm from lateral malleolus according to location of perforators. The ankle stability was maintained, and the desired aesthetic outcome was achieved. CONCLUSIONS: The DBSPF is an addition to the armamentarium in plastic surgery for defects around ankle, distal leg, and foot. It is an easy and swift procedure as compared with complex microsurgical reconstruction.