Background:The purpose of this study is to decrease the incidence of venous congestion occurring in the reversed flow posterior interosseous artery flap used for coverage of hand defects.Methods:This may be achieved by studying the incidence of venous congestion in flaps including only 1 perforator and comparing the results with others including more than 1 perforator both in small and large sized flaps.Results:This study showed that inclusion of only 1 perforator in the flap decreased the incidence of venous congestion with complete flap loss in flaps to 5%. Also, it decreased the incidence of venous congestion with partial flap loss in flaps to 10%.Conclusions:The small sized reversed flow posterior interosseous artery flap should be less than 40 cm2 and should include only 1 perforator to decrease the incidence of venous congestion with partial and complete loss of the flap. The level of evidence for this study is the type II prospective comparative study.
The reversed radial forearm flap is considered the workhorse flap for hand reconstruction, while the posterior interosseous artery (PIA) flap did not take the same interest. This paper presents 25 cases with ulnar side hand defects that was reconstructed with PIA flap with 22 flaps survived (88%). The PIA flap seems a good option and should be considered as another option for hand coverage when the surgeon prefers not to use free tissue transfer or the radial artery flap. The flap should be learned to senior and junior reconstructive surgeons, because familiarity with the flap anatomy lessens the operative time greatly and makes surgical dissection easier.
Huge upper limb defects poses difficulty due to its length and need of thin skin flaps allowing tendon gliding and durable coverage. Many reliable flaps have been described either pedicled local, regional, distant pedicled or free flaps. The lower abdominal flap based on the superficial circumflex iliac and superficial inferior epigastric vessels; branches of the superficial femoral systems on both sides that were divided sequentially from the abdomen due to its robust size to avoid vascular compromise of the flap. The flap survived completely with good adherence and coverage. The donor site was closed primarily with very minimal donor site morbidity. In conclusion; bilateral combined groin and hypogastric flap may be useful in extremely huge combined skin defects on the hand, forearm and the elbow with high reliability and safe.
Background:The incidence of thrombotic manifestations during aesthetic procedures may be overwhelming, as it may endanger patients' lives. Lipoabdominoplasty is one of the precarious aesthetic treatments with risk for thrombosis. COVID-19 convalescent patients may have an abnormally high rate of thrombotic events, which should be studied further. Patients with a history of COVID-19 infection who undergo the aesthetic procedure may have a greater risk of thrombosis than non-COVID-19 patients who undergo lipoabdominoplasty. Methods: Thirty-seven patients who underwent lipoabdominoplasty were followed retrospectively for the occurrence of thrombotic events postoperatively and their relationship to previous COVID-19 infection. The study design comprised an examination of their medical records for prior COVID-19 infection, a history of thrombotic events before, during, or following COVID-19 infection, and D-dimer levels during and after COVID-19 infection. Thrombotic signs were studied in COVID-19 convalescent and non-COVID-19 patients following lipoabdominoplasty. The universal prophylactic measures for anticoagulation were followed. Results: Four patients out of 37 (10.18%) had thrombotic manifestations, with a high incidence in the COVID-19 convalescent group. The occurrence rate in COVID-19 patients was 30.7%, much higher than the global rate (0.2%). The presence of D-dimers was discovered to be abundant. Conclusion: Additional precautions should be taken to closely monitor patients with a prior history of COVID-19 infection who seek aesthetic surgery, particularly riskier procedures such as lipoabdominoplasty.
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