Lateral malleolar region defects with exposed implants: proximally based peroneus brevis muscle flap.

OBJECTIVE: Reconstruction of lateral malleolar region defects with exposed implants is a problematic situation for the reconstructive surgeon because there are limited options. The objective of our study was to revise the management of these defects and point out the role of proximally based peroneus brevis muscle flap. METHOD: Patients with an implant exposed tissue defects of the lateral malleolar region were evaluated retrospectively. All defects reconstructed with proximally based peroneus brevis muscle flap were included in this study. RESULTS: Of the 17 patients identified the mean age was 37.1 years (range 16-58 years). The size of the defects were 2-9cm in length (mean: 4.9cm) and 2-4cm in width (mean: 2.6cm). All defects were successfully covered with proximally based peroneus brevis muscle flaps combined with split-thickness skin grafts. All flaps healed with no complication or need for secondary surgery. The mean follow-up was18.8 months (range 12-32 months). CONCLUSION: Proximally based peroneus brevis muscle flap is a good alternative for reconstruction of lateral malleolar region defects with reliable blood supply, short surgical time, and minimal donor site morbidity.

New end-to-end microvascular anastomosis with geometrically adaptable ends technique: an experimental study on rats.

OBJECTIVE: The aim of this study was to develop an effective arterial anastomosis model with a high patency rate and low operation time. We introduced a new end-to-end microvascular anastomosis with geometrically adaptable ends. METHODOLOGY: In this technique, two triangular flaps were prepared at the end of the vessels and four stitches applied on the tip of those flaps. During this study, 15 new technique anastomoses were compared to 15 conventional 8 stitches anastomoses in 30 rat femoral arteries. Operating time, patency rates and number of stitches with consequential effects on the vessel wall were analyzed statistically. The anastomotic patency of both groups was assessed by: (1) in vivo observation using the milking test under the operating microscope and (2) flow study using laser Doppler ultrasound. Healing was assessed by the light and electron microscopy. RESULTS: According to statistical results and compared to the conventional method, the new technique was associated with a significant time savings (mean 18 vs 26 minutes, p < 0.001). The patency rates were equivalent to the conventional technique by observation and laser Doppler ultrasound (p > 0.05). Histological evaluation of both techniques showed that rats operated with the new technique healed faster and with less endothelial damage. CONCLUSIONS: This new "Geometrically Adaptable Ends Technique" is faster, easier to perform and a reliable method with patency and flow characteristics similar to those of the conventional end-to-end anastomoses (Fig. 7, Ref. 20).

Vertical rectus abdominis myocutaneous flap for vaginal reconstruction after radical pelvic surgery for Stage II vaginal carcinoma.

Primary carcinomas of the vagina are uncommon, occurring only 2-3% of all gynecological malignancies. In women with early stage of disease, primary surgery, consisting of radical vaginectomy (plus hysterectomy in patients with tumors involving the upper vagina) and systematic dissection of lymphatic drainage of tumor, is a valid option. In these patients, a rectus abdominis myocutaneous (RAM) flap may be favorably used for vaginal reconstruction during radical pelvic surgery. Here we describe a case of Stage II vaginal carcinoma treated with radical pelvic surgery and vertical-RAM (V-RAM) flap reconstruction.

Prefabrication of a high-density porous polyethylene implant using a vascular induction technique.

Three-dimensional defects have been reconstructed with carved and remodeled frameworks wrapped within vascular carriers and have wide use in ear and nose reconstruction. The main problem with thick coverings is masking of the fine details in the frameworks. Other problems are insufficient blood supply, infection, and exposure of the implant. If sufficient vascular penetration can be established without any change in size and shape of the implant, it will be possible to cover it with a thin skin graft and improve aesthetic results. In this study we planned to prefabricate a high-density porous polyethylene implant that has been used frequently. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally in 10 adult New Zealand White rabbits. Twenty implants were prefabricated in this procedure, and they were evaluated via histological examination and perfusion scintigraphy. Results revealed that the implants were invaded by fibroneovascular tissue. Blood supply coming from the vascular pedicle was sufficient to maintain the implant as a prefabricated composite flap, which could be transferred as a pedicled flap or a free flap.