Medial triceps brachii free flap in reconstructive surgery: a prospective study in eight patients.

INTRODUCTION: In this study, we present a prospective series of medial triceps free flaps for ankle and foot complex defects coverage and discuss its numerous advantages. MATERIALS AND METHODS: Between January 2011 and December 2012, eight patients, two women and six men underwent medial triceps brachii (MTB) free flap procedure to cover defects localized at the ankle and foot in our department. Patient mean age was 37.3 ± 15.2 years at the time of surgery (range of 13-53 years). Mean defect size to be covered was 21.8 ± 9.9 cm(2). The bone was exposed at the level of the calcaneum in six cases, at the level of the forefoot in one case, and at the level of the lateral malleolus in one case. Special attention was accorded to intra-operative findings. Flap survival and complications on both the donor and recipient site were prospectively evaluated. RESULTS: Mean MTB flap raising time was 51.3 ± 6.0 min. All the flaps survived and there was no partial flap necrosis. A skin graft was performed after a mean time of 11.8 ± 2.1 days post-operative. The mean follow-up was 18.1 ± 3.8 months. Complications at the donor site level included one hematoma and a case of hypertrophic scar. Complete healing of both the donor and recipient sites was achieved in all cases. CONCLUSIONS: MTB free flap appears to be a useful option for covering small to medium defects in lower limb extremities. Due to the constant anatomy of the MTB nerve, we suggest that the flap could also be used as an innervated free flap for small or medium muscular reanimation such as sequelae of forearm and hand muscle impairment, or facial palsy.

Surgical treatment of congenital lymphedema.

Lymphedema is a pathologic condition that results from a disturbance of the lymphatic system, with localized fluid retention and tissue swelling. Primary lymphedema is a congenital disorder, caused by a malformation of lymph vessels or nodes. Major progress has been achieved in the radiologic diagnosis of patients affected by lymphedema. The ideal treatment of the affected limb should restore function and cosmetic appearance. Surgical treatment is an alternative method of controlling chronic lymphedema. Free lymph nodes autologous transplantation is a new approach for lymphatic reconstruction in hypoplastic forms of primary lymphedema. The transferred nodes pump extracellular liquid out of the affected limb and contain germinative cells that improve immune function.

The medial head of the triceps brachii. Anatomy and blood supply of a new muscular free flap: the medial triceps free flap.

PURPOSE: The anatomical features of the posterior compartment of the arm seem to provide the basis to raise one of the smallest free muscular flaps, with minimal donor site morbidity: the medial triceps free flap. METHODS: The anatomic study was carried out on 27 fresh cadaver arms: 7 prepared for corrosion cast, 15 for simple dissection and 5 for dissection after latex injection. Morphological data of the muscle, as well as pedicle constancy and size, were recorded. RESULTS: The mean size of the medial head was 10.7 × 2.5 × 3.3 cm; the mean weight was 30.1 g. We found a constant and unique pedicle supplying the whole medial head of triceps muscle, composed by the middle collateral artery (MCA), two veins and a nerve. The mean length of MCA was 2.9 cm and the "extended" pedicle, including the deep brachial artery (DBA), was 8-12 cm long. At their origin, the mean caliber of MCA was 1.5 mm and the mean caliber of DBA 2.4 mm. CONCLUSIONS: Our findings confirmed the reliability of the MC vessels and their anatomical relationships with the medial head of triceps brachii muscle, which could be harvested as a free flap or as a pedicled flap based on anterograde or retrograde flow. This technique should be safe, yielding mild donor site morbidity, and suitable in regional reconstruction or distant reanimations.

Variations in glial cell line-derived neurotrophic factor release from biodegradable nerve conduits modify the rate of functional motor recovery after rat primary nerve repairs.

Accelerating axonal regeneration to shorten the delay of reinnervation and improve functional recovery after a peripheral nerve lesion is a clinical demand and an experimental challenge. We developed a resorbable nerve conduit (NC) for controlled release of glial cell line-derived neurotrophic factor (GDNF) with the aim of assessing motor functional recovery according to the release kinetics of this factor in a short gap model. Different types of resorbable NCs were manufactured from a collagen tube and multiple coating layers of poly(lactide-coglycolide), varying in poly(lactide-coglycolide) type and coating thickness to afford three distinct release kinetics of the neurotrophic factor. GDNF release was quantified in vitro. End-to-end suture and GDNF-free NC served as controls. Thirty-five Wistar rats underwent surgery. Motor recovery was followed from 1 to 12 weeks after surgery by video gait analysis. Morphometrical data were obtained at mid-tube level and distal to the NC. NCs were completely resorbed within 3 months with minimal inflammation. GDNF induced a threefold overgrowth of fibers at mid-tube level. However, the number of fibers was similar in the distal segment of all groups. The speed of recovery was inversely proportional to the number of fibers at the NC level but the level of recovery was similar for all groups at 3 months. The resorbable conduits proved their ability to modulate axonal regrowth through controlled release of GDNF. In relation to the dose delivered, GDNF strikingly multiplied the number of myelinated fibers within the NC but this increase was not positively correlated with the return of motor function in this model.