Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,adva...Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.展开更多
Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, whi...Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.展开更多
Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical exci...Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical excision and end-to-end microvasculer anastomosis using a superficial vein of the dorsal foot.To our knowledge,there have been only 15 reports of congenital aneurysms of the palm.展开更多
文摘Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.
文摘Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.
文摘Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical excision and end-to-end microvasculer anastomosis using a superficial vein of the dorsal foot.To our knowledge,there have been only 15 reports of congenital aneurysms of the palm.
