Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control.

Anatomical and clinical observations elucidated several technical points related to composite tissue transplantation of the midface. Careful graft harvest, appropriate selection of donor and recipient vessels, complete allograft revascularization, and restoration of sensory and motor function are critical to making face transplant surgery safe and functional.

Many techniques have been described to improve facial scars. In this review we address nonoperative strategies to manage facial scarring. Scar characteristics and anatomic location are discussed. The following nonoperative techniques are comprehensively examined: pulsed dye laser (PDL), subcision, fat transplantation, collagen injection, dermabrasion, steroid injection, and fillers. The PDL is advocated to flatten and decrease the volume of hypertrophic scars while improving texture and pliability. Dermabrasion is used to blend acne scars into the surrounding facial skin by subtly improving their contour. Fat transplantation, collagen, and filler injection is recommended in the treatment of acne depressed scars and traumatic scars with resulting contour deformity.