Lateral arm perforator flap as an island advancement flap for posterior elbow soft-tissue reconstruction.

Many flap designs for coverage of soft-tissue defects of the posterior elbow have been reported, and the lateral arm flap is considered reliable. With the advantages of less donor site morbidity and preservation of the continuity of the source artery, perforator flaps have taken the place of lateral arm flap recently. The lateral arm perforator flaps for elbow soft-tissue coverage have a propeller design. In this report, we describe a case of posterior elbow defect that was reconstructed with posterior radial collateral artery perforator island advancement flap. Lateral arm perforator island advancement flap is a good alternative for a propeller flap for coverage of soft-tissue defects of the posterior elbow.

Reconstruction of Achilles region defects: A single-centre experience.

BACKGROUND: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to the use of free flaps. The aim of this study was to discuss reconstruction options and to help the surgeon to select reliable approach to achieve favourable outcomes. METHOD: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single centre. RESULTS: Reconstructions were performed with secondary healing (n = 2), negative pressure wound therapy and skin grafting (n = 2), free flaps (n = 6) and local and distant flaps (n = 4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. CONCLUSION: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. The use of special digital imaging techniques facilitates flap surgery and helps minimise the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Super-thin free flaps offer a distinct advantage in skillful hands. The use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favourable outcomes.

Reconstruction of firearm and blast injuries in Syrian war refugees.

BACKGROUND: War injuries differ from other injuries owing to the large tissue defects they cause and their high risk of contamination. As fragments scattered by high-energy firearms and explosives cause serious composite tissue damage, repair of such injuries is difficult and requires a long treatment period. We discuss the treatment methods used for injured Syrian War refugees admitted to our clinic and present the most effective repair methods for war-related tissue defects for each region of the body. METHODS: A total of 61 patients treated between June 2012 and April 2015 were retrospectively evaluated in terms of age, gender, duration of hospitalisation, injury site and repair method employed. The patients were grouped by region injured (head/neck, extremities and trunk). RESULTS: The female-to-male ratio of the patients was 16/45, and their mean age was 25.2 (range, 3-51) years. Twenty-two patients were under the age of 18. The mean duration of hospitalisation was 28.5 days. A total of 130 operations were performed on the patients, including debridement and revisions. Repairs were conducted with free flaps in 17 patients (6 on the head/neck region, 11 on extremities) and with pedicle flaps in 28 patients (11 on the head/neck region, 12 on extremities, 5 on the trunk). Two patients experienced flap loss without other complications, and other patients experienced complications including bleeding, infection, flap detachment, hematoma and seroma. CONCLUSIONS: War injuries cause tissue damage of a composite and extensive nature. Most affect the extremities, followed by the head/neck and trunk regions. They are primarily sustained by the young population, not usually easy to treat, and require long hospitalisation periods. A variety of methods may be preferred to treat these injuries.

Perforator artery response to tissue expansion: An experimental study in rabbits.

BACKGROUND: The reconstruction of defects is a major area of interest in plastic surgery. Tissues are expanded to extend the tissue surface area and to prepare more reliable perforator flaps. OBJECTIVES: Because expanded perforator flaps have become more popular, the aim of this study is to determine the response of the perforator artery to tissue expansion. MATERIAL AND METHODS: We used a rabbit S1 perforator (first perforator branch of the thoracodorsal arteries) flap model. In 12 New Zealand White rabbits, left flaps were used as the experimental group (n = 12) and right flaps were used as the control group (n = 12). Both flaps were constructed in the dorsal skin. The experimental group was further divided into 3 subgroups according to expansion volume: 150 mL (n = 4), 200 mL (n = 4) and 250 mL (n = 4). We evaluated the responses of the perforator arteries to tissue expansion using the resistivity index (RI), the pulsatility index (PI), vessel diameter (D), histopathological examinations, and angiography. RESULTS: After 3 weeks of expansion, the perforator artery diameter had increased (p = 0.002) and the RI had decreased (p = 0.031) in the experimental group. The perforator artery diameter (p = 0.006) and RI had increased (p = 0.003) in the control group. No significant changes were observed in the PI in either group (p > 0.05) and no significant differences in post-expansion measurements were observed between experimental subgroups (p > 0.05). CONCLUSIONS: Suprafascial expansion of a perforator flap leads to an increase in diameter and a decrease in the RI of the perforator artery. The decrease in RI may indicate increased flap perfusion.

A convenient flap for repairing the donor area of a distally based sural flap: Gastrocnemius perforator island flap.

OBJECTIVE: The reconstruction of complex lower leg and foot defects is difficult for plastic surgeons. The distally based sural flap (DBSF) is an option for non-free flap lower leg reconstruction. However, one of the major drawbacks of the DBSF is its aesthetically non-acceptable donor area scarring. MATERIALS AND METHODS: Eight patients (six men and two women) who had lower leg or foot defects were evaluated in this study. We used an ipsilateral or cross-leg DBSF to repair the defect. A medial or lateral gastrocnemius perforator island flap (average size 8.1 × 6.1 cm) was used to cover the donor area of the DBSF in a two-stage operative procedure. RESULTS: We did not observe any complications with the gastrocnemius perforator island flap. Two patients had local infections under the DBSF and were treated with bacteria-specific antibiotherapy. All patients were followed up for 1 year postoperatively. The donor areas of the distally based sural flaps were aesthetically acceptable. Patients gained ambulatory status during the follow-up period. CONCLUSIONS: Reconstruction of the donor area of a DBSF with a gastrocnemius perforator island flap allows for more acceptable aesthetics and functional results than do other reconstructive procedures.

Nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae in healthy children.

Streptococcus pneumoniae carriage is a risk factor for the development of respiratory system infections and the spread of penicillin-resistant strains. The aim of this study was to investigate nasopharyngeal carriage of S. pneumoniae in healthy children and resistance to penicillin and other antimicrobials and to assess related risk factors. Nasopharyngeal specimens collected from healthy children less than six years of age, visiting a Mother and Child Health Center for health control, were investigated microbiologically between February-March 2004. Carriage rate was 37.2% (n=112/301); 33.9% intermediate and 5.4% high penicillin resistance were detected. According to multivariate analysis, carriage rate was inversely related to number of rooms (OR:0.574) and child age (OR:0.978), while penicillin resistance was correlated well with antibiotic use in the last two months (OR:2.193). Decreased sensitivity plus resistance to other antimicrobials were: trimethoprim-sulfamethoxazole (TMP-SMX) 45.6%; erythromycin 16.1%, tetracycline 16.1%; clindamycin 9.8%, and ofloxacin 3.6% in pneumococcal isolates, which increased significantly (p<0.05) to 72.7%, 31.8%, 27.3%, 20.5%, and 6.8%, respectively, in penicillin non-sensitive S. pneumoniae (PNSSP) except for ofloxacin. Overall multidrug resistance was 17.9%, while PNSSP exhibited a resistance rate of 38.6%. In conclusion, S. pneumoniae carriage rates determined in healthy children were high and PNSSP strains also showed increased resistance to other antimicrobials.