Assessing the Usability of Flexor Digiti Minimi Muscle for Opponensplasty: An Anatomic Study.

PURPOSE: The abductor digiti minimi (ADM) and flexor digiti minimi (FDM) muscles have a similar vascular and nerve supply. The purpose of this study was to assess the feasibility of transferring the FDM instead of ADM for thumb opposition. METHODS: Thirty cadaver hands were dissected under loupe magnification to assess the presence of the ADM and FDM muscles as well as their blood and nerve supply. The length of these muscles and their location in relation to the radial aspect of the thumb metacarpophalangeal joint were assessed. RESULTS: The ADM muscle was present in all cadavers whereas the FDM muscle was absent in 33% of hands. When the dimensions were suitable (53%), the more radially located FDM muscle reached the thumb metacarpophalangeal joint more easily. CONCLUSIONS: Although the dissections revealed considerable variability in FDM anatomy, when present, it can have positional advantage over the ADM for opponensplasty. CLINICAL RELEVANCE: In some cases with radial longitudinal deficiency, preservation of ADM function is essential. In these children, the FDM can potentially be explored and transferred if it is found to be suitable.

Replantation of Nine Fingers in a Patient: A case report.

Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors' knowledge, this is the first case of several finger amputations in Oman.

Tailgut cyst: A case report in a 9-month-old infant.

INTRODUCTION: Tailgut cysts or retrorectal cystic hamartomas are rare developmental anomalies that are believed to arise from the embryonic hindgut. PRESENTATION OF CASE: 9 months old male infant was presented with swelling in the right gluteal region. MRI lumbo-sacral spine showed well defined round to oval lesion which is brightly hypertense on T2W1 and hypotense on T1W1 posterior to sacrum and coccyx with no evidence of connection to the thecal sac indicating cyst. Complete excision of the cyst was done. Histopathology report shows cyst wall partially lined with stratified squamous epithelium and cyst wall shows spaces lined by cuboidal epithelium and nerve bundles with no evidence of malignancy suggestive of tailgut cyst. DISCUSSION: Tailgut cysts are rare congenital anomalies. Most commonly located in the retrorectal space. They are thought to be derived from the remnants of the embryonic hindgut. Age ranges from 4 to 73 years but an average presentation is at 35 years. Female to male ratio is 3:1. MRI is a good diagnostic tool for diagnosis of tailgut cyst. Complete surgical excision is the treatment of choice as this provides a definite diagnosis and prevents possible complications such as infection, fistula formation and malignant degeneration. CONCLUSION: The aim of presenting this case is its rarity. Complete surgical excision is the treatment of choice. Preoperative imaging with MRI is essential to plan the most appropriate surgical approach.

Short-term augmentation of venous drainage with extra-corporeal shunt and simultaneous auto-transfusion, for salvaging a congested free flap.

Adequate drainage of venous blood is the most critical part of successful free tissue transfer. We report a case of anterolateral thigh flap used for covering open communited tibial fracture. The flap was salvaged with short term augmentation of venous drainage with external shunt. The drainage was continued for six days. It was confirmed that there is no more congestion after blocking the catheter and then the drainage was discontinued on seventh day. The flap was successfully salvaged. This method has potential applications in multiple situations for successful salvage of free tissue transfer.

Unfavourable results in free tissue transfer.

With recent advances in the instrumentation and with increased expertise the results of microvascular surgery are getting better. Complications though, cannot be completely avoided. This paper gives a brief introduction to the possible complications at various stages of free tissue transfer. With careful planning and execution and vigilant postoperative care the overall success rate can be improved.

Reverse peroneal artery flap for large defects of ankle and foot: A reliable reconstructive technique.

BACKGROUND: Large soft tissue defects around the lower third of the leg, ankle and foot always have been challenging to reconstruct. Reverse sural flaps have been used for this problem with variable success. Free tissue transfer has revolutionised management of these problem wounds in selected cases. MATERIALS AND METHODS: Twenty-two patients with large defects around the lower third of the leg, ankle and foot underwent reconstruction with reverse peroneal artery flap (RPAF) over a period of 7 years. The mean age of these patients was 41.2 years. RESULTS: Of the 22 flaps, 21 showed complete survival without even marginal necrosis. One flap failed, where atherosclerotic occlusion of peroneal artery was evident on the table. Few patients had minor donor site problems that settled with conservative management. CONCLUSIONS: RPAF is a very reliable flap for the coverage of large soft tissue defects of the heel, sole and dorsum of foot. This flap adds versatility in planning and execution of this extended reverse sural flap.

Distally based cross-finger flaps for amputation stumps in avulsion amputations.

BACKGROUND: Though advances in microsurgery have resulted in better survival rates of replants, replanting crushed and avulsed digits are difficult. If replantation is not possible these digits need local tissue cover to retain length. PATIENTS AND METHODS: Twenty seven patients underwent distally based cross finger flaps for coverage of exposed vital structures over the amputation stumps. RESULTS: All the flaps survived well. They provide good quality thin pliable tissue over the fingertips and help in achieving near normal range of movements in injured digits. CONCLUSION: Distally based cross finger flap gives tissues of right dimensions, at the most desired site, making reconstruction of these difficult problems quiet easy.

Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft.

Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

An effective technique of helical cartilage scoring for correction of prominent ear deformity.

Otoplasty has a long history starting from 1948, when Dieffenbach described it first. Multiple technical modifications have been reported since. We propose a technique of scoring the helical cartilage without a visible incision on the lateral aspect of pinna for easier remolding of cartilage through posterior approach. The results have been excellent.

Endoscopic-assisted shoulder-contour-defect augmentation.

Need for cosmetic reconstruction around the shoulder is uncommon and is always challenging to the plastic surgeon. In this area, the scars often have a tendency to undergo hypertrophy. Any reconstruction in this area requires careful planning of incisions. In the following case report, we present an augmentation technique of the shoulder-contour defect. The use of an endoscopic pocket dissection helps in avoiding long scars in this notorious area. If planned and executed properly, this technique can be a valuable option for reconstruction of contour defects in difficult areas such as the shoulder.

Coverage of defects over toes with distally based local flaps: A report of four cases.

Reconstruction of the distal foot, especially of the toe has always been a challenging problem. Various methods have been tried with variable success rates and limitations. Presented here is a series of four cases, where distally based flaps were used. Two of them were Extensor Digitorum Brevis (EDB) muscle flaps and the other two were first dorsal metatarsal artery (FDMA) based skin flaps. One in each of the two was augmented with a plantar V-Y advancement flap. All flaps survived completely without any flap- or donor site-related complications. The patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. Distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.