Pedicled latissimus dorsi transfer for immediate soft-tissue coverage and elbow flexion.

This case report describes a new method of unipolar transfer of the latissimus dorsi for restoration of elbow flexion. The advantages of the technique are that it has superior resting tension compared to other unipolar transfers and provides more extensive soft-tissue coverage at the elbow than other unipolar or bipolar transfers. The disadvantage is that it does not restore the supinator function of the biceps. The technique is felt suitable for traumatic defects requiring extensive soft-tissue coverage as well as restoration of an active elbow flexor.

Vascular variation of the radial forearm flap: a case report.

Anomalies of the radial forearm flap have been reported; however, rarely does one encounter variations that jeopardize the vascular supply of the flap. In the reported case, an anomalous superficial vessel in the forearm supplied the skin island of the radial forearm flap. In addition, there were no perforating vessels from the radial artery.

Microvascular application of the nonreversed vein graft.

To determine the applicability of the nonreversed vein graft technique to 1-mm-diameter vessels, 24 New Zealand White rabbits underwent bilateral replacement of 2-cm defects in the femoral artery with vein graft conduits. On one side a standard reversed vein graft (RVG) was employed, and on the other side a nonreversed vein graft (NRVG) was placed after valve disruption with a Hall valvulotome. Patency rates were not statistically different (RVG 87 percent, NRVG 96 percent, p > 0.1). Electron and light microscopy revealed similar endothelial damage and time to endothelial recovery between the two techniques. There was no difference in flow volume between the two techniques. We conclude that the NRVG technique has acceptable patency rates in 1-mm-diameter vessels within the parameters of this study but that further research is required to determine clinical applicability.

Soft-tissue reconstruction of the face: a comparison of dermal-fat grafting and vascularized tissue transfer.

Eight patients treated with dermal-fat grafts and 8 patients treated with vascularized tissue transfer were retrospectively reviewed to determine the efficacy of the two methods in the treatment of the soft-tissue defects in Romberg's disease, clefting syndromes including hemifacial microsomia, and traumatic defects. Follow-up averaged 4 years and ranged from 1 to 9 years for the vascularized transfers and 1.5 to 11 years for the dermal-fat grafts. Both techniques were able to provide enduring augmentation. The vascularized transfers were able to provide a greater amount of augmentation. We conclude that dermal-fat grafting is a satisfactory technique for mild to moderate defects, but that vascularized transfers are required for moderate to severe defects.

Delayed reconstruction following Mohs' chemosurgery for skin cancers of the head and neck.

The case records of 52 patients with 55 cutaneous neoplasms treated by Mohs' chemosurgery and subsequently reconstructed by plastic surgeons were reviewed to determine if delay between resection and reconstruction adversely affected the outcome of reconstruction. Reconstruction was performed from 5 to 61 days after Mohs' chemosurgery for 45 basal cell carcinomas and 10 other cutaneous neoplasms. There were no complications during the interval between resection and reconstruction. Following reconstruction, minor wound complications occurred in 6% of patients; there were no major complications. Microscopic examination of the re-excised wound revealed residual disease in 2 of 45 cases of basal cell carcinoma and 0 of 10 other cutaneous malignancies. Both patients with residual basal cell carcinomas (i.e., false-negative margins after Mohs' surgery) had presented to the Mohs' surgeon with recurrent tumors. During a follow-up period of 3 months to 3 years after complete resection, recurrent tumor developed in 2 of 45 cases of basal cell carcinoma and 3 of 8 cases of squamous cell carcinoma. Delayed reconstruction, usually 5 to 20 days after Mohs' chemosurgery, can be performed without significant morbidity. Re-excision of the Mohs' chemosurgical wound for pathologic examination can detect residual disease and may be especially indicated for large recurrent wounds.