Free vascularized fibula graft for a cystic femoral head and neck lesion in the West Indies

A case is presented of an 18-year-old athlete with fibrous dysplasia of the femoral neck and head. The approach was by joint plastic and orthopaedic teams, which minimized operating time and allowed the option of vascular bone grafting. The lesion was curetted through a greater trochanteric window and the defect reconstructed with a free vascularized fibula graft with excellent result. Weight bearing was achieved in six months and there was minimal donor site morbidity. We believe the free vascularized fibula graft to be a reconstructive option, in difficult orthopaedic problems, facilitated by microsurgery and there is immense benefit of a joint effort between the orthopaedic and plastic surgical teams

Latissimus dorsi muscle flap based on arterial branch to serratus anterior as salvage of a failed bipedicled transverse rectus abdominis muscle flap. A case report

We present a case of a failed bipedicled (unilateral rectus flap with superior epigastric pedicle preserved and inferior epigastric vessels anastomosed to the thoracodorsal trunk as the second pedicle) transverse rectus abdominis muscle flap that had compromised the dominant pedicle of the latissimus dorsi muscle. A salvage procedure was possible using this muscle as a pedicle flap based on the back-flow from the serratus anterior arterial branch with success. The use of the reconstructive ladder is highlighted

A case report of post-traumatic facial reconstruction in the West Indies

The radial forearm free flap is one of the most commonly used free flaps in reconstructive surgery. It is a recognized option for facial reconstruction internationally, but, to our knowledge, it has not been widely used in the Caribbean. We present a patient who posed a difficult reconstructive problem, for which the radial forearm free flap was the ideal solution, utilizing the flap's features of a long length of pedicle, large area of coverage, minimal tissue bulk, and options for further cosmetic revision

Pedicled flaps in reconstructive surgery

An audit was conducted of pedicled flaps used in reconstructive surgery in Trinidad from 1983 to 2000. This consisted of 65 flaps. There were four cases of partial flap necrosis: three involving tram flaps and the other involving the metacarpal artery flap. There were no cases of total flap loss. Pedicled flap coverage provides immediate closure of potentially difficult wounds. This early cover reduces the risk of infection as a result of increasing the blood supply and providing a physical barrier. This contributes to a shorter hospital stay and earlier rehabilitation. Our present team approach with the inclusion of a reconstructive surgeon now allows for uncompromised dÚbridement in trauma and oncological resection.