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Background: Emmett has described a single triangular flap that contains a partial skin bridge on one of its sides and called it the hatchet flap. It was successfully used for defects located on various body parts. The aim of this study was to present the authors' experience and results obtained with this flap in fingertip amputations. Methods: Nine patients who have completed their 1-year follow-up period were included in the study. Two-point discrimination and stiffness were tested, and the patients were queried about the existence of cold intolerance, hypersensitivity, numbness, and pain in the early (3 months) and late (1 year) postoperative periods. Results: The amputations were located on the thumb in three patients, index finger in one patient, middle finger in three patients, and ring finger in two patients. The average defect size was 2.1 ϫ 1.5 cm. Partial wound dehiscence was observed in one patient. The flap has provided good protective padding and aesthetic contour for the fingers. All incisions healed with inconspicuous scars. Average two-point discrimination was 6.3 mm (range, 4 to 8 mm). Cold intolerance was observed in two (22.2 percent) and paresthesia in one patient (11.1 percent). Joint stiffness was not noted. Most patients could return to their normal routine in approximately 4 to 5 weeks. Conclusions:The hatchet flap is a good alternative for transverse and lateral oblique fingertip amputations and valuable for volar oblique amputations (defects Ͻ2 cm) with more extensive flap designs. The technique is simple and safe and provides good protective padding and acceptable tactile gnosis. (Plast.

The tensor fascia lata flap is one of the appropriate choices for the coverage of trochanteric pressure sores. The authors designed a new, hatched-shaped tensor fascia lata musculocutaneous flap with distal Z-plasty closure and applied it to four trochanteric defects in 4 patients. Satisfactory results were obtained in all patients. The hatchet-shaped tensor fascia lata musculocutaneous flap is very safe, reliable, and practical. Designing the flap in a hatchet shape allows one to use the proximal and well-vascularized portion of the flap in the trochanteric pressure sore area. Another important advantage is the possibility of reuse resulting from recurrence. Prevention of a "dog-ear" deformity at the recipient site provides a smooth contour on the lateral aspect of the thigh. Another advantage is the tension-free Z-plasty closure of the donor site without need of grafting.

This study was carried out to observe the isolated effects of pedicle torsion on island skin flaps, without further damaging the pedicle. Twelve adult male Sprague-Dawley rats, weighting 240 to 300 gr, were used, and hexagonal flaps with edges measuring 1.5 cm and pedicles measuring 1 cm in length were raised in the inguinal region. The animals were divided into two groups. In Group A, flaps were re-sutured to the donor beds without any rotation. In Group B, flaps were rotated 360 degrees, applying the same degree of torsion to their pedicles before re-suturing. After 7 days, the percentage of surviving skin areas of the flaps was determined by planimetry, and transverse sections of the flaps and pedicles were taken and evaluated in terms of signs of arterial or venous insufficiency. Statistically significant differences between the groups were determined by analyses using the multiple comparisons test. Pedicle torsion in Group B did not affect flap viability, both macroscopically and microscopically. The presented study shows that 360-degree torsion applied to the pedicle of the flap in this model had no effect on flap viability.

Hair transplantation in the form of follicular units constitutes the cornerstone of hair-replacement surgery. Harvesting follicular units directly from the donor area by using punches is described as follicular unit extraction (FUE) technique, and it eliminates the need for excision of a hair-bearing strip. In this article, we presented our surgical approach for hair transplantation, which is based on performing follicular extraction in 2 phases: follicular unit isolation and follicular unit collection, and discussed some technical details of FUE and some advantages and disadvantages of this approach. We transplanted an average of 1651 follicular units in 1 day, 2610 follicular units in 2 days, and 3200 follicular units in 3 days.

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Flaps with venous occlusion have a decreased survival rate compared with arterial occlusion. It seems that several factors are involved in the etiology of total venous occlusion, including free radicals, edema, thrombosis, and reperfusion injury. In the present study, the authors evaluated the blockage of polymorphonuclear leukocyte endothelial adhesion by using a monoclonal antibody to the intercellular adhesion molecule 1 (ICAM-1) ligand to prevent venous ischemia-reperfusion injury in rat epigastric island flaps. A skin flap (3 x 4 cm) supplied by the superficial epigastric artery and vein was harvested unilaterally in 40 male Wistar rats. Total venous occlusion of the skin flap was achieved. Arterial inflow was left intact. Rats were randomly divided into four groups (n = 10). In Group 1; rats were intravenously pretreated with 0.5 ml of 0.9 percent normal saline 15 min before applying a venous clamp, and the flaps were subjected to 6 hr of venous ischemia. In Group 2; rats were intravenously pretreated with 0.05 mg of monoclonal antibody to the intercellular adhesion molecule 1 (0.20 mg/kg) in 0.5 ml of 0.9 percent normal saline 15 min before applying the venous clamp, and the flaps were subjected to venous ischemia as in Group 1. In Group 3; rats were pretreated as in Group 1, and the flaps were subjected to 8 hr of venous ischemia. In Group 4; rats were pretreated as in Group 2, and the flaps were subjected to 8 hr of venous ischemia. The flaps were assessed histologically and by measuring viable and non-viable areas on postoperative day 7. Flap measurements revealed that blocking the action of ICAM-1 IN VIVO by administering monoclonal antibody significantly attenuated ischemic injury after 6 or 8 hr of venous occlusion.

Reconstruction of soft-tissue defects of the calcaneal region and the heel is very demanding and necessitates, as a rule, a sensate and thin flap. The ideal characteristics of a sensate and thin layer of flap should be combined with a reliable blood supply and minimal morbidity at the donor site. The authors report an updated review of their experience with the use of island modifications of the lateral calcaneal artery skin flap-the lateral calcaneal island flap, the lateral calcaneal V-Y advancement flap, and the bilobed-shaped lateral calcaneal island advancement flap-for the reconstruction of small and medium-sized tissue defects over the exposed calcaneal tendons and calcaneal bones of 18 patients. All of the procedures were performed under spinal or epidural anesthesia. There were no problems associated with flap viability, but the authors have seen necrosis of undermined skin between the lateral malleolus and calcaneal tendon in two cases and a partial loss of skin graft in one case. In this article, the authors discuss some advantages and disadvantages of the use of a lateral calcaneal island flap and its modifications.