Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

Options for thumb revascularization: our experience and literature review

Traumatic injuries to the thumb resulting in segmental loss of a digital artery are not uncommon.To bridge the gap and repair a transacted digital artery,the superficial palmar arch or the radial digital artery of the index finger can be used to reconstruct the ulnar digital artery of thumb for revascularization.Revascularization following segmental loss resulting from a crushed ulnar digital artery of the thumb can be performed based on the superficial palmar arch or the radial digital artery of the index finger,avoiding anastomosis at two sites and hence providing better results.The digital vein from the index finger can also be used to enhance the venous return of the injured thumb.However,because of known variability in the palmar arch,intraoperative verification is needed to ensure the safe transfer of the arch or the radial digital artery of the index finger.The aim of this article is to discuss the possibilities for thumb revascularization,using a case report in which the injured thumb was revascularized with a superficial palmar arch.

Superiorly based perforator plus fl ap for inguinal defects

Aim:Inguinal block dissections for metastasis to inguinal lymph nodes and occasionally trauma are always associated with soft tissue loss over the groin region.A clinical study was undertaken to demonstrate the ability to utilize a superiorly-based perforatorflap with reliable vascularity and less donor site morbidity to cover defects in the inguinal region.Methods:A prospective study was performed on 7 patients with inguinal soft tissue defects managed in our institution from January 2013 to September 2013.During the study period,a“superiorly-based perforator plusflap”was used for soft tissue coverage over the femoral vessels in the inguinal region.Hyperbaric oxygen therapy was administered postoperatively.The postoperative period,hospital course,and follow-up after radiotherapy was documented in patients with inguinal block dissection.Results:Seven patients presented with soft tissue defects in the inguinal region.Five of the defects were secondary to prior surgery,and 2 were secondary to trauma.A superiorly-based perforator plusflap was performed in all patients.The defect sizes ranged from 9 cm×4 cm to 17 cm×8 cm.Theflap dimensions ranged from 12 cm×5 cm to 20 cm×10 cm.No secondary procedures were necessary following surgery.Postoperatively,there was no evidence of partial or totalflap loss.Noflap revisions were required,and no complications were experienced at either the donor or recipient site following radiotherapy.Patients were followed-up for 10-18 months.Conclusion:Inguinal defects require stable soft tissue coverage to withstand radiotherapy following inguinal block dissection surgery,and are susceptible to wound complications.The superiorly-based perforator plusflap technique is simple,requires little operative time,and is a reliableflap for coverage of the femoral vessels and inguinal region with improved tolerance to postoperative radiotherapy.