Distally based sural artery flap: a workhorse to cover the soft tissue defects of lower 1/3 Tibia and Foot

To present our experience of soft tissue cover of lower one third of tibia and foot, treated by an Orthopaedic Surgeon without any special training and reliability of this flap. Eleven patients, ten males and one female, with soft tissue defect of lower one third tibia and foot requiring soft tissue cover were treated from March 1999 to February 2004. The flap was outlined at the posterior aspect of junction of upper and middle 1/3 leg. The pivot point of the pedicle was at least 5cm i.e., 3 fingers" breadth above the lateral mallelous to allow anastomosis with the peroneal artery. Skin incision was started along the line in which the fascial pedicle would be taken. The subdermal layer was dissected to expose the sural nerve, accompanying superficial sural vessels and short saphenous vein. The subcutaneous fascial pedicle was elevated, with a width of 2cm to include the nerve and these vessels. At the proximal margin of the flap, the nerve and the vessels were ligated and severed. The skin island was elevated with the deep fascia. The donor site defect was closed directly when the flap was less than 3cm wide. A larger donor site defect along with the pedicle was covered with a split thickness skin graft. All flaps except one survived. Most flaps showed slight venous congestion which cleared in a few days. There was no loss of split skin graft. Distally based Sural artery flap remains the choice for reconstruction of soft tissue defects of lower 1/3 tibia and foot. The dissection is easy, quicker and can be done by an Orthopaedic surgeon without any special training

Management of Supracondylar fractures of humerus in children at Nawabshah

To assess the outcome of the management of Supracondylar Humeral Fractures in children. Retrospective study from Jan. 2002 to Dec. 2004. Setting: Department of Orthopaedics, Peoples Medical College Hospital, Nawabshah. Out of 102 children [<12 years] who presented with the Supracondylar fracture of Humerus, only 90 fulfilled the criteria and were included in the study. The data of the above mentioned children was collected and analyzed. Most [94%] of the fractures were extension injuries-Gartland Type-II [40%] and Type-III [54%]. Five cases had open fractures. Of the 90 fractures, 78 [87%] were operated within 24 hours and nine within 72 hours, whereas the remaining three were operated within fifteen days of the injury, due to their late arrival in hospital from remote areas. Nevertheless, all cases were operated within three days of their admission. All fractures required open reduction and internal fixation with two crossed K-wires; the facility of the image intensifier being not available. The results of our study are good as there was a low rate of long term deformity, due to quicker surgery and accurate reduction

Immobilization of cross-leg flap by external fixator

This is a study of 34 patients having Gustilo type III i.e. open fracture with soft tissue defect that cannot be filled by simpler methods like partial thickness skin grafting but requires cross leg flap with stabilization. In this study, stabilization was done with a relatively new method i.e. by an external fixator which allows easy access to the flap and readjustment if necessary together with early mobilization. The flap grafts were accepted in all cases. Age [minimum 3 years] and site [exposed heel, dorsum of foot, exposed tibia] are not a restriction for the use of external fixator. Complications were minimum and easily treated e.g. pin-tract infection [17.65%], joints stiffness [20.59%, etc. this flap was used for 24 tibial fractures out of which 21 united giving a nonunion rate of 12.50%. We feel that management of cross-leg flap with external fixator is simpler and gives better results