Background: The aim of post-traumatic digital reconstruction is to restore form and function, all... more Background: The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF). Methods: Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs. Results: Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result. Conclusions: The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.
Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg... more Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap. Materials and Methods A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction. Results A total of 1...
Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and low... more Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and lower limb. This case report describes the reconstruction of a 5-cm nerve defect involving the superficial peroneal nerve (SPN) where it divides into its two terminal branches. A 5-cm nerve graft was harvested from the proximal part of the medial dorsal cutaneous nerve (MDN) and interposed to fill the gap between the distal stump of the SPN and the intermediate dorsal cutaneous nerve (IDN). The stump of the MDN was then sutured with an end-to-side (ETS) technique to the IDN, distally to the nerve graft, by opening a window in the epineurium of IDN. The sensory restoration of the dorsal area of the foot after 8 months was evaluated satisfactory from the authors. Tenderness and Tinel’s sign at the lesion site were not present. The patient’s satisfaction was excellent. The results of this case may suggest that a nerve defect involving a bifurcation point can be treated with satisfactory result...
Background: The aim of post-traumatic digital reconstruction is to restore form and function, all... more Background: The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF). Methods: Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs. Results: Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result. Conclusions: The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.
Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg... more Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap. Materials and Methods A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction. Results A total of 1...
Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and low... more Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and lower limb. This case report describes the reconstruction of a 5-cm nerve defect involving the superficial peroneal nerve (SPN) where it divides into its two terminal branches. A 5-cm nerve graft was harvested from the proximal part of the medial dorsal cutaneous nerve (MDN) and interposed to fill the gap between the distal stump of the SPN and the intermediate dorsal cutaneous nerve (IDN). The stump of the MDN was then sutured with an end-to-side (ETS) technique to the IDN, distally to the nerve graft, by opening a window in the epineurium of IDN. The sensory restoration of the dorsal area of the foot after 8 months was evaluated satisfactory from the authors. Tenderness and Tinel’s sign at the lesion site were not present. The patient’s satisfaction was excellent. The results of this case may suggest that a nerve defect involving a bifurcation point can be treated with satisfactory result...
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