Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap

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Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part II - Breast Reconstruction after Total Mastectomy

This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy. For both primary and secondary reconstructions, the authors explain how to analyze the mastectomized breast and the deformed chest wall, before giving step-by-step guidelines for rebuilding the entire breast with either autologous tissue or implants. The differences in shaping unilateral or bilateral breast reconstructions with autologous tissue are clarified. Regardless of timing or method of reconstruction, it is shown that by breaking down the surgical strategy into three easy (anatomical) steps, the reconstructive surgeon will be able to provide more aesthetically pleasing and reproducible results. Throughout these four parts, the three-step principle will be the red line on which to fall back to define the problem and to propose a solution

A simple concept for covering pressure sores : wound edge-based propeller perforator flap

We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process. Between January 2009 and January 2017, 33 wound edge-based propeller perforator flaps were used to cover pressure sores at various locations in 28 patients. In four cases more than one flap was used on the same patient. The patients comprised 18 males and 10 females with a mean age of 4125 (range, 16-70) years. All patients underwent follow-up for 0-12 months. The mean follow-up duration was 503 months. Venous congestion was observed in three flaps that were rotated by 180 degrees (91%). However, there was a significant difference between flaps rotated by 90 degrees and 180 degrees according to the complication rate (P = 0034). Out of 33 flaps, 29 flaps healed uneventfully. Patients were able to sit and lie on their flaps three weeks after surgery. In our study, we were able to obtain satisfying final results using these novel flaps