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Twenty children are presented after undergoing a distally based superficial sural flap for coverage of defects at the lower leg and foot. The age of the patients was between 1 and 12 years. Fifteen patients had trauma to the lower leg, with eight of them having associated injuries. Three had postburn contracture and two had pressure sore. In 14 cases, the flap was used as a fasciocutaneous flap, whereas in six cases it was used as a fascial flap covered with a skin graft. The flaps were used to cover the defects from the dorsum of the foot distally up to the mid third of tibia proximally. The mean follow-up was for a period of 2 years. Even though free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children, the distally based superficial sural flap has the advantage of being easy to perform, with short operating time, minimal donor side morbidity, and preservation of major arteries of the leg.

The need for a thin flap has increased for contour or coverage of the shallow defects caused by trauma, tumor ablative surgery, or defects created after the release of contractures. The authors describe their experience with the use of an extremely thin anterolateral thigh free flap for covering such defects in a series of 12 patients. Extreme thinning of the flap (4-5 mm) was achieved by removal of deep fascia and subcutaneous fat except for a 3- to 4-cm area around the entry of the perforator into the flap. Subdermal fat and immediate underlying superficial veins should be preserved during the thinning procedure for venous drainage of the flap. Their clinical experiences with 12 patients indicate that an extremely thin, long flap can survive on a single perforator.

We report a case of a 7-year-old girl in whom a vascularized fibular head with preserved epiphyseal and metaphyseal blood supply was used to reconstruct the missing lateral malleolus. Two-year follow-up showed good bony stability and growth potential of the transplanted epiphyseal plate.

We describe our experience with the use of an island gluteus maximus musculocutaneous flap (from its most inferior part) based on perforators from the inferior gluteal artery. The study is based on a series of 27 patients in whom treatment was carried out for 31 ischial pressure sores. Eight patients had postoperative complications in the form of dehiscence of the donor flap site and/or infection. Follow-up ranged from 6 to 32 months. During this period three patients developed recurrent sores which were treated with other flaps. We feel strongly that the use of this flap should be considered as a first choice in the treatment of the mild to moderate size ischial pressure sore. Its advantages include ease in elevation of the flap and the provision of a vascularized bulky flap which also spares the vascular pedicles of adjacent flaps for future use.

Vascularised fibula has been used to treat three patients with skin-bone defects of the foot following severe trauma. Similarity between fibula and metatarsal bone is obvious and makes fibula an ideal choice in the replacement of defects in the first metatarsal. Depending on the size of soft tissue defects, different combinations of fibula-skin transfer were used.

Management of multiple bed sores which are deep and of large area presents a special challenge to the surgeon, especially when all the sores are within the same anatomical region. We are presenting our experience of one-stage repair of bed sores. Representative cases are discussed including a patient who needed four flaps to close the ulcers. There were no major complications in any of the patients. We advocate one-stage repair in selected patients.

There are many procedures for vulvar reconstruction after excision for cancer. The aim of which is to provide cosmetic and functional results with minimal secondary deformity. A patient presented with gross fibrous contracture and vaginal ectropion after radical vulvectomy and groin dissection for cancer. We used the pendulous lower abdominal tissue to reconstruct the vulva and mons pubis. There was no secondary deformity.

This study evaluates the effect of the new combined thromboxane synthesis inhibitor and receptor blocker, ridogrel, on the circulation of arterial skin flaps in sheep. Sixteen flaps, 8 controls and 8 treated with 5 mg/kg ridogrel, were investigated using 111Indium chloride labelled plasma and 99mTc labelled red blood cells (RBCs). Dynamic imaging was performed after a bolus injection using a GE 400 AT gamma camera. For each flap quantitative analysis of plasma and RBC flow was based on time activity curves obtained from 12 regions of interest. Analysis of flow data was made immediately after flap elevation and three hours later. Both plasma and RBC flows declined after 3 hours. Treatment with ridogrel significantly prevented deterioration of perfusion by increasing plasma and RBC flow mostly in the distal, ischaemic regions of the flap where stasis was evident in the control flaps.