[Reconstruction of posttraumatic soft tissue defects of the ankle using free fascial flaps from the anterolateral thigh]. / Rekonstruktion posttraumatischer sprunggelenknaher Weichteildefekte durch freie Faszienlappen aus dem anterolateralen Oberschenkel.

BACKGROUND: Free fascial flaps from the anterolateral thigh (ALT) were used to reconstruct soft tissue defects after trauma to the ankle. This modification was compared to the conventional fasciocutaneous method. MATERIAL AND METHODS: The defect size, the thickness of the subcutaneous fat layer on the thigh and the extent of the soft tissue covering the ankle were determined retrospectively. The evaluations were compared between fascial (Fo) and fasciocutaneous flaps (Fc). The foot and ankle outcome score (FAOS) was used. Esthetic outcome surveys were carried out. RESULTS: A total of 18 isolated fractures of the ankle were evaluated. In 94% of the cases a closed soft tissue damage predominated. After fracture fixation using a plate, soft tissue defects with a mean area of 40.4 ± 13.1 cm2 (28-76 cm2) developed. The thickness of the soft tissue covering over the affected malleoli increased significantly in both groups as a result of the flap surgery (4.5 ± 0.7 vs. 21.1 ± 6.4 mm, p < 0.05). A significant difference was found when comparing the body mass index (BMI) between the groups (Fc 26.3 ± 3.4 kg/m2 vs. Fo 30.1 ± 4.2 kg/m2, p < 0.05). For both groups there was a positive correlation (r = 0.843) between the BMI and the thickness of the epifascial fat layer of the thigh. The FOAS survey revealed 75.9 ± 28.9 and 47.9 ± 32.4 points, respectively, for "function in daily life" and "foot and ankle-related quality of life". The esthetic reconstruction result was rated as "acceptable" by 55% and as "good" by 45%. DISCUSSION: The modified method of a free fascial flap from the ALT can be useful in situations where a bulky flap makes it difficult to fit it into the defect.

[Turbo-propeller flap for elbow reconstruction under regional anesthesia]. / Turbopropellerlappen zur Rekonstruktion eines Ellenbogendefektes in Regionalanästhesie.

A method for the reconstruction of an extensive soft tissue defect after a complicating olecranon fracture is presented. A perforator-based retrograde pedicled propeller flap was used from the lateral upper arm with additive microvascular "turbo"-anastomosis to the radial artery and vein. The turbo-flap was performed under regional anesthesia.

[Perforator-based keystone flap in the reconstruction of extensive tissue defects after lumbosacral spondylodesis]. / Perforatorbasierte Keystone-Lappenplastik in der Rekonstruktion ausgedehnter Gewebedefekte nach lumbosakraler Spondylodese.

BACKGROUND: Prolonged surgical site infections after spinal fusion surgery may lead to exposure of the implant due to the formation of extensive tissue defects and endanger the clinical outcome. OBJECTIVE: This study aims to enlighten the role of the keystone perforator flap method in the reconstruction of lumbar soft tissue defects. MATERIAL AND METHODS: The retrospective study included 11 consecutive patients with a wound dehiscence of over 6â€¯× 6 cm defect area persisting for 2 weeks after spinal fusion. The keystone perforator flap was applied for the reconstruction of tissue defects, whereas the arterial blood supply of the flaps was based on the intramuscular and intermuscular perforating branches of the dorsal branches of the lumbar arteries. RESULTS: The median age of our cohort was 58 years. The median body mass index (BMI) and Charlson comorbidity index (CCI) were 29.9 and 3.4, respectively. In eight cases a lumbosacral was carried out whereas in the remaining series a lumbar fusion was performed. In the course of the subsequent wound revision, on average 4 applications of negative pressure wound therapy (NPWT) were performed. The average defect size was 7.5 cm in width and 16.5 cm in length. The microbiological analysis of the tissue samples obtained intraoperatively after repeated NPWT revealed positive evidence of pathogenic bacteria in all cases. The average duration of inpatient treatment after flap surgery was 15 days, which was significantly shorter than the NPWT management of the open defect wounds (15.5 ± 2.5 vs. 37 ± 16.5, p < 0.05). CONCLUSION: The keystone perforator flap offers a stable coverage for soft tissue defects and supports infection control after spinal fusion.