DIEP flap breast reconstruction--new experience.

One of the important microsurgical procedures in our department is breast reconstruction after ablations. For many years, the standard method was reconstruction with autologous tissues--a free TRAM flap with a recipient vessels vasa mammaria. We are convinced that this give very satisfactory results with microsurgical safety of operations. We use this method of reconstruction in 17-20 patients per year. The standard time of unilateral reconstruction is 2.5-4 hours, of bilateral reconstruction 4-6 hours. Postoperative morbidity in the abdominal region is, as a rule, associated with a weakening of the abdominal wall and the development of hemias (Galli et al., 1992); a perforator flap in which neither muscle nor fasciae are used creates the prerequisite condition for markedly reduced the morbidity associated with the site of flap collection. Although we used a perforator flap three times for reconstructions of the extremities as early as three years ago, we began to use it for breast reconstruction from the beginning of 2000. No doubt this late use of a large skin flap supplied by 1-2 perforators was due to a lack of trust in the provision of adequate blood perfusion for the large amount of tissue of the flap. From the beginning of 2000, in the course of five months, nine DIEP flaps were used for breast reconstructions, in two cases for bilateral reconstruction. In two instances sensory nerves of the flap were sutured to the branch of the intercostal nerves at the site of insertion. Seven flaps healed p.p.i; in two instances we were faced with the complication of postoperative venostasis, calling for revision and connection of the superficial venous system of the flap to the circulation. Subsequent healing was without complications. Preparation of the flap appears to be relatively easy, and the only pitfall is the selection of a suitable perforator. The operation is longer by half an hour than the classical free TRAM; when the sensory nerve of the flap is sutured, it is ca 1 hour longer. We like to use the DIEP flap for breast reconstruction, and it is a reliable method even for the reconstruction of large pendulous breasts. The donor site morbidity is significantly lower.

Microsurgical reconstruction of a stiff jointless thumb after an avulsion injury.

We demonstrate three types of reconstruction of a stiff jointless thumb after an avulsion injury. In the first type, the skeleton of the thumb was harvested from the iliac crest or from a rib, the cutaneous cover was formed from a forearm flap on the a. radialis. In the second type, the preserved skeleton of the thumb from crushed tissues was transferred to the forearm and from there subsequently used for reconstruction together with the forearm flap. These two types of reconstruction were carried out if the amputation line reached the metacarpophalangeal (MP) joint of the thumb. In an amputation proximally from the MP joint, the skeleton of the thumb was reconstructed with a graft from the fibula on a vascular pedicle. The fibula with the vascular pedicle was transferred to the forearm and sutured in an Y-shape suture to the a. radialis. The tissue block of the forearm flap together with the fibula were subsequently transferred for the reconstruction of the thumb. The fundamental prerequisite for the reconstruction of a stiff jointless thumb were freely mobile three-phalangeal digits which could form a functional unit with the stiff thumb. The reconstructions were performed in 7 patients. The advantages and disadvantages of these particular operation schemes are discussed postoperatively after 2 years.

Long time follow-up of flexor tendons of the hand after reconstructive operations. Part 1. Monitoring method.

Monitoring method for patients who undertook the reconstructive operation of flexor tendons of the hand is described. Pre-operative condition, operation finding, surgery execution, post-operative condition, rehabilitation as well as the situation during the graduated checks up after 6 and 9 months; 2, 6 and 10 years were noted down into standard forms.