BACKGROUND: Although early free flap coverage for lower extremity traumatic defects has been recommended by several authors , it is often not practical due to associated patient injuries or logistics. The aim of this study was to evaluate the impact of suba-cute and delayed surgical timing on flap success. METHODS: A retrospective analysis of adult patients who underwent a microsurgical free flap operation between 2007 and 2012 following lower extremity trauma was performed. The patients were divided into 2 groups according to the time period between the injury and the free flap operation: a subacute group (flap performed 10 to 29 days after injury) and a delayed repair group (>30 days after injury). The details of patient demographics, the mechanism of injury, timing from operation to discharge, minor and major complications, and flap failure rates were evaluated and compared. RESULTS: The study included 35 patients who underwent 37 free flap operations. A total of 20 patients were operated on 10 to 29 days after the injury (subacute repair group), and 15 patients were operated on more than 30 days after the injury (32-92 days) (de-layed repair group). No significant correlation was found between the timing of the reconstruction, flap failure, and complication rates. CONCLUSION: Both subacute and delayed reconstruction for lower extremity traumatic defects can be performed with favorable results with appropriate wound preparation and precise preoperative planning.
Background: Nasolabial flap is a work-horse flap for coverage of many facial units. However, these flaps have limited mobility and these limit their use in many instances. Facial artery with its numerous small cutaneous perforators can be a source for free-style skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory flap. Methods: The authors present a case series of 35 patients with central facial unit defects reconstructed by a single flap harvested from the nasolabial sulcus. Results: In our series, we did not encounter any significant flap loss and patient satisfaction was high both functionally and aesthetically. Main drawbacks were temporary venous congestion and hair bearing flaps in male patients. Conclusion: The authors think with its reliability and versatility nasolabial perforator flaps, based on the same donor area as the traditional nasolabial flap can be a valuable addition to our arsenal in reconstruction of central facial unit defects.
Background Ischemia-reperfusion injury plays an important role in flap failure. Ischemic preconditioning technique is the only proven method for preventing ischemia-reperfusion injury, but it is not used widely in daily practice because of difficulties such as prolonging the operation time, need for surgical experience, and increasing the risk of complications. This study has been performed with the assumption that piracetam may be a simple and inexpensive alternative to the preconditioning technique due to its antioxidant, antiaggregant, rheological, anti-inflammatory, antiapoptotic, cytoprotective, and immune modulating effects. Methods Thirty-two rats were divided into four groups and latissimus dorsi musculocutaneous flaps were raised. No extra procedure was applied, and no treatment was given to the control group. Four hours of ischemia was created by clamping the thoracodorsal pedicle in the second group. The animals in the third group were treated with 10 minutes of ischemia and reperfusion periods as a preconditioning procedure before the 4 hours of ischemia. Animals in the fourth group received systemic piracetam 30 minutes before and 6 days after reperfusion. Nitric oxide and myeloperoxidase levels in serum and tissue, acute inflammatory cell response, and vascular proliferation in tissue were examined at the postoperative 24th hour and 10th day. Results Myeloperoxidase activity in both preconditioning and piracetam groups, was significantly lower than the ischemia-reperfusion group. Acute inflammatory cell response was similarly decreased in both preconditioning and piracetam groups compared with ischemia-reperfusion group. Tissue measurements of nitric oxide were also significantly higher in both preconditioning and piracetam groups than in the ischemia-reperfusion group. However, vascular proliferation increased in the preconditioning group, while it did not show any significant change in the piracetam group. Conclusion This study shows that systemic piracetam treatment provides protection against ischemia-reperfusion injury in musculocutaneous flaps and can offer a simple and inexpensive alternative to the preconditioning technique.
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