Considerations on 100 cases of free microsurgical flaps in the reconstruction of the soft tissues of the lower limb.

The authors evaluate the results for 100 cases of severe loss of substance of the lower limb treated by microvascular free flaps at the Division of Plastic Surgery, Bellaria Hospital in Bologna, between 1994 and 2001. The cases involved recent traumatic loss of substance in 48 cases, post-traumatic defects such as osteomyelitis, ulcers, unstable scarring, sequelae of burns in 40, and neoplasms in 12. Muscular flaps were used in 89 cases, skin flaps in 9, a flap of the omentum in 1; the latissumus dorsi flap was that most frequently used (50 cases). A total of 87 cases had favorable results, while in 13 cases there was failure of the flap. Based on the results obtained, and experience, current indications and causes of failure are discussed.

[From surgical gloves to the rat. The various stages of microsurgery learning]. / Dal guanto di silicone al ratto. Le varie fasi dell'apprendimento microchirurgico.

The paper describes the different stages of microsurgical training which should be followed in an experimental laboratory; it also stresses the main characteristics to which microsurgical trainees must pay attention without neglecting any steps, even the most banal ones, because microsurgery is a sequence of exercises and not a single one (microsuture). The rigorous and increasingly difficult step-by-step progress of the different phases allows the trainee to face the different passages with greater ability and mastery without losing that enthusiasm which is the motivating force. Obstacles and failures can be evaluated with a more critical and reflective eye. Microsurgical training foresees the gradual passage from synthetic materials, such as surgical gloves, to non-living biological structures, such as chicken legs, finishing with experimental animals such as the rat. These biological models are almost identical to human structures making the experimental stage very similar to direct clinical application. Microsurgery, nowadays, is an integral part of all surgical disciplines. A correct approach to surgery using a microscope, according to this teaching scheme, is surely of great help not only for young surgeons but for the veterans of surgery too.