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The sacral region is one of the most frequent sites of pressure sore development, and local flaps in the gluteal region are usually preferred when surgical closure is needed. The authors used the gluteal fasciocutaneous rotation-advancement flap with V-Y closure to manage sacral pressure sores in 15 patients. The design was a combination of the classic rotation and V-Y advancement flap patterns. When the wound was closed, the tension at the distal end of the rotation flap was relieved by flap advancement and the combined rotation-advancement action was supported laterally with V-Y closure. A wide skin pedicle was preserved at the inferomedial part of the flap. This pedicle augmented the blood supply to the flap skin and kept the surgical incision small, thus helping to reduce the risk of fecal contamination and associated wound-healing problems. This flap can also be converted to any design of fasciocutaneous or musculocutaneous V-Y advancement flap, should such a change be required. The largest defects that were closed with a unilateral rotation-advancement flap and bilateral rotation-advancement flaps were 12 and 18 cm in diameter, respectively. In 1.5 to 35 months of follow-up, none of the patients developed wound dehiscence or flap necrosis requiring repeated surgery. This technique is simple, can be performed quickly, has minimal associated morbidity, and yields a good outcome.

Reconstruction of partial, marginal defects of the ear has been a challenge. The ascending helix free flap based on superficial temporal vessels has been described and used solely to repair nose defects. We used reversed pedicle helical free flap for the repair of a major loss of the upper one-third of the opposite auricle. The method permits the transfer of tissue of the same quality with satisfactory cosmetic result. The equalization of the ears in dimension was accomplished with minimal donor-site deformity.

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The presence of a short sciatic nerve in the free edge of a popliteal pterygium makes this syndrome a surgical challenge. We present a case of popliteal pterygium that was treated by nerve expansion. The range of motion of the patient's knee joint was between 30 and 120 degrees. A 75-cc tissue expander was placed under the sciatic nerve and filled with 5 cc of saline solution weekly. When a total of 60 cc was reached, wound dehiscence was observed, and the procedure had to be stopped. The maximum extension obtained was 160 degrees. Since the expansion process had to be stopped early, the elongation attained by expansion was less than expected. We conclude that the nerve expansion method can be used as a good alternative treatment modality for patients with popliteal pterygium.

A case of bilateral anomalous arterial supply of the lower limb is presented. In this case, both anterior tibial arteries were hypoplastic. These arteries came to the anterior (extensor) compartment by passing superiorly through the interosseous membrane. They ran between the tibialis anterior and the extensor hallucis longus muscles and terminated after giving numerous muscular and fascial branches. The dorsalis pedis arteries originated from the peroneal arteries. The peroneal arteries reached the anterior compartment by piercing the interosseous membrane at its lower part and ran as the dorsalis pedis arteries. Awareness of the anatomical variations in anatomy of the distal popliteal artery is important for angiographers, vascular surgeons and reconstructive surgeons who operate upon these regions.