Mustafa Kürşat Evrenos

Soft-tissue management with immediate free flap transfer in segmental prosthetic replacement of proximal tibia sarcomas

Knee reconstruction with endoprosthesis after tumor resection is accepted as superior when compared with the other methods. But sometimes soft tissue reconstruction would be a challenging problem in this way of treatment. Five patients who were operated for tumor resection in this location, followed by reconstruction were presented with their one‐year post operative results. Four latissimus dorsi and one rectus abdominis myocutaneous free flaps were used in these patients in order to manage soft tissue problems. All patients underwent chemotherapy in postoperative period. All flaps were successful in one year post operative examination. In this report we would like to stress the importance of surgical planning and soft tissue reconstruction of a specific patient population. We think that large musculocutaneous flaps such as latissimus dorsi and rectus abdominis musculocutaneous flaps should be preferred in soft tissue reconstruction of knee region after tumor resection followed by prosthetic replacement. Additionally, this way of treatment is superior when compared to the other methods in order to prevent complications such as prosthesis exposure or infection.

A rare poland syndrome deformity: humero-pectoral band.

Since Dr. Lallemand has defined isolated pectoral muscle absence in 1826 [1], many articles have been published about Poland Syndrome. Ipsilateral syndactyly with pectoralis major muscle agenesis has been defined by Dr.Froriep in 1839 [1]. Dr. Alfred Poland has defined same entity in 1841 while he was a medical student [1]. Agenesis of the pectoralis major muscle’s sternal head is the major finding in diagnosis of Poland Syndrome. Additionally, scoliosis, lung, rib cage (two to four or three to five costal cartilages), breast and nipple-areolar hypoplasia, ipsilateral brachysynphalangism, serratus, pectoralis minor, latissimus dorsi and external oblique muscles hypoplasia, absence of axillary hairs and sweet glands and decreased subcutaneous tissue would be seen together in Poland Syndrome [1, 2].

A new flap design: prefabricated neuro-osseous flap.

Abstract We hypothesized that an osseous tissue can be prefabricated with a peripheral nerve by vascular induction, and by using a rat model, we tested this hypothesis. Twenty Wistar rats were used in the prefabricated neuro-osseous flap study. Bilateral sciatic nerves were placed linearly within the medullary cavities of the femurs. Left femurs were accepted as the experimental group. The right femurs of all the rats were used as internal control where the sciatic nerves were ligated at the bony entrance of the flap. After 6 weeks, all experimental femur flaps were viable. Radioactivity counts and metabolic activity studies showed viable and functional bone tissue in experimental group compared with control group (P = 0.001). On microangiographic evaluation, significant dilatation of the perineural vasculature was observed in experimental group. Histologic investigations showed viable bone tissue only in the experimental group flaps. Due to its easy applicability, reproducibility, and robust circulation, the prefabricated neuro-osseous flap would be an option in reconstructive surgery.

A reliable option for lower extremity complex defect reconstructions: Two case reports with free osteocutaneous radial forearm flap

Extensive complex tissue defects of leg and foot are difficult to manage and often result in amputation. Various techniques are used for reconstruction of defects including bone grafting with fasciocutaneous flaps to composite free flaps to avoid amputation. Free osteocutaneous radial forearm flap (FOCRFF) is reliable option with vascularised bone, predictible long pedicle and large soft tissue. We present two cases treated succusfully who has complex tibia defect and has first metatars defect with dorsal and volar soft tissue loss of the forefoot due to bomb explosion injury.

Amniotic band and foot polydactyly: A rare case

Amniotic band syndrome (ABS) is defined as the triad of fetal deformation, malformation, and amputation caused by adhesions and entanglement of the fetal parts by the placenta, lacking an amniotic membrane and the remnants of amniotic membrane. The current case report presents a rare case with amniotic band syndrome, in whom constriction bands in the left hand second finger and left foot second and fourth toes are accompanied by preaxial polydactyly in the left foot. ABS is a rare condition observed in infants and it is frequently accompanied by other extremity anomalies. Appropriate treatment options allow better functional and cosmetic outcomes.

Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients.

BACKGROUND AND OBJECTIVE Reconstructing defects related to the leg soft tissue may be quite difficult because the soft tissue over the bone is rather thin and the tendons lie right under the skin. Distal pedicle sural neurocutaneous flap with its long pedicle composed of skin, subcutaneous tissue and fascia is suitable for superficial defects. This study aimed to determine the usability of the delayed reverse-flow (distally based) islanded sural flap for correcting tibial and ankle defects. DESIGN AND SETTINGS A prospective clinical trial conducted from 2012 to 2013 in Plastic & Reconstructive and Aesthetic Surgery clinic, Necmettin Erbakan University, Turkey. METHOD Eleven patients with pretibial defects and a visible open bone who underwent reconstruction with reverse-flow islanded sural flap between 2012 and 2013 were included in the study. All patients who had defects between the middle of the tibia and the foot underwent surgery in 2 sessions under spinal anesthesia. In the first session, necrotic tissues were debrided and cultures were taken, and the flap was delayed. Reconstruction was performed in the second session. RESULTS The biggest flap was 16×11 cm and the smallest one was 5×6 cm. The longest pedicle was 27 cm long and the shortest one 21 cm. A total of 6 patients were smokers and 3 had diabetes mellitus. One patient had partial necrosis of the flap, and the necrosis was healed secondarily. No complications were seen in other patients. CONCLUSION Delayed reverse-flow islanded sural flaps can be used as an easy, quick, and secure surgical alternative to free flaps for correcting in leg defects involving an exposed bone between the middle portion of the tibia and the heel.