Transversely Dividing Gracilis Muscle Free Flap for the Simultaneous Reconstruction of Two Anatomically Distant Defects

Free muscle flap for the simultaneous coverage of two anatomically distant sites has previously entailed the harvest of tissue from separate donor areas, Although it may be possible to achieve this goal with a variety of available donor site, the transfer of a single donor muscle to two different sites has been considered. The gracilis muscle is commonly usef by reconstructive surgeon in a variety of application as pedicled muscle or musculocutaneous flap and as a free tissue transfer for soft tissue coverage or a functioning muscle transfer. The gracilis muscle is classified as having a type II blood supply that anatomy is reliable. The main arterial supply to the gracilis muscle is a branch of the profunda femoris, which enters the muscle 10+/-1cm from its attachment to the pubis on its deep(lateral) surface. The distal portion of muscle between the main arterial pedicle and musculotendinous junction is supplied by one to three small arterial branches of the superficial femoral artery. The first minor pedicle located approximately 20 cm from the pubis. In 1990 Tadeusz reported the successful treatment of patient with bilateral calcaneal fractures and posttraumatic osteomyelitis using a longitudinal single split free gracilis muscle transfer. In 2001 We performed a transversely dividing gracilis muscle free flap in the patient with two soft tissue defects and osteomyelitis in anterior tibial region and foot.

Toe Partial Pulp Free Flaps in Multiple Digits Reconstruction

Reconstruction of a finger-pulp defect is one of the most difficult procedures. The reasons are that the identical donor tissue is not easy to obtain and the reducing the donor site morbidity is not easy to achieve. Particularly, reconstruction of multiple digit pulp defect is more difficult. We propose toe partial pulp free flaps for the replacement of defects of multiple fingertip. It can provide identical color matching to donor defect, and cut down the morbidity of donor site. The 33 digits of 15 patients were treated with this method. The donor sites were medial aspect of the second toe or third toe and lateral aspect of big toe. The neurovascular pedicles were composed of medial plantar digital artery, medial plantar digital nerve, and superficial plantar vein of the second toe, third toe or big toe. All flaps were survived. The average of static two-point discrimination was 5.9 mm. Primary closure of donor sites was possible in all cases. Toe partial pulp free flaps has many advantages in multiple digit reconstruction. It can provide excellent color and texture matching, excellent sensory recovery. It avoids long term immobilization. Vascular anatomy was so consistent that vessels were easily dissected. Primary closure of donor site was possible. However, there were some restrictions. The flap could not be applied to a large defect, and to patients with vascular disease and old age. It also required skillful technique in anastomosis of pedicle. In conclusion, we consider that toe partial-pulp free flaps are useful method to reconstruct the defects of multiple fingertips.

Reconstruction of Composite Tissue Defect of the Hand using the Osteofasciocutaneous Lateral Arm Free Flap

There are severe soft tissue defects associated with intercalary segmental or distal loss of bone in the crushing injury of the hand by high-energy machine such as presser, electrical saw, and agricultural machine. Bone grafting to restore the skeletal scaffold is essential for reconstruction of the soft tissue and preservation of the digit function. However, non-vascularized free bone grafts are not desirable, because recipient sites often have a poorly vascularized bed. We described 12 cases, which were reconstructed by the lateral arm osteofasciocutaneous or osteofascial free flap from 1997 to 2001. The bone was harvested from the distal humeral bone as an osteofasciocutaneous lateral arm flap that has constant osseous branches from the main pedicle of the posterior radial collateral artery along the lateral intermuscular septum. Lateral arm osteofasciocutaneous flap is able to provide well vascularized bone and soft tissue for hand reconstruction. All flaps survived and had acceptable shape and function without bone resorption. We consider that lateral arm osteofasciocutaneous flap is a useful method for reconstruction of the composite tissue defect containing the bone in one-stage operation of the hand.