Reconstruction of the Soft Tissue Defect of the Lower Leg by Distally Based Superficial Sural Artery Flap Using the Endoscope

A soft-tissue defect of lower one third of the leg presents a challenging problem because of the tightness and poor circulation of the skin. Various forms of coverage, including muscle flaps, facial flaps, septocutaneous flaps, axial flaps, and free flaps, have their own specific indications and inherent disadvantages. The distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. Up to now, distally based superficial sural artery flap has some disadvantages such as postoperative flap edema, congestion, partial necrosis of the flap margin and unfavorable scar. However, we could decrease these disadvantages by means of endoscopy. When subcutaneous fascial pedicle dissected includes sural nerve, superficial sural artery and small saphenous vein, the endoscope offers the magnified view, and enables us to dissect them more easily and safely. We report 2 cases of endoscopic surgery with some references concerning the defect of soft tissue in distal area of lower extremity and ankle joint using distally based superficial sural artery flap without complication.

Beast reconstruction using TRAM flap after nipple sparing subcutaneous mastectomy in breast paraffinoma ; report of 2 cases

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A Case of Orbital Pseudotumor

The orbital pseudotumor is non-specific inflammatory disease and is unrelated with specific local or systemic disease. The major symptoms are orbital pain, limitation of the ocular movement and exophthalmos. The inflammatory change can be diffuse within the orbit or may involve a specific structure such as an extraocular muscle or lacrimal gland. It occasionally occurs acutely, but chronically in some cases. It may bring about scarring accompanied by the intraorbital soft tissue including retroorbital fat or extraocular muscles. This can be detected by ultrasound, CT orMRI. The findings by imaging procedures are thickened extraocular muscles, diffuse inflammation of intraorbital soft tissue, enlarged lacrimal gland and enhanced periorbital tissue like "a ring". Sometimes, the focal masses may be seen around the optic nerve, within the retroorbital fat or near the opbital periosteum. The diagnosis of pseudotumor is made by excluding other causes or orbital mass lesions, such as neoplasm, and other causes of orbital inflammation such as Graves' disease and local infection. Treatments are usually used systemic high-dose steroids, additionally surgical excision and radiation. Authors experienced a 52-year old female with progressively enlarged tumor in right orbital area, exophthalmos and loss of sight was treated with surgical excision, and then the defect was reconstructed with the radial forearm free flap successfully.