Background Distal lower limb reconstruction is one of the most difficult and challenging tasks in plastic surgery. Despite the continuous advances in microsurgical techniques, pedicled cross-leg flaps still have a major role particularly in pediatric patients. Many techniques have been described to maximize the potential of the cross-leg flaps. The introduction of fasciocutaneous flaps has provided more potentials and made lower leg reconstruction easier and more successful. The description of perforator system in the leg has also made a revolution in the regional reconstruction. In this report, we present a new modification that increases the reach and facilitates the inset of the flaps. Methods The flap is taken from the posteromedial skin of the middle third of the leg. The design is determined by the location, size, and shape of the defect. The base of the flap should contain at least 2 perforators located by Doppler device. After elevation of the fasciocutaneous flap, 2 back cuts are performed in the upper and lower edge of the flap base preserving the 2 previously located perforators. Results Fifty patients, 32 males and 18 females, were reviewed and presented. Age of the patients ranged from 4 to 13 years and the defect size ranged from 20 to 130 cm. All flaps survived with 3 flaps had mild marginal ischemia, 2 flaps had mild infection, and 1 flap had partial dehiscence. Conclusions Back cuts made at the edges of the base of a cross-leg flap, preserving the feeding perforators, can increase the flap reach without jeopardizing its viability. It is also an easy to do technique and does not require any extra equipment or time.

No abstract

Lower limb reconstruction remains a big concern. Great advancements have been made over the past century for reconstructing traumatic and non-traumatic defects in leg and foot. The reconstructive methods ranged from leaving the wound to heal by secondary intention up to free flap. Large defects are commonly reconstructed with free fasciocutaneous flaps or free muscle flaps with skin grafts. The result of a reconstructive operation is mainly due to the vascular component's stability, which is crucial in ensuring the flap survival and proper function. The lower extremity has also been recognized for slow wound healing and as an inadequate source of the flap for reconstruction. In this study, we will present our experience in sohag university hospital In free Antero Lateral Thigh flap used in leg and foot reconstruction as regarding flap outcome, complications.

No abstract

Introduction: The medial canthus is an important structure to maintain the shape of the eye and assist in drainage of the lacrimal sac. Traumatic telecanthus is a difficult deformity to treat which involves both esthetic and functional aspects. Transnasal wiring remains the gold standard for repair of the medial canthal tendon (MCT) avulsion; however, it is often complicated by canthal drift, extrusion of wires, and in-fracture of the contralateral orbital bones from pressure by tied wires. In order to overcome traditional transnasal wiring technique pitfalls, this study proposes a transnasal wiring fixation method supported with a bone graft to treat patients presenting with telecanthus following complex nasoorbitoethmoid fractures. Patients and Methods: From December 2018 to October 2020, 12 patients with traumatic telecanthus underwent transnasal wiring fixation of the MCT supported with bone graft. The wire holding the MCT was delivered through a single hole to the contralateral side and secured to a small bone graft by passing the wire through 2 holes in the graft in a button-like fashion. Then the wire end is pulled again to the affected side through the same hole and the 2 wires ends are tightly twisted after setting the MCT posterior to the lacrimal crest. Results: Restoration of the MCT to its normal position was achieved in all patients. There were no observed major complications. Only 2 cases of wound infection and 1 case of dacrocystitis were encountered, which settled with conservative management. The preoperative palpebral fissure width (mean: 28.33mm ± 2.188mm) was significantly lower than the postoperative palpebral fissure width (mean: 34.17mm ± 1.03mm) (P<0.05). Conclusions: This study introduces a modified technique of transnasal wiring fixation to restore palpebral shape and intercanthal distance. The proposed technique could eliminate most of the frequently observed complications of the traditional methods.