Maxillary reconstruction by fibular flap was reported in 1994. Now, it is known as one common method for skeletal reconstruction in the maxilla. Maxillary reconstruction by fibular flap contributes to improvement of facial contour, closing the palate, and stabilizing the denture. Many patients are satisfied with this operation. Procedures of maxillary reconstruction by fibular flap are similar to mandibular reconstruction, but differ in some points. We introduce some tips and pitfalls of maxillary reconstruction using a fibular flap. 1. Preoperative planning is crucial. 2. 3D Models are useful for preoperative planning. 3. Fixing the bone pieces should be completed before setting the bone graft to the defect. 4. To prevent unfavorable strain and pressure to the anastomosed vessels, the positioning of the flap and the vessels must be considered carefully. 21 years ago, we performed the first ever case of maxillary reconstruction by fibular flap with implant denture and the patient is still alive and healthy.
In this paper, a review of unfavorable head and neck reconstructive cases due to the complication of microvascular anastomosis at our institute is described. Between 2004 and 2014, the total number of head and neck reconstructive cases in which free flaps and microvascular augmentation were performed as team surgery was 239. In this series, 11 cases ( 4.4% ) required secondary surgical salvage due to postoperative thrombosis at the anastomosed site. Finally, 9 flaps failed and the rate of total necrosis of free flaps was 3.8%. Evaluation of the causes and methods of surgical salvage in cases with unfavorable results is very important for future advances and improvements in reconstructive surgery.
This paper reports on extensor tenolysis with transfer of an adipofascial flap including the perforator of the dorsal metacarpal artery. This technique was performed on 5 fingers in 5 cases. Extensor adhesion was caused by proximal phalanx fracture in 3 cases, extensor laceration in 1 case, and dorsal dislocation of PIP joint with central slip laceration in 1 case. The average age of the patients was 43 years, ranging from 20 to 56 years. Injured digits included 4 little fingers and 1 index finger. The results revealed that the active ROM of PIP and DIP joints improved postoperatively in all cases, but the extension lag of PIP joints deteriorated in 4 cases ( P < 0.05 ). The pedicled adipofascial flap using the perforator of the dorsal metacarpal artery is effective for preventing extensor adhesion. This technique is quite simple for flap elevation and acceptable for donor site morbidity. Furthermore, this flap does not include the muscle belly, so the operation can be performed under local anesthesia.
We have performed toe-to-hand transfer on nine pediatric patients with congenital ectrodactyly ( oligodactyly 1 ; monodactyly, 5 ; adactyly, 3 ) since 1994. Mean age at the time of transfer was 4.7 years and the mean follow-up period was 12 years. Seven patients received transfer of the second toe from a normal foot, and the remaining two patients underwent simultaneous amputation of anomalous lower extremities and transfer of the toes from the amputated foot. The toe-to-hand transfers were all successful ; however, all patients required secondary operations. Five patients required surgery for opposing digits. For a patient with a severely ectrodactylous hand, toe-to-hand transfer is an essential procedure, but secondary surgery is required to achieve pinching and grasping function. Additionally, when planning treatment for patients presenting with combined upper and lower extremity abnormalities, reconstruction using “spare parts” should be considered in order to minimize the loss of normal tissue.
Aneurysms of the palmar ulnar artery are rare events. They are usually related to repetitive trauma to the involved upper extremity. They can be found more frequently in young males and are sometimes related to anatomical abnormality of the origin of the vessels, infection, or vasculitis. We report a true non-traumatic aneurysm in the palm that arose from the ulnar artery. A 36-year-old right-handed woman had felt a nonpulsatile mass in the left palm. She gave no history of trauma or vasculitis. Magnetic resonance imaging showed that the lesion looked like a schwannoma. However, Doppler ultrasonography revealed blood flow signals within the mass. Three-dimensional CT angiography definitely showed an ulnar arterial aneurysm in the palm. The aneurysm was resected and microsurgical reconstruction was performed using a vein graft. Three years after the operation, the patient had no coldness, numbness, or recurrence of the aneurysm. Doppler ultrasonography showed good blood flow signals within the vein graft.
This is a report of a 54 year old woman who had received a Kenacort injection ( triamcinolone acetonide ) for de Quervain disease at a previous clinic, and had developed neuritis of the superficial branch of the radial nerve at the injection site. In adverse reaction to the Kenacort the subcutaneous tissue had already atrophied. Neurolysis was performed and a graft of free medial sural artery perforator adipofascial flap was wrapped around the superficial branch of the radial nerve. This operative treatment required no postoperative exposure or debulking of the forearm. The patient obtained pain relief with no recurrence of the symptoms. This flap was useful for the treatment of this neuritis.