Hourglass dorsal metacarpal island flap: a new design for syndactylized web reconstruction

Web space reconstruction is the key point and an important component of syndactyly treatment. A design of the dorsal metacarpal artery flap was used as an island flap based on the direct cutaneous branch arising from the dorsal metacarpal artery at the distal end of the flap to reconstruct congenital web syndactyly. The flap rotated from 0 degrees to 180 degrees and passed under a skin bridge at the distal end of the flap to reach the web defect. Such design enables a better use of the skin territory from the intermetacarpal space proximal to the pedicle, with a short donor site scar and a more supple reconstruction of the web space.     

Modified dorsal rotation advancement flap for release of the thumb web space

The dorsal rotational advancement flap described by Buck-Gramcko in 1998 is a good local flap for release of the thumb index web space. This paper describes a modification which broadens the apex of the flap and increases its length. This modification provides a long wide flap which releases the thumb index web space with suture lines far beyond the web. In addition, it provides a release of the palmar skin even when very tight in severe narrowing of the web. It is suitable for release of thumb-index syndactyly, severe narrowing of the web in thumb hypoplasia and congenital clasped thumb.     

Dorsal pentagonal local flap: a new technique of web reconstruction for syndactyly without skin graft

Background  

Many techniques for web space reconstruction have been described over the years. However, few techniques are completely satisfactory in terms of cosmetic requirement and functional recovery due to scar contracture, web creep, or conspicuous scarring resulting from skin grafting or additional incisions on the dorsal palm. Based on the anatomy of the dorsal metacarpal artery, the authors describe a local pentagonal advancement flap including perforators of the dorsal metacarpal artery to optimize web reconstruction and facilitate direct closure in the syndactyly treatment.     

Dorsal thumb flap for release of adduction contracture of the first web space.

A local flap, utilizing the skin over the dorsum of the thumb, for release of a first web space contracture has been described. Its construction allows for full integumentary release, adequate visualization of underlying contracted tissues, and a closure that provides full thickness sensory skin coverage over the entire web space and key pinch contact area.     

A new flap design for release of parallel contracture bands: Dual opposing five-flap z-plasty

Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients.     

The split peroneus muscle flap: a new flap for lower leg defects.

The peroneus brevis tendon mechanism is more effective than the peroneus longus mechanism in rotating the navicular externally and the calcaneus into valgus. A longitudinal vertical split of the peroneus brevis muscle is a new technique that allows coverage of the fibular and pretibial region defects without impairing the muscle function. The essential features of the flap are: transposition of the muscle without disinsertion, splitting the muscle longitudinally along a distinct anatomical plane, and preservation of the anatomical continuity of the muscle. The flap has been tested on seven male patients who had sustained open fractures of the ankle region with metal implant exposure of the fibula. The size of the flap ranged from 13x6cm to 15x7cm (mean 13.8x6.5cm). The soft tissue defects were located between the pretibial region and the lateral malleolus. Their ages ranged from 22 to 39 years (mean 28.7 years). Follow up was from 3 to 24 months (mean 14.5 months). The technique of split peroneus muscle flap was applied successfully in all patients. There was no necrosis of the muscle flap and stable wound healing was achieved. The cosmetic result was good and the function of the muscle was preserved. The advantages offered by this new flap include: technical simplicity, reliability, and the allowance of future use of other local skin and muscle flaps. With the help of this new technique it is possible to cover defects of up to 20x7cm and to preserve the muscle function.     

A rare cause of upper airway obstruction in a 5-year-old girl: a laryngeal web

A case is described of a 5-year-old girl with respiratory distress. She was intubated without difficulty, but developed respiratory distress on extubation. Laryngoscopy/bronchoscopy via a laryngeal mask airway revealed an extensive layngeal web which was removed with laser therapy. The causes and differential diagnosis of laryngeal web are discussed.     

Increasing flap survival: a new method

A new method of continuous irrigation beneath a flap with special irrigation was designed to attempt to improve flap survival in 42 animals. In each animal experimental and control flaps were symmetrically designed using two flanks or limbs (total number of flaps, 154). The flap length survival in the 77 experimental flaps ranged from 18 to 88% greater than that in the control flaps. Bacterial cultures of the secretions from all flaps suggested that this method has a practical value in preventing and controlling the infections that would result in flap necrosis.