Rui Barbosa

The use of forearm free fillet flap in traumatic upper extremity amputations.

Background: Complete traumatic upper extremity avulsions are an infrequent but devastating injury. These injuries are usually the result of massive blunt trauma to the upper limb. Intact issue from amputated or nonsalvageable limbs may be transferred for reconstruction of complex defects resulting from trauma when the indications for replantation are not met. This strategy allows preservation of stump length or coverage of exposed joints, and provides free flap harvest for reconstruction without additional donor‐site morbidity. Methods: A retrospective review at São João Hospital was performed on seven patients who had undergone immediate reconstruction with forearm free fillet flaps between 1992 and 2007. Results: There were six men and one woman, with patient age ranging from 17 to 74 years (mean, 41 years). Amputation sites were at the humeral neck (n = 1), at the humeral shaft (n = 5), and below the elbow (n = 1). The area of the forearm free fillet flap skin paddle was 352.14 ± 145.48 cm (mean ± SD). The two major complications were the flap loss and the patient death on postoperative day 3 in other case. The postoperative course in the remaining five cases was uneventful with good healing of the wounds. Minor complications included two small residual defects treated by split‐thickness skin grafting and one wound infection requiring drainage and revision. Conclusions: The forearm free fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor‐site morbidity. Microsurgical free fillet flap transfer to amputation sites is valuable for achieving wound closure, improving stump durability, and maximizing function via preservation of length.

Neurosensible reconstruction of the thumb in an emergency situation: review of 107 cases.

Coverage of a soft tissue defect of the thumb that cannot be replanted or without bone shortening is difficult to achieve, but it is essential to preserve key-pinch and to restore a sensible and painless pulp. We reviewed retrospectively 107 cases of thumb reconstruction in an emergency situation using the following flaps: Moberg, radial innervated cross-finger, Venkataswami-Subramanian, Foucher, Tezcan, and Littler. The choice of the flap was determined by the extension and location of the injury; Foucher flap (56 cases) was the most used one, and it proved to be the best choice as shown by the results. Nevertheless, Tezcan flap also proved to be a good alternative.

Reconstruction of Middle Third Defects of the Face With the Temporal Flap

The temporal flap is of great interest in head and neck reconstruction when a skin graft or a local flap cannot be used. It has shown important results on the facial reanimation and in oncological surgery. We describe our experience with the pedicled flap in reconstruction of the middle third face defects in 8 oncologic patients. This flap allows the covering of bone and noble structures such as the periorbital, auricular, frontal, or parotid gland areas. Few major or minor complications were seen and good aesthetic results were achieved. It also can be done with or without adjuvant radiotherapy. The patient prognosis however, depends on the stage of the tumor.

Cervical impalement injury.

Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.