The combined scapular/parascapular flap for the treatment of extensive electrical burns of the upper extremity

The combined scapular parascapular flap was used for coverage of six high voltage electrical burn defects of upper extremity. The flaps resurfaced the exposed tendon, nerve, bone or blood vessels on the volar and dorsal side of the distal forearm and the hand. In all cases successful soft tissue coverage and wound healing was achieved. After the stabilisation of the wounds, secondary reconstructive procedures, such as nerve grafting, tendon grafting, tendon transfers were performed. Nerve healing and tendon gliding was found to be successful under the flap

SURVIVAL OF A FREE RADIAL FOREARM FLAP WITHOUT VENOUS RETURN

The radial forearm free flap is an ideal transfer for intraoral reconstruction because of its large vessels and pliable nature. In the case presented, a proximally-based forearm flap was transferred for reconstruction of an intraoral defect in the buccal and retromolar region after carcinoma resection, but there was no venous flow from either cephalic vein or venae comitantes following completion of the arterial anastomosis. In order to reduce the congestion in the flap, and end-to-end anastomosis between the distal end of the radial artery and the ipsilateral lingual vein was performed. Despite the absence of venous return, flap survival was complete

Mandibula reconstruction with fibula flap

Microvascular mandibular reconstruction should be considered the procedure of choice for bone replacement in radiated tissue beds, orocutaneous fistulae with segmental bone loss, osteoradionecrotic mandibles and for immediate composite tissue reconstruction. The free vascularised fibula has significant potential for the reconstruction of the mandible. Its architecture has certain advantages over other donor sites where considerable planning is required to orient the bone curvature and vascular pedicle in relation to the recipient vessels. In this study we present 21 cases of mandible reconstruction with fibular flap (1, 2)

The folded double paddled free flaps for head and neck reconstruction

We report our experience in the reconstruction of the full thickness defects of oral cavity and pharyngo-eosephageal region after wide surgical cancer ablation using different free flaps during the past ten years. 22 radial forearm flaps, six latissimus dorsi flaps and three rectos abdominis flaps were used in bipaddled fashion for full thickness defects of the cheek, floor of the mouth, maxillectomy and pharyngostoma defects resulting from cancer resection. The flaps provided both intraoral lining and skin cover in all cases. All the flaps survived, in one latissimus dorsi transfer a partial skin necrosis occurred in the distal paddle. No major complication were observed, salivary fistula developed in six cases which healed spontaneously up to four weeks postoperatively. The patients started oral feeding around three weeks postoperatively. Double paddled free flap reconstruction of oral cavity has many advantages. It is a one stage reconstruction, patient recovery is shorter and quality of life of the patient is better

THE FOLDED DOUBLE PADDLED FREE FLAP FOR ORAL CAVITY RECONSTRUCTION

Six radial forearm flaps, two transverse rectus abdominis flaps and one latissimus dorsi myocutaneous flap were used in a bipaddled fashion for full thickness defects of the cheek and the floor of the mouth resulting from cancer resection. The flaps provided both intraoral lining and skin cover in all cases. Immediate reconstruction was carried out following tumor resection in six cases. In three patients who presented with large full thickness defects due to failure of primary reconstruction, late reconstruction with double paddled free flaps was performed. All transfers were successful, in the latissimus dorsi transfer a minimal area of necrosis occurred at the tip of the flap. A salivary fistula developed in two cases, both healed spontaneously up to three weeks postoperatively. The average operating time was 5.5 h; the average hospital stay was 13.4 days