Distally based tenosynovial sheath flap of peroneal tendons for exposed tendo Achilles: preliminary report of five cases.

A distally based tenosynovial sheath of peroneal tendons was used as a flap with skin graft to cover the exposed tendo Achilles. The flap has a reliable blood supply being perfused by a constant sizeable musculofascial perforator. Cadaveric dissection with methylene blue dye study has been conducted to prove the rationality and reliability of blood supply. The position of the perforator had been confirmed prior to surgery by a hand-held Doppler. The flap used to cover the exposed Achilles tendon in five cases yielded positive results. To our knowledge, a retrograde flap of this nature is unprecedented though an antegrade flap of similar composition has been described.

Skeletonised retrograde distal perforator island fasciocutaneous flaps for leg and foot defects.

Defects involving the distal leg and foot are frequently encountered following various aetiological factors. Paucity of local tissue causes surgeons to resort to the retrograde peninsular flap, the cross leg flap or the free flap. With specific knowledge of perforators, the fasciocutaneous flap from the calf area can be transferred to the defect in a single stage based on skeletonised distal perforators. The surgical anatomy, flap planning and procedure have been detailed. Nineteen patients were treated during the period 1995 to 2005. The perforators were identified preoperatively by audio Doppler. The flaps were marked and dissected proximal to the defect skeletonising the distal perforators under loupe magnification and transferred to the defect in a single stage. The donor site was skin grafted. Out of 19 cases, 16 flaps healed uneventfully, one flap necrosed completely and in two cases there was marginal necrosis. The cases were followed up for 2-10 years with an average of 6 years. With detailed knowledge of perforators one can safely reconstruct distal moderate-size defects of the lower limb in a single stage, thus having the benefits of free tissue transfer without resorting to microsurgery. This technique has proved to be an advancement in the reconstructive repertoire allowing flaps of non conventional dimensions to be perfused by skeletonised perforators.

Angiographic evaluation of fasciocutaneous flaps.

Extensive studies have been carried out to understand the vascular anatomy of fasciocutaneous flaps both in human cadavers and in experimental models. Seldom has angiographic study been undertaken in clinical cases. Before peroperative clinical angiography, microangiographic study was performed on rabbits to understand the vascular supply of the skin and deep fascia. Major vascular dominance could be seen in the deep fascia compared with the skin. Thereafter, peroperative angiography was carried out to visualize the vascular network of fasciocutaneous flaps. The study was conducted in 10 patients who required antegrade fasciocutaneous flap for exposed upper two thirds of the tibia. It showed longitudinally oriented rich vascular network in the flap. This study provided peroperative objective assessment of the nature of vascularity and an explanation for the viability of fasciocutaneous flaps of nonconventional dimensions. The procedure did not have any detrimental effect on the physiology of the flap.