Usefulness of perforating branches of the deep femoral artery and vein as recipient vessels during free-flap reconstruction for extensive defects of the thigh

The perforating branches of the deep femoral artery and vein are considered useful recipient vessels during free-flap reconstruction for extensive defects extending from the knee to the mid-thigh or from the lateral to the posterior region of the thigh. Despite being located deep between the adductor longus and magnus muscles, they can be easily identified, allowing for a sufficient surgical field for the vascular anastomosis. Approximately four perforators from the deep femoral artery can be found on the posterior aspect of the thigh, easily identified by dissecting the semitendinosus and biceps femoris muscles. The calibre and length of the perforators were suitable for vascular anastomosis. In this study, we present three cases of free-flap reconstruction for extensive thigh defects using perforating branches of the deep femoral artery and vein as recipient vessels.

Surgical treatment for a giant venous malformation of the parotid area

This report discusses the surgical treatment of a giant parotid venous malformation (VM) that had grown beyond the dimensions of the parotid gland, causing significant displacement. Special attention was paid to identifying the facial nerve, which was found to traverse the surface of the VM. Although, in our case, the facial nerve ran superficially on the VM, it is possible that a portion of it penetrated the mass. A two-stage excision and revision surgery strategy was employed due to the complexity of assessing deformities after removing the giant lesion. During the initial surgery, the displaced superficial lobe of the parotid gland was repositioned to its original location and carefully laid over the facial nerve, ensuring its safety during the subsequent procedure.

Mid-axillary pacemaker re-implantation after contralateral pocket infection in an emaciated elderly case

The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and expansion of indications for CIEDs have led to an increase in associated infections. We experienced a case of a 99-year-old man presenting with skin erosion at the pocket site, where a 6-month-old implantable pacemaker was replaced. He was referred for pacemaker pocket infection and presented with fever accompanied by pain and swelling around pacemaker generator. We could not explant 7-year-old pacemaker leads and the patient refused to undergo either laser lead extraction or surgical removal. We planned to re-implant in the contralateral chest. However, the patient was emaciated with low body-mass-index (15.2 kg/m²), thus concerns arose about the possibility of tissue disruption and re-infection owing to thin skin and absence of sufficient subcutaneous tissue in contralateral subclavian region. Axillary placement of CIEDs has been adopted in patients with limited venous access. We applied a mid-axillary pacemaker implant procedure to this elderly and emaciated patient. Postoperative clinical course was uneventful. After discharge, no history of unexplained fever or illness was recorded. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation. <Learning objective: We apply the mid-axillary pacemaker implant procedure to a nonagenarian with contralateral pacemaker infection to minimize the risk of skin disruption after implantation. This implies that implantation is possible in patients with emaciated or cachexic or infection of the contralateral subclavian pocket. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation.> .