Although artificial dura maters such as Gore-Tex are used in cranioplasty, the use of artificial products occasionally results in the formation of infectious lesions. Recently, we encountered two patients who underwent brain surgery and contracted infection from artificial dura maters used for cranioplasty. To treat the postoperative infection, we prepared a vascularized fascia lata attached anterolateral thigh flap that could be applied to the infected wounds in the reconstruction of dura maters and obtained satisfactory results. The present study demonstrated that fascia lata attached anterolateral thigh flaps were useful for reconstructing intractable cranial fistulae complicated by infection. The disadvantages of our surgical technique were the impossibility of simultaneous bone reconstruction and the difficulty in creating a watertight closure of fascia and dura mater, although leakage of cerebrospinal fluid was not observed so far.
The medialis pedis flap is a fasciocutaneous flap based on a branch of the medial plantar artery. The authors have used this flap in the reconstruction of skin defects of the hands and fingers because its skin is very similar in texture, color, and thickness. Because of its characteristics, this flap can also be applicable for orofacial reconstruction, when small or thin skin coverage is needed. Two cases are reported in which free medialis pedis flaps were used to reconstruct the eye socket in one patient and the alveolar ridge in the other. The authors concluded that the skin of the medialis pedis flap is not flexible enough and thus less suitable than the radial forearm flap for reconstruction of defects in which flexible skin is required, such as eye-socket reconstruction. However, reduced flexibility of the medialis pedis flap may provide an advantage in reconstruction of the gingiva and palate, where thin and rigid coverage is necessary.
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