Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would not be feasible, the lower limb can be salvaged with a cross-leg free flap procedure. We present a case with a large composite tissue loss that was reconstructed with cross-leg free transfer of a combined latissimus dorsi and serratus anterior muscle flap. This case indicates that this large muscle flap can survive with the cross-leg free flap method and this technique may be a viable alternative for large lower extremity defects that have no reliable recipient artery.
In reconstructive surgery, many autograft/allograft/xenograft and synthetic materials are being used for repairing congenital or acquired tissue and skeletal deformities. Compatibility of the graft or the material to the tissue, the risk or rejection, toxicity, and morbidity affect the preference. With the aim of searching the usability of human cadaver nail being used as xenograft instead of cartilage graft on small and composite defects, 60 rats were separated into 3 groups, each of which was composed of 20 rats. One hundred twenty nail samples of 1 × 1-cm size, whose epithelium tissue was shaved 2-sided, were prepared for the purpose of placing 2 of them into the back of rats. They were placed under the dorsal skin of rats as naked in the first group, as fascia-wrapped in the second group, and as amnion membrane-wrapped in the third group. It has been stated as a result of the pathologic surveys performed in 2, 4, 12, and 24 weeks from rats in all groups that all the nails were available; acute and chronic inflammatory signs that were observed in early stages regressed, and in late stages, histopathologic signs of all groups were similar. Nail has some advantages such as being cost-effective, being easy to obtain, and having less rejection risk for being composed of dead cells. Application of nail xenograft eroded 2-sided can be taken into account instead of cartilage graft in small-size areas needing support tissue.
Miniplates have been used for mandibular angle fractures during the past 2 decades. The technique of placing single miniplate at the upper border based on the tension lines of the fracture was proposed by Michelet and Champy. The need for a second miniplate to be applied to the lower mandible has been discussed recently. Biomechanical comparison of biplanar and monoplanar dual-miniplate fixation techniques was investigated by Haug. Our hypothesis is in dual-miniplate fixation; the proximal 3 holes of superior border miniplate could be fixated by bicortical screws. The first 2 are at the proximal bone segment and are not related to the tooth and also superior to the alveolar nerve. Generally, the third molar tooth is extracted because it is at the fracture site. Hence, the proximal third hole could also be fixated by bicortical screws. We define a biplanar dual-miniplate technique in which the lower plate and the proximal 3 holes of the upper plate are fixated by bicortical screws. We have designed a study for biomechanical comparison of our method and popular types of mandibular fixation methods.
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