Pelvic limb reconstruction failed by propeller flap resolved with microsurgery

Reconstruction of lower limb defects is a constant challenge for surgeons, the etiology of the defect can be very variable from diabetic ulcers, traffic accidents, fall from height, oncological resections and many others. Free flaps have always been an important option because it has great results in complex reconstructions in lower limbs, it is a microvascular technique, so it has a higher level of complexity. This technique is usually reserved for extensive perilesional wide defects. On the other hand, the propeller flap, which is considered less invasive and easier as it does not involve microvascular surgery. An 18-year-old patient who had a fracture of the right tibial pylon due to a 7-meter drop, who after orthopedic treatment had a defect with exposure of ostesynthesis material of 3 cm in circumference in the medial malleolus. This defect was first managed with a propeller flap complicated with necrosis at 48 hours which was treated with sub atmospheric pressure system for 5 days and later with an ultra-thin anterolateral flap of the pelvic limb. Complete pedicled propeller flap failure is very rare but, because necrosis develops distally, even partial necrosis can expose bone, tendons, or other tissue. Some surgeons consider that propeller flap placement is risky in this location, especially the distal third of the lower leg a prefer to use free flaps. Whenever any pelvic member reconstruction plan fails in the distal third, the best and safest is the use of microsurgery even with the failure of a previous micro vascular flap.

Study of Loss of Free Flap and Safer Timing of the Operation in Electrical Injury

An electrical burn used to result in the damage of the skin and underlying deep soft tissue injury. Thus, in order to preserve devitalizing tissues and promote the structural survival free flaps with ample blood supply are frequently employed. However, early unpredictable vascular injury and progressive tissue necrosis may cause the free flaps full of hazards. We applied 50 free flaps upon 41 acute electrical burn cases between 1998 and 2004. Injured areas, timing of operation and causes of flap loss were studied. The victim's ages ranged from 13 to 60 years. (an average 37.8 years) Thirteen out of 50 free flaps were lost totally: three cases were due to arterial insufficiency and ten venous congestion. Total loss of flaps were observed in 5 of 12 cases in the postoperative 3 weeks, 6 of 20 cases between 3 and 6 weeks and 2 of 18 cases after 6 weeks. In three of 12 cases the free flap was lost partially in the postoperative 3 weeks, 4 of 20 cases between 3 and 6 weeks and 1 of 18 cases after 6 weeks. The result was statistically significant by a T-test (p<0.05). This study showed that timing of the operation is accountable for the loss of free flap. It is most important to conduct the free flap procedure on an electrical injury at the time when the recipient vessel is definitely discernible and intact so as to minimize the loss of flap and spare the structures.

A Case of Loss of LASIK Flap Due to Accidental Trauma

PURPOSE: Laser Assisted In Situ Keratomileusis(LASIK) is a preferred method to excimer laser photore-fractive keratectomy. In our paper, we insist that postoperative care, especially to avoid postoperative trauma. is considered to be important. CASE: A 22-years old boy was transferred into our hospital due to injuried left eye during playing basketball. His eye was received LASIK(OD: -7.00 Ds=-1.00 Dc Ax 50, OS: -8.00 Ds=-1.00 Dc Ax167) 1 years ago and then loss of LASIK flap developed due to this trauma. Injuried left eye of his was irrigated and then he weared therapeutic contact lens. RESULT: After wound healing, hazziness of traumatic cornea developed. He received lamellar keratoplasty for flap loss and corneal hazziness after postoperative accidental trauma. After receiving lamellar kerato-plasty, he maintains relatively good visual acuity(0.5 X -4.00 Dsph with K-840). CONCLUSION: As to review personel experience of the authors-lamellar keratoplasty for a flap loss and corneal hazziness after postopertive accidental trauma, we consider that it is an important vision-related complication of LASIK in the life and we report this unusual late complicated case with a review of available literature.