Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities.

UNLABELLED: Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. THE AIM OF THE STUDY: To present the results of treating lower extremity defects with various modifications of the reverse sural flap. MATERIAL AND METHODS: Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. RESULTS: All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partial-thickness skin graft. CONCLUSIONS: The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps.

Result of arm-level upper-limb transplantation in two recipients at 19- and 30-month follow-up.

BACKGROUND: Arm transplantation (ATx) is a novelty in the field of upper-limb transplantation, with only 7 procedures performed world-wide. CASE REPORT: In this paper we report on early results of unilateral arm transplantation recipients. Patient 1, a 30-year-old man, examined 30 months post-transplant, is able to actively flex the elbow, has 160 degree of ROM in the fingers of the grafted limb, and scored 92 points in the DASH questionnaire and 62 points in the Comprehensive Functional Score System (CFSS). The post-transplant period was complicated with 1 acute rejection episode due to CMV infection, and delayed bony union. Patient 2, a 55-year-old woman, examined 19 months post-transplant, is able to actively flex the elbow, has 180 degree of ROM in the fingers of the grafted limb, and scored 89 points in the DASH questionnaire and 64 points in the Comprehensive Functional Score System (CFSS). CONCLUSIONS: The post-transplant period was complicated with a delayed bony union. The ATx seems to be a valuable reconstructive therapeutic modality.

Hand transplant - outcome after 6 months, preliminary report.

BACKGROUND: Hand transplant still remains a partly experimental procedure because of the small number of patients and short follow-up (not longer than 10 years). Most hand transplantations have been performed at the distal forearm level. MATERIAL AND METHOD: The transplant recipient was a 29-year-old man who had lost his dominant right hand 3 years before in a milling machine accident; the donor was a 52-year-old woman. The procurement and transport of the limb were performed according to standard procedures. Preparation of the donor limb and the patient's stump was performed simultaneously by two surgical teams. Anastomoses were done in the following order : bones-tendons-nerves-veins-artery. The radial artery and 3 large veins were anastomosed. The operative wound was closed without a skin graft. Ischemia time was 9 hours. Pharmacological treatment was similar to that usually administered to replantation patients; immunotherapy consisted of Simulect, Prograf, Cell-Cept, and steroids. Physiotherapy was started on the second postoperative day; it consisted of early protective active motion (EPM), continuous passive motion (CPM), splinting, and sensory stimulation. The function of internal organs was monitored; the early outcome was evaluated at 6 months after the transplantation. RESULTS: The function of internal organs remained undisturbed, no rejection episodes were observed. Bony union was achieved after 11 weeks and progressed steadily, as did the range of motion and reinnervation. On the day of the preliminary assessment, the active range of motion was 200 degrees , 2PD exceeded 15 mm, and electromyography demonstrated temperature sensation and hypothenar muscle function. Functional assessment according to the DASH questionnaire was rated at 67 points, and a quality of life evaluation with the SF-36 questionnaire produced a score of 110 points. CONCLUSION: The distal third of the forearm is a replantation zone promoting early functional recovery.

[Management of soft tissue defects in the region of finger PIP joints by means of pedicular skin flaps taken from abdomen]. / Zaopatrywanie niewielkich ubytków skórnych powierzchni dloniowej okolicy stawów PIP palców reki za pomoca platów uszypulowanych z powlok brzucha.

Management of soft tissue defects in the region of finger PIP joints makes a serious operative problem. Commonly recommended skin plastics require a wide experience in hand surgery. There is also lack of a comprehensive doctrine of surgical therapy depending on the extent of the mutilations. The paper presents the results of treatment of 17 mutilated fingers of 11 patients (8 men, 3 females) treated over the period of 2 years (2002-2004). The method applied was pediculated skin flaps taken from an abdomen. According to the extent of lesions three groups of patients were created. Eight patients were treated as emergencies, three appeared from 4 to 11 weeks after the accident. Flaps were cut off after 20.4 days on average. The secondary plastic was performed after the following 9.5 weeks. In 2 patients tendon plastics were performed. Fingers were mobilized during the whole period of the therapy. No complications in healing of the flaps were observed. The functional results were assessed 6 months on average after the primary operation. The average TAM and TPM were evaluated as follows: group I (no, or minor tendon lesions) TAM--186 degrees, group II.

[Results of reconstruction of the thumb by emergency pollicization of mutilated index finger]. / Wyniki odtworzenia amputowanego kciuka poprzez policyzacje uszkodzonego wskaziciela przeprowadzana w trybie naglym.

Traumatic amputations of the thumb are frequently associated with mutilation of one or more of the remaining digits. The most common digital injuries associated with thumb loss are partial or complete amputation of the index finger. This was the case in 7 of our patients (men, 37.3 years of age on average), who had had emergency pollicization of the mutilated index finger performed. In 4 patients the palmar neurovascular bundles, in one dorsal metacarpal artery were used for this procedure. In 2 patients, because of lesion of digital blood circulation caused by a trans-metacarpal wound, a two-stage procedure was performed. There were no complications, but 3 secondary reconstructive procedures in the same number of patients were performed. Early rehabilitation was favored by bone fixation of the first metacarpal with tension-band wire. All these patients were re-examined with a minimum 10 months follow up. Six of the patients resumed an active work. The results were evaluated according to opposition, two-point discrimination. Discrimination sensibility was 8mm or less in 5 patients, protective sensibility was observed in 2 patients, cortical integration with reference to the recipient thumb on stimulation of the pollicized segment was adequate in all of the patients. Five patients could achieve tip-to-tip contact between the thumb and the little finger, 2 between the thumb and the most radial finger. The results show that this procedure conversing a useless, mutilated finger into a functioning one is an interesting option for amputations of the thumb occurring in manual workers at the level of or above the MP joint.