ABSTRACT
INTRODUCTION: The sensory reconstruction of the lower extremity is one of the main goals in lower extremity reconstruction. Reconstructive options endowing sensory recovery are limited. The aim of this report is to evaluate the neurotized sural flap in reconstruction of foot and ankle defects. PATIENTS AND METHODS: Seven cases that were operated for foot and ankle skin defects with the neurotized sural flap were reported. The largest flap was 10 cm × 14 cm in size. Median age was 38 years. Four defects were on the heel, two were on the ankle, and one was on the dorsum of the foot. The sural nerve was coaptated to a recipient nerve in seven patients. RESULTS: All flaps survived totally. Follow-up time ranged between 9 and 29 months. All cases had hot-cold perception and two-point discrimination at average 14 ± 1.63 mm at 6th month. Sensory conduction test revealed very low action potentials related to stimulation of the flap. CONCLUSION: The neurotized sural flap is a versatile modification, for the sensory reconstruction of the moderate size foot and ankle defects.
Subject(s)
Foot Injuries/surgery , Free Tissue Flaps/innervation , Plastic Surgery Procedures/methods , Soft Tissue Injuries/surgery , Sural Nerve/transplantation , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Free Tissue Flaps/transplantation , Humans , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To increase the viability of fat grafts using vascular endothelial growth factor (VEGF) in a calcium alginate microsphere controlled release system. DESIGN: Twenty-four rats were divided into 4 groups of 6 rats each. Group 1 was the preconditioning group in which VEGF was applied prior to the fat grafting. In group 2,VEGF was given at the time of the grafting. In group 3, an empty microsphere was added to the grafting material. The fourth group, which received the fat graft only, was the control group. At the 90th day, samples of the fat grafts were weighed and compared with preimplantation weights. RESULTS: The graft viability ratios of the first 3 groups were significantly higher than those of the control group. The relative adipocyte index was significantly higher in the first and second groups compared with the control group and group 3. Consistent with the literature, VEGF used both in the preconditioning procedure and simultaneously with the grafting procedure increased the graft viability ratio and relative adipocyte index. CONCLUSION: This study suggests that VEGF-induced preconditioning of the recipient bed improves fat graft viability via increased revascularization.
Subject(s)
Adipose Tissue/transplantation , Graft Survival/drug effects , Vascular Endothelial Growth Factor A/pharmacology , Adipocytes/drug effects , Adipocytes/metabolism , Animals , Cell Survival/drug effects , Disease Models, Animal , Graft Rejection/prevention & control , Immunohistochemistry , Male , Microspheres , Preoperative Care/methods , Random Allocation , Rats , Rats, Wistar , Reference Values , Regional Blood Flow/physiology , Sensitivity and Specificity , Tissue Transplantation/adverse effects , Tissue Transplantation/methodsABSTRACT
The management of soft-tissue defects in the ankle and foot area is a challenging task. Distally based sural flap is widely used, however it leaves donor area paresthesia. For this purpose, the sural nerve was dissected and preserved in the distally based sural flap in five cases of ankle and foot soft tissue reconstruction. This modification did not cause any compromise in flap circulation. All flaps survived with one partial distal necrosis. We suggest that, the distally based nerve sparing sural flap can be securely elevated with only a 3-4 cm wide subcutaneous pedicle without any compromise in flap circulation.
