The malignant peripheral nerve sheath tumor (MPNST) originates from neurofibromatosis type 1 (NF1). Because NF1 patients have many accompaniments with growth of additional masses, they usually overlook potential malignant changes in their masses. Our patient had two growing mass near the left elbow for several months; however, she ignored these masses until 7 days prior to writing this article, at which time they began bleeding. Traditionally, sarcoma including MPNST treatment consisted of amputation of the involved extremity. However, treatment now consists of surgical resection with adjuvant therapy. Therefore, we conducted resection of the mass and subsequent coverage with a local advancement flap. We believe that the most effective treatment for MPNST is early diagnosis and fast surgery, coupled with notification that there is always potential for malignant change in NF1 patient's masses.
Amputation ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Elbow ; Extremities ; Hemorrhage ; Humans ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Peripheral Nerves* ; Sarcoma ; Writing

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.
Abdominal Pain ; Aged* ; Colon, Sigmoid ; Colostomy ; Compliance ; Constipation ; Defecation ; Diabetes Complications ; Diagnosis ; Dietary Fiber ; Disabled Persons ; Early Ambulation ; Fecal Impaction ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Immobilization* ; Lower Extremity ; Shock, Septic ; Thigh* ; Thumb* ; Walking ; Wounds and Injuries

The superior gluteal artery perforator flap technique has increasingly been used for soft tissue defects in the sacral area following its introduction nearly 25 years ago. Advantages in covering sacral defects include muscle sparing, versatility in design, and low donor side morbidity. The bilateral superior gluteal artery perforator flap procedure is planned in cases of large sacral defects that cannot be covered with the unilateral superior gluteal artery perforator flap. Here, we report two cases of large sacral defects in which patient factors of poor general health, such as old age, pneumonia, and previous operation scar, led to use of a large unilateral superior gluteal artery perforator super-flap with parasacral perforator. The approach was utilized to reduce the operation time and prevent unpredictable flap failure due to the large flap size. Even though the parasacral perforator was included, the versatility of the large superior gluteal artery perforator flap was preserved because sufficient perforator length was acquired after adequate dissection.
Arteries* ; Cicatrix ; Humans ; Perforator Flap* ; Pneumonia ; Tissue Donors

PURPOSE: Fingertip amputations are the most common type of upper limb amputations. Composite grafting is a simple and cost-effective technique. Although many factors have investigated the success of composite grafting, the success rate is not high. Therefore, this study was conducted to investigate whether the microscopic procedure process during composite grafts improves the success rate. MATERIALS AND METHODS: Thirteen cases of unreplantable fingertip amputation underwent a microscopic resection procedure for composite graft in the operating room. The principle of the procedure was to remove the least devitalized tissue, maximize the clean tissue preservation and exact trimming of the acral vessel and to remove as many foreign bodies as possible. RESULTS: All fingertips in the thirteen patients survived completely without additional procedures. CONCLUSION: Composite grafting allows for the preservation of length while avoiding the donor site morbidity of locoregional flaps. Most composite grafts are performed as quickly as possible in a gross environment. However, we take noticed the microscopic resection. This process is thought to increase the survival rate for the following reasons. First, the minimal resection will maximize the junction surface area and increase serum imbibition. Second, sophisticated trimming of injured distal vessels will increase the likelihood of inosculation. Third, accurate foreign body removal will reduce the probability of infection and make it possible to increase the concentration and efficiency in a microscopic environment. Although there is a need for more research into the mechanisms, we recommend using a composite graft under the microscopic environment.
Amputation ; Finger Injuries ; Foreign Bodies ; Humans ; Operating Rooms ; Survival Rate ; Tissue Donors ; Tissue Preservation ; Transplants* ; Upper Extremity

Lymphedema is a frequent complication after the treatment of various cancers, particularly breast cancer, gynecological cancers, melanomas, and other skin and urological cancers. Lymphedema patients have chronic swelling of the affected extremity, recurrent infections, limited mobility and decreased quality of life. Once lymphedema develops, it is usually progressive. Over time, lymphedema leads to fat deposition and subsequent fibrosis of the surrounding tissues. However, there is no cure for lymphedema. Recently, the development of microsurgery has led to introduction of new surgical techniques for lymphedema, such as vascularized lymph node transfer. We report here the latest trends in the surgical treatment of lymphedema, as well as diagnosis and conventional treatments of lymphedema.
Anastomosis, Surgical ; Breast Neoplasms ; Diagnosis ; Extremities ; Fibrosis ; Humans ; Lymph Nodes ; Lymphedema* ; Melanoma ; Microsurgery ; Quality of Life ; Skin ; Urologic Neoplasms

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.
Catheterization ; Disarticulation ; Extracorporeal Membrane Oxygenation ; Extremities ; Humans ; Ischemia ; Knee ; Lower Extremity ; Methods ; Muscular Dystrophy, Duchenne ; Skin ; Surgical Flaps ; Thigh ; Transplants ; Wounds and Injuries

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a 3×5 cm pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to 5×8 cm in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.
Arteries ; Debridement ; Fascia Lata ; Femur* ; Hematoma ; Humans ; Male ; Middle Aged ; Pressure Ulcer* ; Relaxation ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A 5.0×0.5 cm size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.
Aged ; Follow-Up Studies ; Free Tissue Flaps ; Gait ; Humans ; Leg ; Lower Extremity* ; Male ; Perforator Flap ; Skin ; Tibial Arteries ; Transplants ; Ulcer ; Ultrasonography ; Wounds and Injuries

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.
Amputation* ; Ankle ; Bone Lengthening ; Fractures, Open ; Humans ; Leg* ; Male ; Middle Aged ; Osteomyelitis ; Replantation ; Soft Tissue Injuries ; Tibia ; Tissue Expansion

Segmental amputation of the digits and hand has been described as a contraindication for replantation because of poor results. We report the results of replantation for a patient who experienced multi-segment amputation of the hand. A 39-year-old man presented six hours after an accident, while using a straw cutter, that caused a multi-segment amputation of the entire palm and digits. The replantation surgery took 18 hours. We observed the patient gain satisfactory function of the hand. For replantation of a multi-segment amputation, connecting as many blood vessels as possible without tension is most important.
Adult ; Amputation* ; Blood Vessels ; Fingers ; Hand* ; Humans ; Replantation*