J Trauma
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Case Reports
Distally based anteromedial thigh fasciocutaneous island flap for patellar soft tissue reconstruction.
Muscles used for patellar and peripatellar soft tissue construction, which include the vastus medialis, vastus lateralis, gastrocnemius, and sartorius muscle, are often clinically inadequate for reconstruction of the patellar and peripatellar regions. Split-thickness skin grafts are also inadequate in supporting superficial patellar tendons and resisting perpetual shear stress. We report our experience with distally based anteromedial thigh fasciocutaneous island flaps for patellar soft tissue reconstruction in seven patients. ⋯ A distally based anteromedial fasciocutaneous flap is useful and viable option for patellar soft tissue reconstruction due to its versatile vascular pedicle, pliable deep fascia, adequate retrograde perfusion, and the possibility of direct closure of the donor site when no losses of the medial thigh are expected.
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Our aim was to study if baseline serum cortisol is related to the hemodynamic response to steroid treatment in septic shock patients and if the measurement of total proteins and eosinophil count improves its accuracy. ⋯ The measurement of serum cortisol in surgical septic shock patients does not accurately predict the hemodynamic response to steroids. No clear cutoff value for cortisol, alone or in combination with total protein and/or eosinophil count, can be defined to indicate steroid treatment.
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Simultaneous defects of Achilles tendon and skin remain a big challenge for clinical surgeons. This article reviews the experience of a one-stage reconstruction of the defects. The sliding gastrocnemius musculocutaneous flap without anastomosis was used and the associated anatomy was studied. ⋯ For one-stage reconstruction of Achilles tendon and skin defects, the sliding gastrocnemius musculocutaneous flap is advantageous in vascularity, function, and sensation without anastomosis. The harvest of the flap demands familiarity with the anatomy.