Free Adipofascial Flap Interposition for Pediatric Posttraumatic Forearm Synostosis With Closed Head Injury

Double microvascular free flap reconstruction for bilateral lower extremity injury in a paediatric patient

Many challenges have been described by microsurgeons in paediatric free flaps. With the advancement in microsurgical expertise, it is now possible to achieve excellent results. We present a case of a female child with car-tyre friction injury of bilateral feet with associated extradural haemorrhage who underwent emergency bilateral anterolateral thigh flap. A secondary tendon reconstruction of the left foot was performed at 6 months. No complications were observed in the postoperative period after both procedures and good functional recovery was achieved at 1 year follow-up. The problems unique to this case were the presence of head injury and bilateral extremity injury in the paediatric patient. The technical details of planning, execution, difficulties and recommendations to minimise the risk in such cases are discussed. To the best of our knowledge, this is the only case report of bilateral lower limb paediatric emergency free flap with associated head injury.

[Treatment of proximal radioulnar synostosis using a posterior interosseous antegrade flow pedicled flap]

The aim of this study is to determine the different therapeutic options described for the treatment of radioulnar synostosis, and report our experience with posterior interosseous antegrade flow pedicled flap with technical amendments. Two patients, who were treated with the designed flap, and with more than one year of follow-up, were reviewed. The technical innovations, end result and complications are described. In the two cases described, there was no recurrence of synostosis, which is the most frequent complication described in this condition, and no postoperative complications were observed. In the literature, many filler materials, from artificial to biological free or vascularized, have been used the radioulnar space after excision of synostosis. The technique that provides the best results is the interposition of muscle or vascularized adipofascial flaps. The Interosseous posterior antegrade flow pedicled flap is reliable, with a low morbidity, and is an effective alternative for the treatment of proximal radioulnar synostosis.

Prevention of recurrent radioulnar heterotopic ossification by combined indomethacin and a dermal/silicone sheet implant: case report

A 27-year-old, right-handed man developed severe radioulnar synostosis at the distal radius 7 months after open reduction and internal fixation of his distal radius fracture. Heterotopic ossification formed at the radius fracture site, requiring excision of the heterotopic bone and plate removal. A bilayer, dermal substitute and silicone sheet was placed between the radius and ulna in the interosseous space to prevent recurrence of the heterotopic ossification. After surgery, the patient was treated with indomethacin 25 mg orally 3 times daily for 6 weeks. At 1 year after surgery, he has retained full pronation and near normal supination. Radiographs demonstrate no new heterotopic bone formation.