Use of non-enhanced angiography to assist the second toetip flap transfer for reconstruction of the fingertip defect.

Toetip flap transfer is a useful reconstructive method for fingertip defect, but elevation of a toetip flap is technically demanding because of difficulty to dissect a pedicle vein of the flap. Recently, nonenhanced angiography (NEA) has been reported to be useful for preoperative visualization of the digital vessels without contrast enhancement or invasiveness. We report a case in which preoperative NEA visualized a vein suitable for a venous pedicle of a second toetip flap and facilitated successful toetip flap transfer for reconstruction of a fingertip defect. A 27-year-old male suffered from the right middle fingertip crush amputation in Tamai zone 1. The fingertip was reconstructed using a second toetip flap with preoperative NEA guidance. A pedicle vein was easily found and dissected exactly where NEA visualized. Nine months after the toetip flap transfer, the reconstructed right middle finger was functionally and aesthetically pleasing, and the toe nail at the donor site was preserved without any morbidity. NEA may help a surgeon to find drainage veins for a toetip flap, which leads to easier and more secure toetip flap transfer.

Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma.

BACKGROUND: Limb amputation has historically been the first choice of treatment for patients with bone or soft-tissue sarcomas involving major blood vessels. However, recent advances in surgical technique have allowed limb-salvage surgery. We reviewed our experiences with limb-salvage surgery and immediate vascular reconstruction following en bloc resection of bone or soft-tissue sarcomas of the lower extremity. MATERIALS AND METHOD: We reviewed 23 patients (15 male and eight female; mean age, 43.6 years) who underwent limb-salvage surgery and immediate vascular reconstruction. Details of surgical factors and postoperative complications were evaluated. RESULTS: Reconstructed vessels remained patent in 21 cases. The rate of limb oedema was higher in patients who underwent only arterial reconstruction after arteriovenous resection. Twenty patients could walk well without crutches a few months after reconstructive surgery. All patients avoided amputation. Two patients died of disseminated disease within 3 years after surgery. CONCLUSION: The high rate of limb oedema suggests that venous reconstruction is necessary after arteriovenous resection. Vascular reconstruction and musculocutaneous flap techniques are useful in limb-salvage surgery and are indicated for patients who have achieved good disease control. Evidence Rating Scale for Therapeutic Studies: Level III.

Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: review of 20 consecutive cases.

BACKGROUND: The reconstruction of large, complex defects of the abdominal wall after the ablation of malignant tumours can be challenging. The transfer of an anterolateral thigh (ALT) flap is an attractive option. This study compared free ALT flaps and pedicled ALT flaps for abdominal wall reconstruction. METHODS: From 1996 through 2011, 20 patients underwent abdominal wall reconstruction with ALT flaps. The flaps were pedicled in 12 patients and free in eight patients. Medical records were reviewed for complications and clinical and demographic data. Abdominal wall defects were classified into the following four groups: upper midline, lower midline, upper quadrants and lower quadrants. RESULTS: Pedicled flaps were transferred to the upper midline region in one patient, the lower midline region in six patients and lower quadrants in five patients. Free flaps were transferred to the lower midline region in two patients, upper quadrants in four patients and lower quadrants in two patients. Mean reconstructive time was significantly longer with free flaps (6 h 32 min) than with pedicled flaps (4 h 55 min, p = 0.035). Although free flaps (mean size, 360 cm(2)) were larger than pedicled flaps (mean size, 289 cm(2)), the difference was not significant (p = 0.218). The rates of complications did not differ between free flaps and pedicled flaps. No total flap loss occurred, and there was partial loss of only a single pedicled flap, which was the flap furthest from the pivot point. Infections developed of two pedicled flaps and three free flaps. CONCLUSION: This study suggests that complication rates do not differ between free and pedicled ALT flaps. The choice of flap depends on the size and location of the defect and the length of the vascular pedicle.

Reconstruction necessitated by severe hypoplasia or a columella defect.

In reconstruction necessitated by severe hypoplasia or a columella defect, the surgeon must consider various factors in each case, such as the characteristic columellar shape, color match, texture, patient age, original disease, and surrounding scars. In these cases, reconstruction of both the cartilaginous strut and the overlying skin is necessary and important to obtain good results. The authors report three cases of reconstruction of the columella with satisfactory results. Case 1 involved a 6-year-old girl with complete bilateral cleft lip and severe hypoplasia of the premaxilla and prolabium. Columellar reconstruction was performed with small triangular flaps at the columella base, together with a rib chondral graft for cartilaginous support. Case 2 involved a 12-year-old girl with a complete bilateral cleft lip and cleft palate. Columellar reconstruction was performed with small triangular flaps at the columella base, together with bilateral conchal cartilage grafts. Case 3 involved a 17-year-old boy with a right complete cleft lip and columellar defect caused by previous infection after secondary cheiloplasty. Columellar reconstruction was performed using a left nasal vestibular flap and septal cartilage grafting, together with a bilateral conchal cartilage graft beneath the flap. The authors consider the unilateral nasal vestibular flap to be very useful in carefully selected unilateral cleft cases.