ABSTRACT
Currently used tendon transfers for persistent traumatic paralysis of the common peroneal nerve are based on the transfer of the posterior tibial muscle, an antagonist muscle to the paralytic group of muscles. In order to achieve voluntary active dorsiflexion of the foot and automatic walking we have transposed the lateral head of the gastrocnemius to the anterior side of the lower leg, at the same time suturing the undamaged proximal end of the deep branch of the peroneal nerve to the motor branch of the tibial nerve innervating the lateral head of gastrocnemius muscle. After nerve regeneration and neurotisation the transposed lateral head of gastrocnemius was innervated by the deep branch of the peroneal nerve and thus it took over the function of the paralytic muscles. The indications for the operation, the surgical technique, and the results obtained in 6 cases are presented.
Subject(s)
Paralysis/surgery , Peroneal Nerve/injuries , Peroneal Nerve/surgery , Tendon Transfer/methods , Adult , Child , Female , Foot/physiopathology , Humans , Male , Movement , Muscle Contraction , Muscles/surgery , Paralysis/etiology , Postoperative Period , Treatment OutcomeABSTRACT
Vascularised fibula has been used to treat three patients with skin-bone defects of the foot following severe trauma. Similarity between fibula and metatarsal bone is obvious and makes fibula an ideal choice in the replacement of defects in the first metatarsal. Depending on the size of soft tissue defects, different combinations of fibula-skin transfer were used.
Subject(s)
Fibula/transplantation , Foot Injuries , Leg Injuries/surgery , Adolescent , Bone Wires , Child , Fibula/blood supply , Humans , Male , Metatarsal Bones/injuries , Skin Transplantation , Surgical FlapsABSTRACT
The use of a double folded radial forearm free flap for the reconstruction of full thickness cheek defects in six patients is reported. A brief comparison with other methods is made and a modification of the flap for the reconstruction of the angle of the mouth is presented.
Subject(s)
Cheek/surgery , Facial Neoplasms/surgery , Lip/surgery , Mouth Neoplasms/surgery , Surgical Flaps/methods , Adult , Carcinoma, Squamous Cell/rehabilitation , Carcinoma, Squamous Cell/surgery , Facial Neoplasms/rehabilitation , Female , Forearm/blood supply , Forearm/surgery , Humans , Male , Middle Aged , Mouth Mucosa/surgery , Mouth Neoplasms/rehabilitationABSTRACT
Fourteen patients with large tissue deficits in the calvarium and orbits were reconstructed using microvascular free-tissue transfer (15 flaps). The etiology of these defects was skin neoplasms (seven), osteomyelitis (four), burn (two), and trauma (one). The free flaps used were the latissimus dorsi muscle flap with a split-thickness skin graft (seven), latissimus dorsi myocutaneous flap (two), rectus abdominis myocutaneous flap (three), radial forearm fasciocutaneous flap (two), and split-iliac crest flap (one). There was one postoperative death, one flap failure, two recurrences of neoplasm, and one loss of bone grafts and flap from infection. The free flaps can offer good results in patients undergoing wide resection in the cranium and orbits providing immediate repair with acceptable cosmetic result, minimized morbidity, and short hospitalization. However, immediate reconstruction following tumor resection carries a danger of positive margins discovered on permanent histologic sections or the difficulty in detecting recurrence underneath a bulky free flap.
Subject(s)
Orbit/surgery , Skull/surgery , Surgical Flaps/methods , Abscess/surgery , Adolescent , Adult , Aged , Anastomosis, Surgical/methods , Bone Diseases/microbiology , Bone Diseases/surgery , Bone Transplantation/methods , Burns/surgery , Carcinoma, Basal Cell/surgery , Facial Injuries/surgery , Facial Neoplasms/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Muscles/transplantation , Skin Transplantation/methods , Surgical Flaps/adverse effectsABSTRACT
AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand. This paper discusses the mechanisms responsible for the formation of AV fistulae.
