Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

Chui, Christopher Hoe-Kong,Wong, Chin-Ho,Chew, Winston Y.,Low, Mun-Hon,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.2

Background : Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods : A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results : We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from $4{\times}9cm$ ($36cm^2$) to $15{\times}30cm$ ($450cm^2$) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was $102^{\circ}$ (range, $45^{\circ}$ to $140^{\circ}$). Conclusions : In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

Christopher Hoe-Kong Chui,Chin-Ho Wong,Winston Y Chew,Mun-Hon Low,Bien-Keem Tan 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.2

Background Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from 4×9 cm (36 cm2) to 15×30 cm (450 cm2) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was 102° (range, 45° to 140°). Conclusions In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and,access to fascia lata grafts for reconstruction of the triceps tendon.

The Chicken Aorta as a Simulation-Training Model for Microvascular Surgery Training

Ramachandran, Savitha,Chui, Christopher Hoe-Kong,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.4

As a technically demanding skill, microsurgery is taught in the lab, in the form of a course of variable length (depending on the centre). Microsurgical training courses usually use a mixture of non-living and live animal simulation models. In the literature, a plethora of microsurgical training models have been described, ranging from low to high fidelity models. Given the high costs associated with live animal models, cheaper alternatives are coming into vogue. In this paper we describe the use of the chicken aorta as a simple and cost effective low fidelity microsurgical simulation model for training.

The Chicken Aorta as a Simulation-Training Model for Microvascular Surgery Training

Savitha Ramachandran,Christopher Hoe-Kong Chui,Bien-Keem Tan 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.4

As a technically demanding skill, microsurgery is taught in the lab, in the form of a course of variable length (depending on the centre). Microsurgical training courses usually use a mixture of non-living and live animal simulation models. In the literature, a plethora of microsurgical training models have been described, ranging from low to high fidelity models. Given the high costs associated with live animal models, cheaper alternatives are coming into vogue. In this paper we describe the use of the chicken aorta as a simple and cost effective low fidelity microsurgical simulation model for training.

Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

Feng, Jiajun,Pardoe, Cleone I,Mota, Ashley Manuel,Chui, Christopher Hoe Kong,Tan, Bien-Keem Korean Society of Plastic and Reconstructive Surge 2016 Archives of Plastic Surgery Vol.43 No.2

Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

Jiajun Feng,Cleone I Pardoe,Ashley Manuel Mota,Christopher Hoe-Kong Chui,Bien-Keem Tan 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.2

Background The aim of unilateral breast reconstruction after mastectomy is to craft a naturallooking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.