P.L.G. Townsend

Vascularised nerve grafts using composite arterialised neuro-venous systems

Abstract The rationale for the use of revascularised nerve grafts is well established and has been proved both experimentally and clinically. It is a technique that is particularly useful if one wishes to transfer large thick grafts to repair major nerves or insert vascularised cable grafts to bridge long defects in a poorly vascularised fibrous bed of tissue. An experimental technique has been devised to raise a composite neuro-venous graft and by reversing the vein component provide an arterialised composite nerve graft that can be safely transferred to different parts of the body. Experimental work in cadavers and dogs has confirmed these observations and details of seven clinical cases are given. The results are encouraging and in patients with nerve injuries where there are associated vascular and nerve defects, as in the forearm and hand, the technique of a composite reversed neuro-venous graft which is arterialised, should be seriously considered.

Use of a pedicled fascial flap based on septocutaneous perforators of the posterior tibial artery for repair of distal lower limb defects

A distally based fascial flap raised on perforating vessels of the posterior tibial artery is described. Its successful application in the repair of distal soft tissue defects of the lower limb in two patients is reported.

The morbidity of the free vascularised fibula flap

Twenty patients who had undergone free vascularised fibula flap transfers were reviewed to determine the incidence of peri and postoperative complications. The mean follow-up was 3.2 years (0.2-10); 18 grafts were successful, but required 10 re-operations for complications including 5 haematoma evacuations and 3 bone grafts and plates for delayed or non-union. The two unsuccessful fibula grafts required 11 re-operations, the majority for infections and non-union. Technical details of the operative procedure are reviewed for their part in the complications.

Single-stage muscle flap reconstruction of major scrotal defects: report of two cases

Major scrotal defect with exposed testes and/or spermatic cords are a challenge for the reconstructive surgeon. The bacterial flora of the perineum, difficulty of immobilisation and the contour of the testes make testicular cover a difficult task [Br. J. Plast. Surg. 41 (1988) 190]. Traditional approaches have used simple skin grafts or if not feasible, multi-staged procedures with initial burying of the testes under delayed medial thigh flaps. Better techniques then evolved to permit early single-staged coverage using flaps rather than skin grafts in these usually contaminated and unsuitable wounds to improve the cosmetic outcome of the reconstruction and reduce patient discomfort and hospital stay. Muscle flaps represent an excellent reconstruction option in the contaminated perineum especially in patients with impaired ability to deal with infection such as diabetic or toxic patients. We present two cases of reconstruction of the scrotum using simple, reliable single-stage muscle flap techniques with good aesthetic results and review the literature.

A pigmented lesion clinic : analysis of the first year's 1055 patients

The Pigmented Lesion Clinic (PLC) at Frenchay Hospital was started in January 1993 to deal rapidly and effectively with a growing number of referrals of suspicious pigmented lesions. Its objectives were to offer expert assessment and either reassurance or excision at the first PLC following referral by the patients general practitioner. During 1993, 1055 patients were seen in 37 PLCs and 357 excision biopsies were performed. We have compared the Breslow thicknesses of malignant melanomas diagnosed from the PLCs with those of all other (non-PLC) malignant melanomas referred to our unit over the same period. We discuss the development and results of the first year of our PLC and the advantages it confers.

The development of a dynamic model for microvascular research and practice using human placenta: a preliminary report

Human placenta has been investigated in an attempt to develop a non-animal model for microvascular research and practice, with a dynamic artificial circulation. Initial work has been encouraging and further development is in progress.

Lengthening of a short traumtic femoral stump

A case is reported in which a severe open injury of the thigh eventually required amputation of the lower limb. Lengthening of the short proximal femoral stump was achieved by turning over a flap comprising bone and soft tissue, with sensation, from the ipsilateral leg.

Lower limb salvage using an extended free radial forearm flap

A case is reported of an unusual double injury, in which a lower limb salvage procedure employed a free radial forearm flap from an amputated upper limb. The use of amputated parts for salvage procedures is well documented but none has previously involved a free forearm flap. This clinical case shows that the entire forearm and hand skin can be adequately perfused on the radial artery along with the superficial palmar arch.

Vascularised fibular graft using reverse peroneal flow in the treatment of congenital pseudarthrosis of the tibia

Pseudarthrosis of the tibia represents one of the more difficult conditions to treat, often resulting in delayed amputation or shortening. A technique is described where the central segment of the fibula containing the nutrient artery can be mobilised based on retrograde peroneal artery flow. This can then be transposed and slotted into the tibial defect after resection of the pseudarthrosis, allowing bone replacement and correction of length. In the initial two cases presented the bone behaved in the same way as a successful microvascular transfer.

Free vascularized fibular graft to reconstruct early a traumatic humeral defect

A case is reported in which a free, vascularized fibular graft was used to reconstruct early a traumatic 16-cm defect in a humerus. A description of a cast-brace used postoperatively is included. A brief review is presented of the literature with respect to the use of free vascularized fibular graft for defects in the upper extremity.