<i>Introduction</i>. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. <i>Material and Methods</i>. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. <i>Results</i>. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. <i>Conclusion</i>. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

Durga Karki

R. P. Narayan

The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

Ganglion, a benign cyst, most common soft tissue tumor of the hand, usually occurs in the hand, wrist, and foot. It is difficult to treat as reoccurrence is common after surgery and also following other treatment procedures. In this study, sclerotherapy technique in 20 patients treated using a solution of tetracycline after aspiration is described. Most of the patients in this study were between the ages of 20 and 35 years. 16 patients had ganglion on the dorsum of the wrist, 2 patients had bilateral ganglion, and 2 patients had ganglion on the dorsum of the foot. Under aseptic conditions, the ganglions were aspirated using size 21 G needles, and then 1 mL equivalent to 100 mg/mL solution of tetracycline was injected. In the postoperative followup ranging between 18 months to 5 years, 2 reoccurrences were noticed that required the same technique. This procedure is simple, safe, effective, and cheap when compared to surgery and other nonsurgical procedure of treating ganglion.

J. A. Ashindoitiang

Preliminary Report of the Effectiveness of Tetracycline Sclerotherapy in Treatment of Ganglion

Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing environment. Many different products have been developed to influence this wound environment to provide a pathogen-free, protected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most appropriate modality or combination of modalities to optimize healing.

Patrick S. Murphy

Gregory R. D. Evans

Advances in Wound Healing: A Review of  Current Wound Healing Products

Pretibial lacerations are problematic and best managed by surgical debridement, then skin grafting. Traditional postoperative care involves bed rest to optimise graft survival. This meta-analysis assesses early mobilisation versus bed rest for skin graft healing of these wounds. Medline, Embase, Cochrane, Cinahl, and Google Scholar databases were searched.  Analyses were performed on appropriate clinical trials.  Four trials met with the inclusion criteria.  No difference was demonstrated in split skin graft healing between patients mobilised early compared to patients admitted to hospital for postoperative bed rest at either 7 (OR 0.86 CI 0.29–2.56) or 14 days (OR 0.74 CI 0.31–1.79).  There was a statistically significant delay in healing in patients treated with systemic corticosteroids (OR 8.20 CI 0.99–15.41).  There was no difference in postoperative haematoma, bleeding, graft infection, or donor site healing between the comparison groups.  In the available literature, there is no difference between early mobilisation and bed rest for the healing of skin grafts to pretibial wounds.  Corticosteroids exert a negative effect on skin graft healing unlike early mobilisation, which does not cause increased haematoma, bleeding, infection, or delayed donor site healing.  Modality of anaesthesia does not affect skin graft healing.

James Southwell-Keely

John Vandervord

Mobilisation versus Bed Rest after Skin Grafting Pretibial Lacerations: A Meta-Analysis


		The creation of musculoskeletal tissue represents an alternative for the replacement of soft tissue in reconstructive surgery. However, most of the approaches of creating artificial tissue have their limitations in the size as the maximally obtainable dimension of bioartificial tissue (BAT) is limited due to the lack of supporting vessels within the 3-dimensional construct. The seeded myoblasts require high amounts of perfusion, oxygen, and nutrients to survive. To achieve this, we developed a 3-dimensional scaffold which features the epigastric artery as macroscopic core vessel inside the BAT in a rat model (perfused group, <svg style="vertical-align:-0.10033pt;width:35.099998px;" id="M1" height="10.8125" version="1.1" viewBox="0 0 35.099998 10.8125" width="35.099998" xmlns="http://www.w3.org/2000/svg">
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			</svg>) without the epigastric vessels and, therefore, without perfusion. The <i>in vivo</i> monitoring of the transplanted myoblasts was assessed by bioluminescence imaging and showed both the viability of the epigastric artery within the 3-dimensional construct and again that cell survival <i>in vivo</i> is highly depending on the blood supply with the beginning of capillarization within the BAT seven days after transplantation in the perfused group. However, further studies focussing on the matrix improvement will be necessary to create a transplantable BAT with the epigastric artery as anastomosable vessel.

Sebastian E. Dunda

T. Schriever

C. Rosen

C. Opländer

R. H. Tolba

S. Diamantouros

S. Jockenhoevel

N. Pallua

A New Approach of <i>In Vivo</i> Musculoskeletal Tissue Engineering Using the Epigastric Artery as Central Core Vessel of a 3-Dimensional Construct

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.

Ruka Shimizu

Kazuo Kishi

Skin Graft

Eyelid bags and blepharochalasis are the result of relaxation of lid structures like the skin, the orbicularis oculi, and mainly the orbital septum. Therefore, this aged appearance cannot be improved sufficiently with only a skin and orbicularis oculi resection. To improve this appearance, we use a very effective method of tucking of the orbital septum with infraeyebrow excision of the skin and the orbicularis oculi. Between January 2005 and April 2011, 103 patients (206 lids) were treated. There were 89 female and 14 male patients whose ages ranged from 43 to 75 years (mean = 65.2 years). After infraeyebrow excision, blepharoplasty with tucking of the orbital septum, the concealed lid crease becomes apparent and a good rejuvenation effect is obtained in all patients.

Akira Sugamata

Infraeyebrow Blepharoplasty for Blepharochalasis of the Upper Eyelid: Its Indication and Priority

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