Flap elevation of the anterolateral (anteromedial) thigh flap can be difficult due to the complexities of anatomical variation, although it provides both thin and pliable skin and a long vascular pedicle. Detailed anatomy, and the selection and preparation of the perforator are described in this article. Furthermore, methods or dealing with the problem when perforators are not found at their normal location are also described. Motor nerve branches that run along the descending branch of the lateral circumflex femoral artery, the derivative large branch and the dominant perforator should be preserved during harvesting of the flap, with minimum donor site morbidity.
We investigated the clinical features in revision of flap surgery after reconstruction of the extremities for optimal selection of flap and reconstruction. The revision was performed to 42 flaps of reconstruction of the extremities (28 males and 14 females). Ages ranged from 21 to 61 years, with a mean age of 36.5 years. The reconstructed sites were the hand in 21 cases, the forearm in 7 cases, the lower extremity in 11 cases, and the foot in 3 cases. The revisions of flaps were performed for aesthetic aspects in 24 cases, to resolve difficulty with footwear for functional aspects in 10 cases, and pre-operative preparation surgery in 8 cases. The mean timing of the revision was 14.2 months (range, 4-60 months) after reconstruction. To achieve functional and aesthetic results after reconstructive surgery to the extremities are extremely important. For the selection of the flap, the anatomical characteristics of the recipient site should be considered, i.e., color and texture match and recipient vessels. The surgical aspects are: being appropriate for the design, contour requirements of the defect, meticulous procedure, and adequate postoperative care.
We developed a split hypoglossal-facial nerve anastomosis procedure called hemihypoglossal nerve transfer for the treatment of facial paralysis. Thirty-seven patients, most of whom developed facial paralysis after the removal of an acoustic neurinoma, underwent this procedure. The average period of paralysis was 6.3 months before surgery, and all the patients were followed up for >8 months. Except for 1 patient who had infection of the cheek, all patients recovered facial expression, regardless of the choice of side, cranial or caudal, of the split, hypoglossal nerve. A poor success rate was observed when the ansa cervicalis branch was used. A few instances of tongue atrophy were observed; there were 17 patients with minimal tongue atrophy and 15 patients with moderate tongue atrophy. However, severe atrophy, causing functional deficit of the tongue, was not observed. Thus, split hypoglossal-facial nerve anastomosis resulted in good constant facial reanimation. The choice of side, cranial or caudal, of the split hypoglossal nerve did not affect the facial reanimation outcome or tongue atrophy.
We report the use of ulnar parametacarpal flaps for skin defects after surgical treatment for severe Dupuytren contractures of the little finger. Five flaps were used for five little fingers. All cases were Meyerding grade 3 and the average patient age was 66.8 years. All cases affected the dominant hand. We confirmed the pulse on the ulnar side of the MP joint with Doppler inspection before operation. The abductor digiti minimi (ADM) fascial flap was elevated from the proximal side and rotated 90 degrees around the metacarpophalangeal (MP) joint to cover the skin defect. There was no necrosis of flaps. We assessed the postoperative results according to the percent improvement of total extension loss (MP+PIP). The average percentage improvement was 89.8%. This flap technique is simple and provided stable blood circulation, and therefore, this method is a useful alternative for severe little finger Dupuytren contracture. This study reports the short-term clinical results.
Surgical treatment for Buerger's disease is controvertsial. Sympathectomy is considered the effective choice for healing ulcers and relieving pain, especially in the case of upper limb involvement. However, the rate of success is unpredictable and some patients require further treatment because of the recurrence of pain after operation. Distal bypass procedures are rarely feasible in such patients, because it is difficult to find the proper target artery to anastomose the grafted vessel. We attempted to perform distal bypass in such a patient who had severe pain after sympathectomy by performing sympathectomy on the target artery so as to obtain proper outflow in the hand area.