Soft tissue reconstruction of the thumb with the dorsoradial forearm flap.

The dorsoradial flap is a recently described cutaneous flap, which is harvested from the distal forearm and indicated for covering dorsal soft tissue defects of the hand and thumb. Vascularization of the flap is assured by a cutaneous branch of the radial artery, which arises at the level of the first intermetacarpal space and supplies the skin of the distal quarter of the forearm dorsum. This area corresponds to the skin island of the dorsoradial flap. We report our clinical experience on seven patients where this flap was used for covering post-traumatic defects of the thumb. Dimensions of the defect varied from 18 to 28 cm(2). The donor site was skin grafted. All flaps survived and provided satisfactory coverage of the defect. Based on a secondary vascular axis, the flap has a large skin paddle and a wide rotation arc that allows soft tissue reconstruction of the dorsal and radiopalmar areas of the thumb.

Treatment of facial haemangiomas: the present status of surgery.

Although conservative management is usually proposed for haemangiomas occurring in infancy, the presence of these tumours on the face may result in severe complications and provide an indication for treatment. In this paper, we report 35 patients who underwent surgical treatment for facial haemangiomas. The series consists of 23 females and 12 males, ranging in age from 2.5 months to 35 years. In six patients early surgery, before the age of 2 years, was performed because of severe complications, including visual occlusion, repeated bleeding and distortion of adjacent structures. In 16 children surgical resection of haemangiomas was carried out between 2 and 5 years of age, before complete involution. In 13 patients persisting haemangiomas were surgically treated at an older age. The operative technique depended on the location and size of the lesion, and focused on resection of the tumour and reconstruction of the adjacent structures when necessary. The postoperative outcomes were very satisfactory. Early surgery is mandatory in the management of large periocular haemangiomas, to prevent secondary amblyopia, and proliferative labial tumours, which are prone to bleeding and cause difficulty while eating. Early surgical treatment is also recommended for nasal-tip haemangiomas, which regress very slowly and may result in severe distortion of the cartilaginous framework. In conclusion, facial haemangiomas causing functional disturbance or serious psychological distress deserve surgical excision before the age of expected spontaneous regression; surgery can provide active treatment with excellent results and minimal morbidity.

Experimental use of prosthetic grafts in microvascular surgery.

Interpositional microvascular grafts are very often required in reconstructive surgery for bridging microvascular defects, particularly in association with replantation of amputated segments and free tissue transplantation. The present experimental study was undertaken to evaluate patency and healing of small-diameter polytetrafluoroethylene (PTFE) prostheses and to compare them with those of microvenous grafts. 10-mm long microarterial PTFE grafts of 1 mm internal diameter were implanted into the femoral artery of the rabbit to restore vascular continuity. Patency was assessed by Doppler ultrasound up to four weeks postoperatively. After harvesting, all grafts were evaluated macroscopically and examined by light and transmission electron microscopy. According to our results, five of 20 re-explored PTFE grafts (25%) remained patent at four weeks, while all microvenous grafts were judged to be patent at the same time. The difference between patency rates was found to be statistically significant (p < 0.0001). Recent literature on the experimental use of microvascular prostheses is reviewed and various factors affecting graft patency are discussed.