BACKGROUND The Anterolateral thigh (ALT) flap is one of the fasciocutaneous flaps in the thigh region based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral artery (LCFA). This cadaveric study aimed to explore the variability of ALT flap anatomy. METHODS Ten ALT flaps were dissected (2016-20117, Mashhad Legal Medicine Organization) in 10 fresh cadavers (7 males and 3 females). flaps were marked in a 15 cm area centered on the middle point of a line drown from anterior superior iliac spine to the lateral surface of the patella. Dissection began by searching the skin perforators and then continued along the pathway of the vascular pedicle. RESULTS The average distance of ASIS-Patella was 44. 6 cm. The mean number of skin perforators was 2. 4 (ranged from 0 to 4). In one case, we did not find any skin perforator. The majority of skin perforators were musculocutaneous from descending branch of LCFA (66. 7%) and the remaining were septocutaneous (33. 3%). The mean length of vascular pedicle was 10. 17 cm. The average diameter of vascular pedicle was 2. 78 mm for the artery and 3. 79 mm for the vein. The average time of flap harvesting was 85. 3 min (ranged from 50 to 125 min). CONCLUSION The skin perforators supplying the ALT flap showed significant variability in number, location and course. The cadaveric study could enhance the anatomic knowledge and operative skills of ALT flap harvesting.

DEAR EDITOR: The radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. These defects are managed most commonly with either pedicled ipsilateral Anterolateral thigh (ATL) flap or tensor fascia lata (TFL) flap. The reconstruction with complex flaps provide durable coverage and prevent scar contractures, which tend to form in the flexural regions such as the groin.

BACKGROUND thigh-based, groin-based and lateral-thoracic-based flaps are available for microsurgical hand resurfacing –,which is the best? METHODS BestBETS methodology was used to systematically evaluate the advantages and disadvantages. PubMed, EMBASE and Cochrane databases were searched up until Sep 2020, using the search strategy: hand re-surfacing, free-flap, groin-flap, thigh-flap, lateral thoracic-flap, advantages, and disadvantages. RESULTS Overall, 31 papers were identified which were used to synthesize the discussion and conclusions. CONCLUSION thigh-based Anterolateral thigh (ALT) flaps offer the greatest versatility.

Knee rotationplasty is a suitable reconstructive and limb salvage procedure for infected femur and knee prostheses. It involves external rotation of the lower limb with an intact neurovascular bundle to function as a knee joint. Functionally, it has better outcomes when compared to alternate options like above knee amputation. It results in better cortical reorganization and superior stance mechanics, enabling a more efficient gait and better quality of life. Here we report a 57-yr-old male who underwent modified rotationplasty for an infected knee endoprosthesis as a composite lower leg free flap.

Introduction: Septic arthritis is the rheumatological and orthopedic emergency that causes the most difficulties with joints–especially knee and hip joints. The clinical symptoms include pain, swelling, inflammation, stiffness, and a limited range of motion in both active and passive joints. Debridement of the necrotic tissue is one beneficial method for septic arthritis treatment, although soft tissue defects around joints are a challenging issue for surgeons. Our purpose was to investigate the consequences of two flap surgery methods undertaken to repair soft tissue damaged during knee joint debridement caused by septic arthritis.Case Presentation: This is a case report concerning a patient who had septic arthritis in the knee area and so underwent soft tissue surgery. The reconstruction methods were not the same for both knees as the lateral distal thigh island flap reparation method was used on the left knee and the medial head gastrocnemius flap method was utilized on the right. We then investigated the results and outcomes of the surgery three months later.Conclusions: Lower extremity movement extent was carefully evaluated and, in respect to muscle strength, the patient was able to walk independently three months after the surgery. The patient’s balance was studied and the results showed moderate levels of stability.

Introduction: One of the most important problems in plastic surgery is reconstruction of extensive knee soft tissue defect. Many conditions cause this problem such as trauma, infection, burn and tumor resection. Among different reconstruction techniques posterolateral thigh flaps are relatively new and it seems there is no published article of this technique in Iran. In this study we performed posterolateral thigh flap to cover knee defect in 15 Khordad hospital during 1380 to 1382.Materials and methods: During 2 years six patients suffered from extensive knee soft tissue damage due to flame were under investigation. First they were treated with debridement and primary care and defects were covered with gastrocnemius flaps. Then defects were covered by posterolateral thigh flap. Patient's average hospitalization was 20 days and their average follow up time was 15 months. Data was gathered before and after surgery.Results: Four cases had complete survival of flap. Two cases have a mild discoloration and necrosis which was treated by a limited debridement. All knee defects were completely covered. The donor site in one case had a hypertrophic scar which was relieved during time. Statistical tests showed a meaningful relationship in all cases (p<0.05).Conclusion: This flap was used successfully. We recommend this technique for similar conditions because of it's easy usage.

Background: Finger tip injuries are one of the most common types of injury. Destruction of the skin in this area leads to destruction of sensory receptors. As hand function is closely related to sensibility of the finger tips, selecting the best procedure of reconstruction that provides the highest degree of sensation is very important. As V-Y flap and Neurovascular Island flap are more common used, the aim of this study is comparison of these two methods for restoration of finger tip sensation.Methods: This is a clinical trial study of 70 patients with traumatic finger tip injury who were randomly divided into two groups. Finger tip injuries reconstructed by V-Y flap were placed in group A and neurovascular Island flap in group B. Sensation of the reconstructed finger tip was checked in all patients by two point discrimination test 1 year after operation.Results: Each group was included 35 patients. Incidence of necrosis, flexion contracture and discomfort of the patients was similar in the two groups. Sensibility of the fingers was 54.8% in group A, and 93.5% in group B, which is statistically significant. (P=0.0005).Conclusion: Restoration of sensibility to the finger tip is significantly more successful by neurovascular Island flap in comparison to V-Y flap method for finger tip reconstruction.

Fracture-dislocation of lumbosacral junction is rare. It usually affects the patients with multiple trauma. In all reported cases, anterior or posterior displacement of L5 on S1 have been reported, but Anterolateral displacement has not been reported yet. Herein, we report delayed diagnosis of fracture-dislocation of L5-S1 with Anterolateral displacement of L5 on S1, which was treated successfully with surgery (open reduction, posterior fusion, and instrumentation).      

Introduction & Objectives: Reconstruction of extensive soft tissue defects of ~e is one of the most important problems in plastic surgery. This problem may results from Infections, burns and tumor resection. Reconstruction techniques include: Fasciocutaneous flaps (saphenous, postero lateral thigh), muscular flaps (vastus lateralis, vastus medialis and gastronomies) and free flaps which are the last choice for reconstruction of knee defects. We used lateral and distal thigh flap to cover knee defects in 15 khordad hospital during 1380 to 1382. Material and Methods: During 2 years four patients that suffered from extensive soft tissue damage of the knee due to burns were treated. Debridement and primary care were done and defects were covered with gastronomies flaps and with remains of proximal soft tissue defect. Defects were covered by lateral and distal thigh flap. This article reports the analysis and results of this procedure. Results: During this time two patients (17 and 30 years old) were treated by this flap with a mean hospital stay time of 20 days and a mean 15 months of follow up. Conclusions: This flap was used successfully. Usage of this flap for the same conditions is suggested due to an easy technique and a shorter operation time.