We introduce a treatment that combines the cross-leg free flap with the Masquelet technique and describe two cases using this method for bone and soft tissue reconstruction. Both patients were successfully treated and ambulatory. This novel method can be safely performed using the delay technique, indocyanine-green angiography and near-infrared spectroscopy.
We report the case of a 23-day-old neonate who presented at our center with a history of an erythematous lesion on the nose immediately after birth. The infant was born at a gestational age of 40 weeks and 2 days, with a body weight of 3,062 g. On initial examination, the erythema extended from the dorsum of the nose to the columella and ala (Fig. 1A). On the same day, the erythema was irradiated with a variable-pulse-width dye laser (Vbeam ® , Syneron Candela, Tokyo, Japan) with a pulse width of 20 msec and irradiation energy density of 11 J/cm 2 . However, this approach was ineffective. One week later, no ulceration was observed as a complication of the laser treatment. At 6 weeks of age, the hemangioma protruded and small ulcers developed in the right ala, which deformed the right nostril (Fig. 1B). Subsequently, the ulcers expanded; hence, the administration of propranolol (2 mg/kg/day) was initiated 9 weeks after birth. The ulcer healed 3 weeks after
Symmetrical peripheral gangrene (SPG) is a symmetric ischemic necrosis of the peripheral extremities without proximal arterial occlusion. We encountered an immunocompromised patient with pneumococcal pneumonia complicated by septic shock leading to SPG after chemotherapy for posttransplant lymphoproliferative disorders (PTLDs) secondary to the use of immunosuppressants after living-donor liver transplantation. In this case, symmetric necrosis of the peripheral extremities and necrosis of the nasal tip, apex of the tongue, central part of the lip, and tip of the penis were also observed. This is the first report of the development of SPG after living-donor liver transplantation. Necrosis extended beyond the extremities to the peripheral bloodstream with characterization of the symmetry.
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