Soft-tissue defects of the distal foot that involve an exposed tendon and bone demonstrate a reconstructive challenge for plastic surgeons. This report investigates the feasibility and reliability of metatarsal artery perforator (MAP)-based propeller flap for reconstruction of the distal foot soft-tissue defects. Between July 2011 and June 2012, six patients underwent distal foot reconstruction with seven MAP-based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Two patients developed transient distal venous congestion, which subsided spontaneously without complications. There were no donor site complications. All patients were ambulating without difficulty within the first month of surgery. MAP-based propeller flaps can be used to repair the distal foot soft-tissue defects, providing sufficient skin territory and excellent esthetic and functional recovery.
Both surgical delay and ischemic preconditioning (IP) have been shown to be effective in improving the survival of flaps. We used a variety of flap delay methods and IP to increase the surviving area of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats, and the results are compared in between. A 6-× 3-cm-sized TRAM flap in 40 Wistar rats was allocated into five groups. Group 1: TRAM flap was elevated from nondominant pedicle, and the flap was sutured to the original bed. Group 2: Left superior deep epigastric vessels (SDEV) were cut; 1 week later, TRAM flap was elevated. Group 3: Only skin incision was done; 1 week later, TRAM flap was elevated. Group 4: Skin incision was done, and the left SDEV were cut; 1 week later, TRAM flap was elevated. Group 5: TRAM flap was elevated; IP was performed using three cycles of 10 minutes of repeated ischemia/reperfusion (I/R) periods, and the flap was sutured to the original bed. The surviving area of the flap was statistically significant between the control and groups 2, 4, and 5 (p < 0.001), and groups 4 and 2 were superior to group 5. Although preconditioning has been intensively studied for the last two decades and partly provided its beneficial effects in I/R injury, we determined the IP increased the surviving area of the TRAM flap but not effective as much as surgical delay method.
Objective: Repair of lower limb congenital or acquired tissue defesct in proper shape and function is the main topic of plastic surgery. In this article, we investigated different treatment methods of this anatomical region which is difficult to reconstruction and alternative solution methods to reconstruction with free flap, and also reviewed the treatment algorithm depending on the localization and size of the defect.
Material and Methods: In this study; between 2011 and 2017, 27 patients who were surgically treated with a soft tissue defect in the lower extremity were evaluated according to treatment alternative for defect location and advantages of perforator flap to free flap. There were lower extremity soft tissue defect located in the proximal 1/3 cruris in 7 patients, in the middle 1/3 cruris in 12 patients and in the distal 1/3 cruris in 8 patients.
Result: Early venous congestion was observed in 3 cases and wound infection was observed in 1 case. Venous congestion resolved spontaneously, wound infection healed with appropriate wound care. In 3 cases, partial flap loss was observed distal to the flap, and was treated with wound care without the need for a second operation.
Conclusion: Perforator flaps are a reliable and effective method for repairing soft tissue defects of the lower limbs and it can be applied successfully in the early period after trauma. We think that it can be applied safely cause of the surgical technique is relatively easy and does not require microsurgery.
Mekanik pitozise neden olan ve çok nadir görülen, patolojik tanısı Eozinofilili Anjiolenfoid Hiperplazi (EALH) ile uyumlu dört olgu sunularak tedavi yöntemlerini ve tecrübelerimizi paylaşmak. Gereç ve Yöntemler: 2011-2017 yılları arasında üst göz kapağında pitozis yapan kitle nedeniyle opere edilen 4 hasta çalışmaya alındı. Hastaların tümünde eksizyonel biyopsi ile kitle eksizyonu yapıldı. Bulgular: Operasyon sırasında ve sonrasında komplikasyon izlenmedi. Cerrahi sonrasında tüm hastalarda pitoziste düzelme görüldü. Patolojik tanı hepsinde EALH olarak rapor edildi. Sonuç: Üst göz kapağında mekanik pitozise neden olan olgularda EALH ayırıcı tanıda akılda bulundurulmalıdır.
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