Lower Limb Salvage Using the Medial Hemisoleus Flap Associated with the Reverse Sural Flap

Innovative Synchronous Use of a Reverse Sural Flap and Reverse Hemisoleus Muscle Flap for Post-traumatic Lower Leg Reconstruction: A Case Report With a Long Term Follow-Up and a Quality of Life Assessment

We present a case report of a 47-year-old male with an extensive tissue deficiency of the right lower leg. The patient was hospitalized for approximately one month in the intensive care unit following a motorcycle accident that resulted in polytrauma. He suffered a fracture of frontal and parietal bones, traumatic brain injury, intracerebral hematoma with a subarachnoid hemorrhage and thoracic trauma. At first, lower leg wound was treated with a negative pressure wound therapy vacuum-assisted closure (VAC) dressing. Afterwards, he was qualified for a surgical wound closure with synchronous use of two reverse flow flaps: a reverse sural flap (RSF) and a reverse hemisoleus muscle flap (RHMF). Both flaps were dissected, and the RHMF was used to cover the exposed bone and the fracture site while the RSF closed the distal part of the wound. Split-thickness skin graft was meshed in scale of 1:1.5 and used to cover the RHMF and the remaining lower leg wounds. In the following days, uneventful wound healing was observed and the patient was discharged on day 34. The patient was invited for a follow-up examination two years after the procedure. His quality of life was assessed using SF-36 and Lower Extremity Functional Scale. It was determined to be satisfactory when compared to patients with identical injuries. Ultrasound examination of the gradient and blood flow velocity showed preserved graft perfusion and no structural abnormalities were detected. Adequate wound preparation and the choice of surgical technique allowed rapid healing and, above all, salvage of the limb that was at high risk of amputation.

Reconstruction of lower eyelid defects after the excision of basal cell carcinoma

Objectives: The paper presents the reconstructive options of the lower eyelid region in patients who have benefited from the excision of basal cell carcinomas. Methods: The study was based on the clinical and evolutionary particularities analyzed in a series of cases, the patients benefiting from excision and reconstruction for the treatment of basal cell carcinomas located at the level of the orbital region. Results: Following the surgical treatment, the local evolution was favorable with a good functional recovery. The aesthetic results were strongly influenced by the stage of the neoplasm, the final aspect being satisfactory for the patients included in the study. Conclusion: Early diagnosis and rapid and effective surgical treatment are associated with favorable results from a functional and aesthetic point of view. Delayed surgery and treatment of relapses are associated with increased risks and inferior results.

Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma

Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion. Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.