Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer.

Background: Destruction of the radiocarpal and midcarpal joints causes loss of wrist motion, pain, and reduced grip strength. A novel technique for radiocarpal reconstruction is presented.

Methods: Two patients who had radiocarpal and midcarpal destruction and osteoarthritis underwent reconstruction using simultaneous bilateral microvascular second metatarsophalangeal joint transfer.

Circumferential Radical Debridement and Omental Free Flap in the Treatment of Severe Chronic Venous Ulcers.

Background: Chronic venous leg ulcers are a significant health care burden with a difficult and unreliable treatment. Free flaps may be needed for wound coverage in severe cases. Incomplete removal of dermatoliposclerosis (DLS) area and/or not addressing the underlying venous dysfunction may contribute to the reported modest long-term results.

Reconstruction of the Flexor Pollicis Longus Tendon with Vascularized Tendon with Ulnar Artery Preservation.

Unlabelled: Reconstruction of the flexor pollicis longus tendon using staged grafting yields modest results. A modification of the pedicled vascularized flexor digitorum superficialis transfer, without division of the ulnar artery, was used in five patients.

Methods: The flexor digitorum superficialis and its gliding tissue were transferred in five patients, based on a branch of the ulnar artery without division of the ulnar vessels.

Monitor selection according to the defect location in the medial femoral condyle flap.

Background: Medial femoral condyle(MFC) flap is frequently used in hand reconstruction, but like other buried flaps, MFC is not easy to monitor and follow.In this study, we present our adipofascial and periosteal tissue technical modifications and results for MFC free flap monitoring and compare different monitoring methods.

Methods: Twenty one patients with wrist bone or metacarpal defect reconstructed with MFC flap were included in the study.

Vascularized Ribs in the Treatment of Posterior Instrumentation Infection after Thoracic Vertebrectomy. Case Report.

Isolated vertebral mestastases can be successfully treated by surgical removal of the affected vertebral body and stabilization with alloplastic material. The bone union between the upper and lower vertebra is expected, yet a relatively high rate of a non-union has been reported. In case of infection, bone consolidation is altered, and removal of alloplastic material is recommended, which decreases spinal stability and is a devastating complication.

Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series.

Background: One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury.

Unusual Late Complication of Latissimus Dorsi Free Flap Donor Site: Elastofibroma Dorsi.

In existing literature about elastofibroma dorsi (ED), no cases reported ED arising after latissimus dorsi flap harvest. Concretely, we present a patient who developed an ED at latissimus dorsi free flap donor site 10 years after harvesting. After our research, we found the occurrence of ED after thoracotomy surgery, stressing the importance of previous local trauma.

Arteriovenous Vascular Loop Using a Bifurcated Greater Saphenous Vein.

High-energy lower limb trauma may result in complex defects with extensive vascular damage. Free flap reconstruction in these cases may require vein grafts to reach healthy proximal recipient vessels. Vascular loops are an increasingly popular technique in managing recipient vessels in reconstructive microsurgery, especially in the lower limb.

Facial Nerve Reconstruction with Free Vascularized Composite Nerve Flap from Intrapetrous Portion to Terminal Branches-Case Report.

The case presented here is a delayed reconstruction of a facial nerve defect after radical parotidectomy without a useful nerve stump at the stylomastoid foramen. A composite free flap was used to reconnect the nerve's intrapetrous portion to the peripheral branches and reconstruct the soft-tissue deficit.

Treatment of Neuroma of the Dorsal Branch of the Ulnar Nerve With Transfer to the Distal Anterior Interosseous Nerve.

Painful neuromas of the dorsal branch of the ulnar nerve may be difficult to treat. Proximal transposition is the standard treatment, but pain may recur. Sensory-to-motor nerve transfer as an evolution of targeted muscle reinnervation is a recently described technique to reduce neuroma formation in the treatment of painful neuromas.

Abdominal Wall Reconstruction with a Free Fibula Flap after Internal Extended Hemipelvectomy.

Major pelvic resections for malignant tumors are infrequent and have significant morbidity and mortality, for instance, incisional hernias are postoperative complications uncommonly reported probably because most cases are overshadowed by more serious complications. Reconstruction depends on the extent of the resection and overall prognosis of the patient. A case of a late complex hypogastric and femoral incisional hernia after extended hemipelvectomy for recurrent osteosarcoma treated with distal abdominal wall fixation into a free fibula flap is reported.

Total Nasal Reconstruction With Prefabricated and Prelaminated Free Flap.

