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Supplemental digital content is available in the text.Ring avulsions continue to be a challenge in reconstructive surgery. We conducted a retrospective study and reviewed all Urbaniak-Kay type IV degloving injuries replanted at our institution between 2011 and 2018. A systematic review of the literature was also conducted to assess the survival rates, functional, and sensibility outcomes. The results of our systematic review outline a survival rate of 79.50% (101/127). With 1 artery being repaired, 79% of the fingers survived, a value that increased to 87.50% when 2 arteries were anastomosed (P= 0.484). Statistically significant differences (P< 0.001) were found when comparing the survival rates of the fingers with 2 or more veins repaired (87%) with those with only 1 vein anastomosed (51.90%). In terms of nerve reconstruction, there was a significant difference (P< 0.001) with the 2-point discrimination test in favor of the reconstructed group when nerve reparation was done (10.80 mm ± 2.95 mm) versus when digital nerves were not repaired (15.25 mm ± 0.50 mm). Fingers after secondary procedures did not obtain better mobility. The mean total active motion in nonreoperated fingers was 221 degrees (195–270 degrees), whereas the total active motion in the cases who received secondary surgeries was 152 degrees (110–195 degrees), with statistically significant differences (P= 0.02). Therefore, we recommend attempting replantation of degloved fingers. All efforts must be done to carry out 2 vein anastomoses, and our results strongly recommend attempting at least some kind of nerve reconstruction. Secondary surgeries should be reserved for selected cases only, because of the extensive scarring in this kind of injuries. Early mobilization protocols must be encouraged to achieve a good functional result.

Several methods can be used for identifying tissues for transfer in donor-site–depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis.

La reconstrucción mamaria microquirúrgica con tejido autólogo puede asociar complicaciones relacionadas con el colgajo y la zona donante. Nuestro objetivo fue valorar la evidencia clínica en seguridad, complicaciones y factores de riesgo en pacientes reconstruidas con colgajo de perforantes basado en la arteria epigástrica inferior profunda (DIEP). Se realizó una revisión sistemática en Medline de artículos publicados entre septiembre de 1995 y septiembre de 2015. Se recogieron las características demográficas de las pacientes, las medidas de los colgajos y las complicaciones de la cirugía incluyendo la necrosis completa, la necrosis parcial y la necrosis grasa. Se identificaron 34 artículos que incluían 35 series de casos, 2.761pacientes y un total de 3.927colgajos. La media del índice de masa corporal fue superior a 24,5kg/m2, mientras que la tasa de obesidad se situó por encima del 14,5%. Ningún artículo aportó información acerca del peso, superficie o volumen del colgajo tras su tallado en la zona receptora. Las tasas de necrosis completa y parcial fueron del 1,9% (75/3.811) y del 2,6% (68/2.575) respectivamente. La necrosis grasa se diagnosticó en el 8,2% (308/3.746) de los colgajos, con una desviación estándar de 6,9. El 5,5% (107/1.940) de los colgajos requirieron reintervención quirúrgica. La incidencia de hematoma en la zona receptora y de hernia o debilidad abdominal fue de un 3% (59/1.952 colgajos y 52/1.725 pacientes). En conclusión, la incidencia de complicaciones en reconstrucción mamaria con colgajo DIEP fue baja, aunque la necrosis grasa presentó una dispersión elevada.

Several methods can be used for identifying tissues for transfer in donor-site–depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis.

Supplemental Digital Content is available in the text.

Dermatofibrosarcoma protuberans is a tumor of intermediate malignancy and has a high rate of local recurrence. The potential to produce metastases has also been reported. This tumor can be, albeit rarely, located in the breast, and surgical treatment requires wide excision – resulting in important cosmetic sequelae.

Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented.

Replantation surgery in lower extremity amputations continues to be controversial. Overall results have been considered poor and the procedure is usually discouraged. It is the opinion of the authors that infrapopliteal replantation may be indicated.

Recalcitrant nonunions of the distal tibia without bone defect are severe problems whose treatment is difficult. Stable internal fixation and osteogenetic enhancement are required. The thin corticoperiosteal flap based on the descending genicular artery has been previously described to treat nonunions in the upper extremity without bone defect. The use of this flap to treat distal tibial nonunions is reported in the present article.

The gracilis muscle has been used extensively in reconstructive surgery, based on the proximal dominant pedicle. In the literature, little attention has been paid to the secondary distal pedicles. The distribution of the secondary pedicles of the gracilis muscle was investigated in 20 cadaver thighs. The mean number of secondary pedicles was 2.2 (range, two to three). When two pedicles were present—the most common situation—they were located at a mean distance of 12.4 and 17.5 cm from the knee joint line. The most proximal secondary pedicle was injected with barium sulfate in five specimens, and constant and abundant connections with the main pedicle were noted. A series of seven clinical cases of segmental gracilis free muscle flaps based on a secondary pedicle is reported. The flaps were successfully transferred to reconstruct traumatic defects of limited size, with one case of partial necrosis caused by a technical error. The morbidity of this flap is minimal, the scar is well hidden, the muscle need not be sacrificed, elevation is fast and straightforward under tourniquet control, and the pedicle is sizable. This flap should be considered a viable option when a small, straightforward free flap is needed.

To investigate the time course and the relation to prognosis of coagulation and fibrinolytic abnormalities in patients with septic shock.