6 research outputs found
Use of composite anterolateral thigh flap as double-vascularised layers for reconstruction of complex hand dorsum defect
No full textSensorial donor site morbidity after saphenous neurocutaneous flap
No full textNeurocutaneous flaps based on the arterial network around the superficial sensory nerves are popular in soft tissue coverage of the lower extremities, and are usually preferred in reconstruction of the lower leg and foot. Although sacrifice of sensory cutaneous nerves is mentioned as one of their major disadvantages to our knowledge the morbidity in the foot and at the donor site has not been properly investigated. We investigated sensorial morbidity in the foot and at the donor site caused by raising a saphenous neurocutaneous flap in 14 patients by using static two-point discrimination test, Semmes-Weinstein monofilament test, vibration test, and by measuring somatosensory evoked potentials in the twelfth postoperative month. Our results suggest that sensory recovery is good and protective sensation is gained in most patients
A Turkish patient of typical Loeys-Dietz syndrome with a TGFBR2 mutation
No full textA Turkish patient of typical Loeys-Dietz syndrome with a TGFBR2 mutation: We describe a 2-years-old male patient with skeletal, neurological, cardiovascular, and connective tissue anomalies. Skeletal anomalies included pectus excavatum, hammer toes and hallux valgus and camptodactyly. The characteristic craniofacial findings of hypertelorism, down slanting palpebral fissures, strabismus, ptosis of eyelids, bifid uvula, high-arched palate and retrognathia were present. The proband has been operated on twice for bilateral inguinal hernia and several times for his foot deformities. Psychomotor development was retarded. At present, echocardiographic findings show aortic root dilation. The patient has important characteristics of Loeys-Dietz syndrome (LDS). Direct sequencing analysis of the transforming growth factor beta receptor I and II (TGFBR1 and 2) genes was performed and was demonstrated heterozygous missense mutation of the TGFBR2 gene in the patient, which confirms the diagnosis of LDS. This is the first Turkish patient with typical clinical signs of LDS. This report also illustrates that LDS and Shprintzen-Goldberg syndrome (SGS) have some common clinical characteristics
A TURKISH PATIENT OF TYPICAL LOEYS-DIETZ SYNDROME WITH A TGFBR2 MUTATION
No full textA Turkish patient of typical Loeys-Dietz syndrome with a TGFBR2 mutation: We describe a 2-years-old male patient with skeletal, neurological, cardiovascular, and connective tissue anomalies. Skeletal anomalies included pectus excavatum, hammer toes and hallux valgus and camptodactyly. The characteristic craniofacial findings of hypertelorism, down slanting palpebral fissures, strabismus, ptosis of eyelids, bifid uvula, high-arched palate and retrognathia were present. The proband has been operated on twice for bilateral inguinal hernia and several times for his foot deformities. Psychomotor development was retarded. At present, echocardiographic findings show aortic root dilation. The patient has important characteristics of Loeys-Dietz syndrome (LDS). Direct sequencing analysis of the transforming growth factor beta receptor I and II (TGFBR1 and 2) genes was performed and was demonstrated heterozygous missense mutation of the TGFBR2 gene in the patient, which confirms the diagnosis of LDS. This is the first Turkish patient with typical clinical signs of LDS. This report also illustrates that LDS and Shprintzen-Goldberg syndrome (SGS) have some common clinical characteristics
Lebensqualität und Funktionsfähigkeit nach mikrochirurgischen faszikutanem vs. myokutanem Gewebetransfer
No full textBackground: Coverage of soft tissue defects at the lower extremity may necessitate microsurgical tissue transfer, such as by fasciocutaneous anterolateral thigh (ALT) or myocutaneous musculus latissimus dorsi (MLD) flaps. Hitherto, these two flaps have not been compared systematically in terms of patient satisfaction and functional outcome. The purpose of this study was to compare patients' satisfaction and functional outcome following ALT vs. MLD transfer. Methods: Thirty-six patients were divided into an ALT group (n=22, mean age: 42.0 years) and a MLD group (n=14, mean age: 55.5 years). Both groups were compared concerning isokinetic analysis (Biodex System III), circumference measurement, flap volume, scar size, complication rates, patients' satisfaction, and functional outcome (SF-36 questionnaire, Foot and Ankle Outcome Score (FAOS)), hospital stay and duration of surgery.Results: Isokinetic force measurements showed a higher mean maximum force for dorsiflexion in the MLD group at an angular velocity of 60°/sec. (ALT 17.5±7.9 Nm, MLD 18.5±16.3 Nm; p0.05) in quality of life and functional outcome. Average hospital stay and duration of operation showed no differences between groups.Conclusion: In the present study, no significant differences in quality of life and functional outcome were found between ALT and MLD group. Only in isokinetic force measurement isolated significant differences with advantages of MLD group were detected. The current study provides additional information concerning ALT and MLD flaps and may support decision-making in selecting the appropriate free flap.Einleitung: Weichteildefekte können zur Defektdeckung einen mikrochirurgischen Gewebetransfer wie z.B. eine faszikutane Oberschenkellappenplastik (ALT) oder eine myokutane M. Latissimus dorsi Lappenplastik (MLD) benötigen. Bisher wurden diese beiden Lappenplastiken in Bezug auf Patientenzufriedenheit und alltägliche Funktionsfähigkeit weniger untersucht. Ziel dieser Studie ist es, die Patientenzufriedenheit sowie die Funktionsfähigkeit nach ALT- und MLD-Lappentransfer zu vergleichen.Methoden: 36 teilnehmende Patienten wurden in eine ALT-Gruppe (n=22, Durchschnittsalter 42,0 Jahre) und in eine MLD-Gruppe (n=14, Durchschnittsalter 55,5 Jahre) unterteilt. Beide Gruppen wurden hinsichtlich isokinetischer Kraftanalyse (Biodex System III), Umfangmessung, Lappengröße, Narbenlänge, Komplikationen, Patientenzufriedenheit und alltäglicher Funktionsfähigkeit ( SF-36-Fragebogen, Foot and Ankle Outcome Score (FAOS)), Krankenhausaufenthaltsdauer und Operationsdauer vergleichend untersucht.Ergebnisse: Isokinetische Kraftmessungen zeigten in der MLD-Gruppe bei einer Winkelgeschwindigkeit von 60°/sek. eine höhere mittlere Maximalkraft für die Dorsalflexion (ALT 17,5±7,9 NM, MLD 18,5±16,3 Nm; p0,05). Beim durchschnittlichen Krankenhausaufenthalt sowie der Operationsdauer zeigten sich ebenfalls keine Unterschiede.Schlussfolgerung: In der vorliegenden Studie wurden keine signifikanten Unterschiede in der Lebensqualität oder in der alltäglichen Funktionsfähigkeit zwischen ALT-und MLD-Lappenplastik beobachtet. In der isokinetischen Kraftmessung konnten jedoch isoliert signifikante Unterschiede zu Gunsten der MLD-Gruppe festgestellt werden. Die aktuelle Studie liefert zusätzliche wichtige Informationen über die ALT- und MLD-Lappenplastiken und kann somit unterstützend bei der Entscheidungsfindung hinsichtlich einer individuell geeigneten Auswahl einer Lappenplastik mitwirken
Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients
No full textIntroduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND) in recurrent foot ulcers in leprosy patients.Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years). All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months).Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years.Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging function and aesthetic outcomes. It is a quick and easy procedure
