A novel technique in flexor pulley reconstruction using an A1 pulley as a donor.

We describe a novel technique for the reconstruction of an essential flexor pulley over a bowstrung flexor tendon using the A1 pulley of the same or another digit. Replacing 'like for like' ensures restoration of pulley-tendon interface and biomechanics.

Reverse Superficial Palmar branch of Radial artery pedicled flap for Palmar and Digital reconstruction: A systematic review of literature with a retrospective case review.

Background: Most studies on the superficial palmar branch of radial artery (SUPBRA) flap involve its use as a free flap with only few reports in literature regarding its use as a reverse pedicled flap. This systematic review presents a summary of the available literature on the indications, anatomy, technique, complications and outcomes of the reverse SUPBRA flap and also describes our experience.

Methods: A computer search was performed on the Embase, Medline and Pubmed databases for clinical studies describing the reverse SUPBRA flap in accordance with the standard principles for systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Scrotal reconstruction with modified pudendal thigh flaps.

Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature.

Free-Tissue Transfer for the Reconstruction of War-Related Extremity Injuries: A Systematic Review of Current Practice.

Objectives: Extremity injuries in combat zones have devastating sequelae. The increasing survival of war-zone casualties, combined with rapid advances in microsurgery, means that there is a growing role for free-tissue reconstruction. We systematically reviewed the current practices in microsurgical reconstruction of combat-related extremity injuries, focusing on free-flap types, timing of surgery, and outcomes.

Reconstruction of volar skin and soft tissue defects of the digits including the pulp: experience with the free SUPBRA flap.

Background: The ideal flap for volar defects on the digits should provide glabrous skin, maintain length, be sensate and supple enough to allow unimpeded motion of the joints. When local flap options are either inadequate or unavailable, this constitutes a challenge that usually requires free tissue transfer. We describe our experience of the use of the free transfer of glabrous skin based on the superficial palmar branch of the radial artery (SUPBRA) for digital (volar) reconstruction.

Postoperative mobilization regimens following digital nerve repair: a systematic review.

Introduction: Currently there is a multiplicity of postoperative mobility-based rehabilitation protocols following isolated digital nerve repair. The regime chosen appears to be dependent on the preference of the surgeon and unit rather than being evidence based. We aim to systematically review the current evidence to provide an insight toward formulating guidelines for best practice.

The extensor pollicis brevis: a review of its anatomy and variations.

Introduction: The standard anatomical description of the extensor pollicis brevis tendon provided in textbooks of anatomy is at odds with that of published anatomical studies. It is crucial to the hand surgeon that he or she has a clear understanding of its anatomy, including its variations. The aim of this study was to provide a comprehensive review of the current literature on the anatomy and variants of the extensor pollicis brevis.

Late partial failure of a free ALT flap.

Late failure of microsurgical flaps is a rare event and it has been reported as a consequence of compression of the vascular pedicle or late infection. We report a case of late partial failure occurring 3 weeks post-operatively which was shown by vascular imaging to be caused by a previously unidentified complete occlusion of the right external iliac artery. After successful vascular bypass surgery, the suffering flap developed granulation tissue and was skin grafted.

Desmoplastic trichoepithelioma confused with cutaneous squamous cell carcinoma in childhood.

Squamous cell carcinoma of the skin is very rare in childhood, especially without predisposing factors or underlying diseases. We report the case of a desmoplastic trichoepithelioma misdiagnosed as cutaneous squamous cell carcinoma in a 12 years old boy Only accurate multiple reviews of the histological samples and repeated questioning of the mother could finally clarify the diagnostic dilemma. Desmoplastic trichoepithelioma is a quite uncommon benign adnexal tumor with a reported incidence, in adults, of 1 in 5000 skin biopsies.

DIEP flap with implant: a further option in optimising breast reconstruction.

Recent advances in breast reconstruction allow for high expectations regarding long-term symmetry and aesthetic appearance. The DIEP flap is currently considered as an ideal autologous reconstruction. However, there are situations in which the amount of tissue from a DIEP flap is not enough to achieve adequate symmetry.

Subacute nerve compressions after trauma and surgery of the hand.

Background: It is accepted that major injuries of the upper limb may require not only fasciotomies but also nerve decompressions. That nerve compression(s) may occur after less dramatic injuries and "routine" surgery distal to the elbow is less well documented in the literature but well known to experienced clinicians. The aim of this study was to identify a possible link between injuries or elective surgery to the distal upper limb and "subacute nerve compressions.