Free-fillet flap harvested in 'severe, high-energy landmine explosion' injuries of lower extremity: a case report

Transfer of free fillet lateral arm flap for facial reconstruction

We describe a 16-year-old male patient who had a major right facial degloving injury resulting in a soft-tissue defect with exposed zygoma as well as temporal and frontal bones. Multiple operations were undertaken in a staged manner for reconstruction. Lateral arm free fillet flap transfer was initially performed with fixation of bones with miniplates, which is followed by flap debulking, lateral canthopexy, scalp tissue expansion for hairline reconstruction, as well as ear reconstruction with costal cartilage and local flap techniques. After a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures after a successful free fillet flap transfer from an amputated part.

[Forearm osteomusculocutaneous free filet flap for arm reconstruction after amputation as an alternative to shoulder disarticulation]

We report the case of a 55-year-old woman suffering from a type I neurofibromatosis (also known as Von Recklinghausen neurofibromatosis) who was diagnosed with a high-grade schwannosarcoma of the median nerve, between the upper third and the medium third of the arm, upon contact with the humerus, invading the humeral vessels. The oncologic treatment of this tumour consisted in the amputation of the arm through the surgical neck of the humerus. In order to create a laterothoracic claw, to bring a partial function of the upper limb back, we decided to realize a free fillet forearm flap. This composite flap was composed of the radius and the ulna, all the forearm muscles and the skin of the anterior side of the forearm. A humeroradial plate osteosynthesis was done and the flap was then harvested with the radial pedicle, and anastomosed to the axillar artery. This procedure gave our patient a functional stump, giving back the arm functionality, especially the claw movement.

[The use of the "spare-parts tissue bank" concept in emergency hand surgery]

INTRODUCTION

In the case of multidigital hand trauma, the tissue of the amputated parts can be used for the reconstruction of the defected tissue localized on the other fingers.

PATIENTS AND METHODS

A series of seven patients has been reviewed in this paper; the authors illustrate the different possibilities of using the "spare-parts concept" in the emergency hand trauma surgery.

RESULTS

The functional results are presented.

DISCUSSION

The different techniques of reconstruction using the "spare-parts concept" are discussed.

CONCLUSION

In the cases of multidigital lesions, the surgeon should choose the best opportunity to use the tissue of the amputated digits, or the non-conservable ones, to reconstruct the neighboring preserved segments.