Nasal reconstruction is a complex staged procedure. When optimal donor areas are unavailable, flap prefabrication and prelamination techniques can be used for total nasal reconstruction. A technique of total nasal reconstruction using neovascularization of the supraclavicular skin from a skin free flap used for internal lining, along with prelamination of the cartilage framework and surgical delays, is described in 2 patients with adverse anatomical conditions.

Clinical Significance of Alloantibodies in Hand Transplantation: A Multicenter Study.

Background: Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact.

Methods: We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome.

Immediate Versus Overnight-Delayed Digital Replantation: Comparative Retrospective Cohort Study of Survival Outcomes.

Purpose: Ischemia time has been traditionally considered a critical factor in replantation survival rate. The objective of this study was to compare the survival rate between immediate and overnight-delayed digital replantation.

Methods: We performed a retrospective cohort study of all digital replantations performed at our clinic between 2005 and 2016.

Treatment of Hand Macrodactyly With Resection and Toe Transfers.

Macrodactyly is an uncommon congenital hand condition that can be difficult to treat and that can have a profound negative impact on patients and their families. Although many treatments have been described, results tend to be inconsistent. The authors report a case in which a combination of ray resection, partial finger resection, and toe transfer resulted in a 4-digit hand with acceptable function and cosmesis.

Salvage of Infected Nasal Reconstruction with a Polymethyl Methacrylate Spacer.

Total nasal reconstruction is a challenging multistage procedure. Infections can destroy the cartilage framework and seriously compromise the result. The use of polymethyl methacrylate with antibiotics as a spacer has been described in the treatment of skeletal infections.

Interbrachial Pinch by Trapezius Transfer in Amyoplasia Congenita: A Case Report.

Amyoplasia congenita, or "classic distal arthrogryposis," is the most common disorder among the congenital, non-progressive, multiple joint contractural conditions named arthrogryposis. The cause remains unknown, and it occurs sporadically. Abnormal neurological examination indicates that movement in utero was diminished as a result of an abnormality of the central or peripheral nervous system, the motor end plate, or muscle.

Inferior Limb Salvage by Combined Free-tissue Transfer and the Crane Principle Revisited.

Aggressive treatment of ischemia of the lower extremities has decreased the number of amputations in both diabetic and nondiabetic patients; combined vascular reconstruction and microvascular free-flap transfer has been used to improve distal perfusion and cover large tissue defects caused by the critical limb ischemia during the past 30 years. We present our experience with a 71-year-old diabetic patient who underwent revascularization with a vascular bypass and a simultaneous microvascular flap reconstruction for limb salvage after domestic trauma. An extension of the "crane" principle was used to solve bypass exposure due to wound late complication.

Composite Arteriovenous Radial Conduit Flap for Lower Limb Reconstruction.

In complex lower limb trauma, the healthy recipient vessels can be far from the defect to be reconstructed due to the usually high-energy injury sustained. The use of vein grafts, either directly or in the form of arteriovenous loops, is the usual solution in these cases. In the vein graft donor-depleted patient, other options are required; the composite arteriovenous radial conduit flap may be a useful resort in these situations.

Ulnar Head Reconstruction with Microvascular Second Metatarsal.

Background: The distal radioulnar joint along with the interosseous ligament of the forearm and the proximal radioulnar joint, form a functionally integrated system responsible for the pronation-supination of the hand. The distal ulna, the so-called ulnar head, is an integral part of this system. Apart from its well-known role in forearm rotation, the ulnar head is essential in transverse load transmission through the distal radioulnar joint upon resisted elbow flexion.

Segmental Humeral Reconstruction with a Pedicled Radius Bone Flap in Congenital Amyoplasia.

The clinical case of a patient with a segmental humeral defect, in the context of an arthrogryposis congenita multiplex and morbid obesity, reconstructed with a pedicled segmental radial bone flap is reported. The use of the pedicled vascularized diaphyseal radial bone flap may be a useful technique for humerus reconstruction in patients with contraindication for microvascular bone transfers and an already injured or severely handicapped upper limb.

Prelaminated Fascia Lata Free Flap for Oronasal Fistula Reconstruction.

Oronasal fistulae are frequently symptomatic due to rhinolalia and regurgitation of solid food and liquids through the palate. When asymptomatic, fistulae can be managed with conservative therapies. Local flaps are useful to close small fistulae but cannot be used in bigger ones and cases with bad-quality surrounding tissues.

Unique Techniques or Approaches in Microvascular and Microlymphatic Surgery.

Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment.