In conclusion, all types of injuries in sub-zone I and clean-cut injuries in sub-zone II are candidates for composite grafting. Blunt-cut and crush-avulsion injuries in sub-zone II are marginal candidates for composite grafting. Any type of injury in sub-zone III or IV is contraindicated for composite grafting and should be treated by microanastomosis.
It is important to prepare a suitable microsurgical environment for vascular anastomosis or nerve suture. The background sheet is a useful element of this preparation, as it prevents the tissue and nylon thread from sticking and it can pull the sutured nylon thread. Various types of commercially produced background sheets are used according to the surgeon's preference. In order to investigate the parameters important in background sheets, we emailed a questionnaire to our office staff. The variables included color, elasticity, thickness, availability, workability, and cost. In particular, most respondents pointed out the importance of color. Several papers have described the materials or fashion of background sheets, but no studies have discussed their color. The purpose of our study was to investigate the optimal color of background sheets for microsurgery in reference to chromatic papers. We investigated the visibility of objects due to differences in the color of background on chromatic papers. We prepared a figure in which background sheets of different colors were lined up to compare the visibility of objects. To enhance the visibility of black nylon thread, colors with high luminance were deemed suitable for the background sheet. Additionally, green or blue was appropriate as these colors made the borders of objects (pink vessels) clearly visible and reduced a microsurgeon's discomfort in gazing upon objects. Thus, high-luminance green or blue was the optimal color of background sheets for microsurgery. Several papers have described the materials or fashion of background sheets. The materials include silicone, plastic, rubber, polyethylene, and polypropylene. The category
Summary:Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.
Wound edge–based propeller perforator flaps have often been applied to soft tissue reconstruction of sacral pressure sores. Although this flap often causes necrosis due to overtension and twisting of the perforators, salvage surgery using a postoperative delay technique has not been reported thus far. In this article, we present a case in which we successfully reconstructed a sacral pressure sore using a wound edge–based propeller perforator flap. The flap caused severe congestion, which had a concern due to the potential wide-ranging flap loss; it was subsequently salvaged by an emergent delay procedure and negative-pressure wound therapy on day 2 postoperatively.
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