High-tension electrical calvarial burns are extremely rare and difficult to reconstruct. Invariably, these are third- or fourth-degree-deep burns involving the bone and underlying brain. Historically, these wounds have been treated conservatively, adding to morbidity and prolonged treatment. Two patients with high-tension electrical calvarial burns presented to us 2 weeks after the injury, one fourth-degree deep with infected necrotic calvarium and scalp, resulting in a full-thickness frontoparietal defect with herniation of the brain. The other patient had third-degree burns over the occiput with surrounding second-degree-deep burns extending onto the nape of the neck with patches of second-degree deep burns over the vertex. Both patients had the risk for being subjected to prolonged anesthesia. The defects were covered with bipedicled scalp flap. In the face of sepsis and other comorbidities where more complicated flaps are risky, this flap provides a simple and reliable method of reconstruction.
The peroneal artery perforator-based flap is reliable and reproducible in an acute post-traumatic setting. It should be considered as a suitable alternative for reconstruction for limited defects with exposed fractured tibia over the middle and lower third of the leg.
A B S T R A C TThis report describes the surgical reconstruction of a traumatic medial orbital wall blow-out fracture using an autologous calvarial bone graft modeled intraoperatively using a three-dimensional (3-D) fused deposition model of the fracture defect. Previous case reports have demonstrated the use of 3-D models in planning the surgical approach, selecting and fashioning the desired implant in the perioperative period, and even using models with sterile coverings intraoperatively to mold synthetic implants. This is an individually unique application of 3-D printing for the surgical repair of pure medical wall blow-out fracture.
Aim: The classical keystone-design flap, although elegantly employed for various trunk defects, has limited movement on the leg. This study aims to modify the keystone-design flaps for leg defects. Methods: A keystone-design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. Results: It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy. Conclusion: The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.
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