Injury
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The keystone perforator flap is a simple, popular form of advancement flap that can solve many defects of the lower extremity that can avoid consideration of a microsurgical tissue transfer. The actual circulation to this local flap subtype has not yet been delineated. The recent introduction of inexpensive thermal imaging cameras that can be coupled with a SmartPhone allows thermagrams of these flaps where "hot spots" are known to correspond to the location of pertinent perforators that will provide the requisite flap vascularization. ⋯ The use of the SmartPhone for thermography is a simple, rapid, cheaper means for the evaluation of viability of keystone flaps in all surgical phases. This provides a safe method for checking not only flap circulation, but also identification of "cold spots" or flap regions where means to augment advancement by deep fascia interruption or undermining will not interfere with flap perfusion. There is virtually no learning curve in acquiring the skills to use this device, which should now allow anyone to raise actually any kind of local perforator flap as they find suitable.
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Soft tissue defects to the dorsum of fingers are quite demanding for the reconstructive surgeon especially in the cases that bone and extensor tendons are exposed. The purpose of our study was to describe a new adipofascial island flap by a single dorsal digital perforator (dorsal adipofascial digital artery perforator, DADAP). ⋯ The use of DADAP flap is a fast, safe and reliable solution to cover the defects of the dorsum of fingers and can be performed under local anaesthesia as a day surgery.
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Neonatal brachial plexus palsy remains a problem, even in light of current advances in perinatal care. While many cases resolve spontaneously, the concern remains on the best means of surgical management for restoration of elbow flexion and shoulder reanimation. ⋯ The study suggests that if the microsurgical reinnervation takes place early enough, these changes may be diminished. On the other hand there is no way to identify at birth, which injuries will be permanent and will need surgical repair and which will spontaneously improve.
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Replantation of lower extremity is a very complex and difficult procedure. There are still a lot of controversies about indications, even numerous scoring systems are now available that can facilitate the surgeon's decision. We present the functional results of a replanted below-knee amputation in an elderly patient, 27 years after the injury and discuss the indication for replantation.
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One-Bone-Forearm (OBF) is a procedure in which the proximal stump of the ulna is fixed to the distal stump of the radius. Historically, the indications for OBF have been represented by forearm instability due to trauma, infection, tumor resection, and congenital deformities with severe radius and ulna bone loss. ⋯ Compared to standard OBF technique with direct osteodesis, OBF with VFBG showed similar clinical results and high rate of healing even in case of bone infection. Moreover, composite osteocutaneous VFBG might concurrently allow to treat local soft tissue defects.