Successful clinical application in 14 cases confirmed vascular reliability. The gracilis perforator flap is a pliable, thin flap from the medial thigh that can be as large as 18 x 15 cm. The donor site is inconspicuous, and a functional gracilis muscle is preserved. By including a constant intramuscular anastomosis, it is possible to extend the territory of the free flap distally up to a length of 27 cm. Indications include reconstruction of cutaneous defects such as unstable scars or contractures. The medial thigh adipose tissue correlates well with the body mass index and thus can be used for breast reconstruction as a second choice if an abdominal perforator flap is not available.

This study assessed the clinical and radiological outcomes after treatment of scaphoid non-union of the proximal third by non-vascularised bone grafts and stabilisation by Mini-Herbert Screws from a dorsal approach. Thirty-one patients, one woman and 30 men, were reviewed retrospectively at a mean of 42 (12-77) months. All patients received pre- and postoperative CT scans to assess bone union. In addition to demographic data, the range of motion, grip strength, DASH score, Krimmer score, Mayo wrist score and radiological parameters (carpal height, scapholunate and radiolunate angles) were recorded. Bone union was achieved in 21 patients. The average DASH score in patients with bone union was 12 and that in patients with persistent non-union it was 30. No progression into carpal collapse or increase of scapholunate angles was detected. Our study demonstrates that acceptable union rates can be achieved with non-vascularised bone grafts, and this technique compares favourably with other reports in the literature.

Fractures of the scaphoid are relatively common injuries. Differentiation between stable and unstable fractures (Herbert classification) cannot always be made with conventional radiographs and should be additionally evaluated by computed tomographic scan. Under most circumstances, minimal invasive surgery with cannulated screws is currently the treatment of choice. Cast immobilization is not necessary. This article describes the technique of fracture fixation in the middle third of the scaphoid from a palmar approach and early functional outcomes. The outcome assessment included measurement of active range of motion as well as grip strength and the Disability of the Arm, Shoulder and Hand questionnaire as a measurement of activities of daily living. Fifty-four patients with acute scaphoid fractures were treated with minimal invasive screw fixation between April 2001 and January 2005. All patients in this retrospective study received a preoperative computed tomographic scan before surgery. Bony consolidation was found in 52 cases after 6 weeks; 2 patients required reosteosyntheses. The results demonstrate that minimal invasive screw fixation leads to satisfying functional outcomes within a few weeks.