Posterior Tibial Artery Perforator V-Y Advancement Flap for Small-Medium Size Lower Limb Defects.

The posterior tibial artery perforator flap has been described as a good option for small to moderate lower extremity defects with consistent anatomy and caliber. Different geometrical designs are found in the literature for posterior tibial artery perforator flaps and are mostly executed as propeller, peninsular, and island flaps. Upon literature review, V-Y advancement flaps were not commonly used, despite the clear design, persistent anatomy, and straight execution. Our aim was to report our case series to present the validity of such design and the success of reconstruction. METHOD: Over 1 year, three cases were reconstructed successfully with posterior tibial artery perforator flaps with V-Y advancement design. Clinical evaluation was done for all patients as well as follow-up in the outpatient clinic until complete healing of the wounds was achieved. Multiple modifications were done intraoperatively to enhance flap reach and minimize the complications, including designing V-Y advancement flaps larger than the defect, careful perforator dissection, and finally, strict postoperative course. RESULTS: All three cases healed completely with no complications. The average follow-up time in the clinic was 3 months. CONCLUSIONS: Posterior tibial artery perforator flap with V-Y advancement design is a viable option for reconstructing medium sized lower limb defects, but requires careful design and execution. The suggested steps will increase the survival of the flap and reconstruct the defect successfully.

Sodium-ypochlorite injection in antecubital fossa: A case report and literature review.

INTRODUCTION: Caustic cutaneous injections are rare and may result in challenging soft tissue defects necessitating urgent surgical reconstruction to preserve vital structures. We report a unique case of self-inflicted sodium hypochlorite injection to the left antecubital fossa as a suicidal attempt, which resulted in an exposed median nerve and brachial artery. The adventitia of the brachial artery was injured in this case; hence, the risk of an arterial blowout was considerable. After thorough debridement, the defect was reconstructed successfully with a reverse lateral arm flap. CONCLUSION: Household bleach (sodium hypochlorite) injections are rare and may result in challenging soft tissue defects necessitating urgent surgical reconstruction to preserve vital structures.