An Unexpected Late Recurrence of Breast Irradiation-Induced Angiosarcoma Following Autologous Microvascular Breast Reconstruction.

The authors present the case of a 68-year-old female who developed recurrent angiosarcoma, a rare but recognized complication after breast irradiation therapy in the treatment of breast cancer. Microvascular breast reconstruction was performed after the completion of 10 years of disease-free clinical surveillance. Abdominal tissue was harvested and transferred onto the chest wall with restoration of its blood supply using microsurgical techniques to recreate the breast.

New technique for in-continuity axillary and supraclavicular lymphadenectomy for advanced metastatic melanoma using intraoperative image guidance: a case report.

Simultaneousinvolvement of the supraclavicular and axillary lymphatic basins is known to occur in metastatic skin cancers. We present the case of a 35-year-old male with metastatic melanoma present in the right neck and axillary lymph nodes. He underwent a combined, in-continuity dissection of both basins using intraoperative ultrasound to ensure full clearance of lymph nodes from the cervicoaxillary canal, which otherwise would have been impossible to achieve without clavicle osteotomy.

Evolution of midface microvascular reconstruction: three decades of experience from a single institution.

Purpose: Midface reconstruction poses a complex set of challenges for reconstructive surgeons. The optimal midface reconstruction must possess a durable underlying bone construct capable of integrating dental implants. Facial contour is restored by the overlying microvascular soft tissue reconstruction with reestablishment of the oral cavity.

Free ALT-flap can treat chronic seroma: a case report.

Seroma formation after axillary lymph node dissection for metastatic melanoma is a common problem. We present the use of free microvascular tissue transfer to treat a chronic postoperative seroma developed after axillary lymph node dissection for metastatic melanoma.

Distal perforator-only propeller (D-POP) anterolateral thigh flap for reconstructions around the knee: 4-year experience.

Introduction: Soft tissue reconstruction around the knee is challenging from a functional and aesthetic perspective. While locoregional options remain limited, free flaps produce additional scarring and longer hospitalization. We describe the most distal "D-perforator" of ALT-axis and present our 4-year experience with a distal perforator-only propeller anterolateral thigh (D-POP ALT) flap for reconstruction around the knee.

Hybrid perforator flaps: Introducing a new concept in perforator flap surgery.

Introduction: Although perforator propeller flaps provide a safe and reliable reconstructive option, they are often limited in size, reach and degrees of freedom due to venous insufficiency. As a result, partial flap necrosis, particularly at the tip of the flap, may occur in some cases causing the loss of substance. To overcome this problem, we present a new concept of hybrid perforator flaps.

Combined Karapandzic-Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction.

Background: Lower lip reconstruction remains a challenging task due to multi-functional and high aesthetic requirements that have to be achieved for successful outcome. This is particularly true to near-total lower lip defects, encompassing over 70% of lower lip loss due to cancer, trauma or burns. Despite the fact that numerous flaps and their modifications have been described over the past century, only a few valuable techniques and concepts withstood the test of time for sub-total lower lip defects, each having their own drawbacks.

Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects.

Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect.

Contrast CT-scan for preoperative planning of VSLN (vascularized submental lymph-node) transfer.

Background And Objectives: Vascularized submental lymph-node (VSLN) transfer is gaining popularity as a reliable donor-site in microsurgical treatment of lymphedema. However, variations in number, location, and blood supply to submental lymph-nodes as well as associate skin-paddle make a predictable flap harvest a challenging task. We analyzed this region on preoperative imaging, to improve accuracy of VSLN transfers.

Haemostatic property of cyanoacrylate in pedicled flaps.

We present a technique that can, in principle, be applied to any pedicled flap that is routinely used for reconstructions of the forehead. In our experience, cyanoacrylate glue applied to the pedicle before the flap is inserted decreases postoperative bleeding and wound exudate.

Chimeric Upper Eyelid--Supraorbital Flap Reconstruction.

Wide local excision of a lesion that encompasses several facial subunits including medial canthus, nasal sidewall, and cheek provides multiple aesthetic and reconstructive challenges to restore both orbital function as well as appearance. We report the first successful use of a chimeric upper eyelid--supraorbital flap to reconstruct a facial defect, secondary to a wide local excision of the lower eyelid, entire nasal sidewall, and infraorbital cheek in a patient with a biopsy-proven diagnosis of malignant melanoma. Chimeric upper eyelid--supraorbital flap provides simultaneous reconstruction of lower eyelid, nasal sidewall, and infraorbital areas, therefore replacing multiple facial aesthetic subunits at the same time providing unparalleled tissue quality match to all areas as well as excellent functional and aesthetic outcomes.

Complete mapping of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation.

Introduction: The precise vascular anatomy of posterior lower leg skin is not well understood. Despite being a potential donor site for sural artery perforator flaps, this region is rarely used and underestimated. The aim of this study was to provide exact preoperative planning for medial and lateral sural artery perforator flap harvest.

Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal.

Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study.

In search of the ideal method in perforator mapping: noncontrast magnetic resonance imaging.

A reliable method for precise identification of the dominant perforator would be extremely valuable in perforator flap surgery. During the past 5 years, multidetector-row computed tomography has demonstrated excellent results in preoperative planning of abdominal free flap breast reconstruction, significantly reducing operative time and complications. The main drawbacks of computed tomography are unnecessary radiation to the patient and possible allergic reactions to intravenous contrast material.