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Sternal defect reconstruction using a double-barrel vascularized free fibula flap: a case report
Gravina, Paula Rocha,Chang, Daniel K.,Mentz, James A.,Dibbs, Rami Paul,Maricevich, Marco Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.5
Total and subtotal sternectomy oncological defects can result in large deficits in the chest wall, disrupting the biomechanics of respiration. Reviewing the current literature involving respiratory function and rib motion after sternectomy, autologous rigid reconstruction was determined to provide the optimal reconstructive option. We describe a novel technique for sternal defect reconstruction utilizing a double-barrel, longitudinally oriented, vascularized free fibula flap associated with rib titanium plates fixation. Our reconstructive approach was able to deliver a physiological reconstruction, providing rigid support and protection while allowing articulation with adjacent ribs and preservation of chest wall mechanics.
Extracorporeal Pedicles for Free Flap Reconstruction in Diabetic Lower Extremity Wounds
Alejandro R. Gimenez,Daniel Lazo,Salomao Chade,Alex Fioravanti,Olimpio Colicchio,Daniel Alvarez,Ernani Junior,Sarth Raj,Amjed Abu-Ghname,Marco Maricevich 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.6
Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the “hanging” free flap for the reconstruction of chronic lower extremity diabetic ulcers. This twostaged approach involves standard free flap harvest and inset; however, following inset the “hanging” pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the “hanging” pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.