Complex technique of large sural flap: an alternative option for free flap in large defect of the traumatized foot

The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in 13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3[rd] week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot

Epinephrine's effect in varying concentrations on the end artery organ in an animal model

To determine the concentration of epinephrine that causes end artery necrosis and ischemia. An experimental study. Animal Laboratory of Khordad Hospital, Tehran, Iran, from September 2007 to June 2008. This study was done on 54 ear flaps from 9 rabbits [9 [rabbits] x2 [ears] x3 [splits] =54] divided into three groups of 18 ear flaps each. Nine of the ear flaps were randomized as control and nine of them were randomized as study group. The different concentrations of epinephrine and lidocaine 1% were injected in study groups but only 1% lidocaine was injected in control groups. Study group 1 received 1/200000, group 2 received 1/100000 and group 3 received 1/500000 concentration of epinephrine respectively. There was no evidence of necrosis in the control and study groups 1 and 2. However, 4 out of 9 of the ear flaps showed clear evidence of tissue necrosis in group 3. Injecting epinephrine in 1/200000 and 1/100000 concentrations had no side effect for the end artery of the rabbit ear flaps, but 1/50000 concentration is shown that it can cause tissue necrosis. Further studies need to be done in order to find out the effects of epinephrine with the same concentrations on the human end artery

[Evaluation of early oral feeding and traditional oral feeding in upper gastrointestinal surgeries]

Due to fears of postoperative complications following upper gastrointestinal surgeries [UGI], fasting before bowl function recovery is a traditional practice, but fasting following elective surgery is controversial. The aim of this study was to compare early oral feeding versus traditional oral feeding in patients who underwent UGI surgeries. Fifty two patients who underwent UGI anastomosis or surgery for various reasons were randomly divided into early oral feeding [EOF] group and traditional oral feeding [TOF] group. The nasogastric tube [NGT] removal time, tolerance of oral feeding, ileuses, nausea and vomiting, vital sign before and after surgery, postoperative stay, patients. satisfaction and complications were recorded. The mean time of NGT removal was 1.62 +/- 0.49 and 4.61 +/- 1.99 days in EOF group and TOF group respectively [p=0.0005]. The mean start time of oral feeding was 2.04 +/- 0.19 and 5.87 +/- 1.32 days in the EOF group and TOF group respectively [p=0.0005]. Tolerance of oral feeding was seen in 24 [92.3%] patients and 21 [91.3%] patients in the EOF and TOF groups respectively. Duration of hospital stay following surgery was 5.62 days in the EOF group and 8.04 days in the TOF group. 24[92.3%] out of 26 patients in the EOF group were satisfied with oral feeding that started in the second postoperative day. 13 patients [56.5%] complained of delay feeding in the TOF group. The results of the present study suggest that early oral feeding following upper gastrointestinal anastomosis or surgery is safe and can result in a shorter hospital stay and less cost