["Sequential Chimeric Osteocutaneous DCIA-Perforator-SIEA Flap to Reconstruct an Osteocutaneous Defect in the Lower Extremity and the Importance of Preserving the Ascending Branch - A Case Report"]. / "Sequenzieller chimärer Beckenkamm-SIEA-Lappen zur Rekonstruktion eines osteokutanen Defektes des Unterschenkels und die Wichtigkeit zur Schonung des Ramus Ascendens ­ ein Fallbericht".

BACKGROUND: The deep circumflex iliac artery (DCIA) perforator flap is an established method to reconstruct osteocutaneous defects. However, the cutaneous perforators come with a great anatomic variability. To deal with this problem, we used a sequential chimeric osteocutaneous free flap for reconstruction. PATIENTS AND METHODS: A 58-year-old man presented with an open tibial fracture after an avalanche accident resulting in an extended osteocutaneous defect in the lower extremity. The injury required osteocutaneous free flap coverage. We reconstructed the defect with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap. RESULTS: The preservation of the ascending branch of the deep circumflex iliac vessels offered us the possibility to effectively cover an extended osteocutaneous defect in the lower extremity with a sequential chimeric osteocutaneous DCIA-perforator-SIEA flap. In our patient, the sequential chimeric osteocutaneous DCIA-perforator-SIEA flap healed without complications. A small hernia developed at the inguinal donor site area, but it healed without further complications after surgical treatment. The patient regained an adequate function and returned to daily life and physical exercise. CONCLUSION: While preparing the DCIA-perforator free flap, it is important to preserve the ascending branch of the deep circumflex iliac vessels and the vessels needed to harvest either a SIEA or SCIP flap.

Are Genetics the Predicting Factor for the Success of Migraine Surgery? A Report on Identical Twins.

Migraine affects more than 1 billion people globally, with distinct genetic variations influencing susceptibility. Thereby, genetic variations play a key role in the probability of developing migraine. However, personalized genetic analysis-based treatment options in migraine treatments are limited. Notably, surgical deactivation of extracranial trigger has shown efficacy in the treatment of migraine patients with identifiable trigger points in specific anatomical locations in the head and neck region. We present the first case of monozygotic twin sisters, both experiencing occipital and temporal-triggered migraine headaches with identical history and characteristics and without response to conservative migraine treatments. After surgical intervention, targeting the greater and lesser occipital nerves as well as auriculotemporal nerves, both twin sisters exhibited an over 99% reduction in symptoms without postoperative complications. This case suggests a potential correlation between genetic background, irrespective of environmental factors, and the effectiveness of surgical deactivation of trigger points in migraine management.

The Single-port Laparoscopic Omental Free Flap: Reconstruction of Dorsal Hand Defects with Negligible Donor-site Scar.

The reconstruction of complex dorsal hand injuries can be challenging. For coverage of dorsal hand defects, thin flap tissue is preferred. In addition, it is ideal to raise flaps with minimal donor-site morbidity and a discrete scar. In a 65-year-old obese man, we successfully reconstructed a soft-tissue defect measuring 7 × 5 cm at the dorsal hand with an omental free flap harvested through single-port laparoscopy. Our patient regained hand function and is satisfied with the aesthetic results. We propose the single-port laparoscopic omental free flap to be a suitable option for free flap dorsal hand reconstruction, especially in obese patients with small defects. The technique provides a thin free tissue with a concomitant negligible donor-site scar.

The Subcalcaneal Fat Pad: An Innovative Space for Passage of the Pedicle in Free Flap Reconstruction of Lateral Heel Defects.

Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.