Role of staged endoprosthetic revision with flap cover for limb salvage in endoprosthetic failure

Endoprosthetic replacement (EPR) is commonly required for limb salvage in bone malignancies. Endoprosthetic failure is a term used to denote mechanical failure or infection usually requiring removal of the prosthesis. Treatment of infection consists of EPR revision with or without placement of a temporary spacer. Flap cover (either local or free) may be required if the overlying soft tissues are of concern. It is claimed that the investment of the endoprosthesis in well-vacularised soft tissue facilitates the eradication of infection. This series included nine patients with endoprosthetic failure due to chronic infection who needed flap cover. These patients underwent revision of the EPR in two stages. The first stage of revision included removal of the endoprosthesis, insertion of a spacer and soft tissue reconstruction. If serial sampling of the periprosthetic space failed to demonstrate microbial growth, the spacer was exchanged for an endoprosthesis. A total of nine patients underwent staged revision of endoprosthesis. In five patients cover was provided by a local pedicled flap and in four by a free flap. Patients undergoing cover by a broad flat musculocutaneous flap (i.e. free/pedicled latissimus dorsi) performed better. This study reports the results of attempted limb salvage in endoprosthetic failure due to infection in nine cases. Initial findings in this small series indicate that staged revision and soft tissue reconstruction in the form of muscle flap investment of the endoprosthesis carries a higher rate of successful limb salvage

Superficial Temporal Fascia Pedicled V-Y Advancement Flap for Scalp Reconstruction

Repair of scalp defects using local hair bearing scalp is technically challenging. Transposition or rotation of local flaps to close the defect has its own disadvantages. Reconstruction of scalp defect using superficial temporal fascia pedicled V-Y advancement flap using both frontal and parietal branches of superficial temporal artery following the excision of a benign and a malignant pathology is reported here. It is possible to reconstruct the defect with hair bearing scalp in a single stage along with primary closure of the donor site using this technique

Comparação dos resultados da fala após as cirurgias de retalho faríngeo e veloplastia intravelar para correção da disfunção velofaríngea Comparison of speech results following pharyngeal flap and intravelar veloplasty for correction of velopharyngeal dysfunction

OBJETIVO: Comparar a fala e o funcionamento velofaríngeo após as técnicas de retalho faríngeo e veloplastia intravelar para a correção da disfunção velofaríngea residual. MÉTODOS: Foi realizado um estudo retrospectivo com análise de 148 casos com fissura labiopalatina operada e submetidos à correção cirúrgica da disfunção velofaríngea, sendo 77 com retalho faríngeo (média de idade: 20,4 anos) e 71 com veloplastia intravelar (média de idade: 16,2 anos). Foram avaliadas a ressonância da fala, a presença de articulações compensatórias, a emissão de ar nasal e a extensão da falha no fechamento velofaríngeo antes e após as duas técnicas. RESULTADOS: Dos 77 casos submetidos ao retalho faríngeo 64 (83%) apresentaram melhora na ressonância, enquanto que dos 71 casos com veloplastia intravelar 48 (68%) revelaram melhora, havendo diferença significativa entre os grupos. No grupo com retalho faríngeo, seis (8%) apresentaram melhora na articulação compensatória e dois (3%) no grupo veloplastia intravelar, enquanto a emissão de ar nasal melhorou em 17 (22%) casos com retalho faríngeo e em 18 (26%) com veloplastia intravelar. Não houve diferença entre os grupos quanto à articulação compensatória e emissão de ar nasal. A falha no fechamento velofaríngeo reduziu em 75 (96%) casos com retalho faríngeo e 46 (66%) com a veloplastia intravelar, havendo diferença entre os grupos. CONCLUSÃO: A técnica de retalho faríngeo mostrou-se mais efetiva na melhora da ressonância e no fechamento velofaríngeo quando comparada à veloplastia intravelar.<br>PURPOSE: To compare speech and velopharyngeal function after pharyngeal flap and intravelar veloplasty techniques for the correction of residual velopharyngeal dysfunction. METHODS: It was carried out a retrospective study analyzing 148 cases of cleft lip and palate operated and submitted to velopharyngeal dysfunction surgical correction, 77 with pharyngeal flap (mean age: 20.4 years) and 71 with intravelar veloplasty (mean age: 16.2 years). Speech resonance, presence of compensatory articulations, nasal air emission, and velopharyngeal gap size were assessed before and after the use of both techniques. RESULTS: Sixty four (83%) of the 77 cases submitted to pharyngeal flap presented resonance improvement, while 48 (68%) of the 71 cases with intravelar veloplasty improved, with significant difference between the groups. Six (8%) subjects with pharyngeal flap, and two (3%) with intravelar veloplasty showed improvement in compensatory articulations, while nasal air emission improved in 17 (22%) cases with pharyngeal flap, and 18 (26%) with intravelar veloplasty. No significant differences were found between the groups regarding compensatory articulations and nasal air emission. The velopharyngeal gap size reduced in 75 (96%) cases with pharyngeal flap, and 46 (66%) with intravelar veloplasty, with a significant difference between the groups. CONCLUSION: The pharyngeal flap technique was more effective in improving resonance and velopharyngeal closure, when compared to intravelar veloplasty