The diabetic foot is frequently susceptible to extensive infections and for its management a lot of tissue should be sacrificed. Vessel obliteration of the main arterial trunks associated with diabetic microangiopathy in most cases lead to major segmental amputations.Classics techniques of tissue revascularization using by-pass techniques are usually not effective in these pathologic conditions. Therefore, for well-selected cases (based on clinical examination, Doppler, angiography), the FREE tissue transfer may represent an alternative to amputation.The authors report the case of a diabetic patient who sustained a FREE transfer for plantar coverage, including the long-term postoperative improvement during 44 months. The final result stimulates us to consider the FREE tissue transfer as a viable solution for defect coverage in the diabetic foot.

Purpose: To report visual and anatomical outcome of FLAP loss after LASIK surgery for correction of high myopia. Materials & Methods: Retrospective evaluation of FLAP loss in two eyes of two patients, a rare complication of LASIK Surgery. Case No. 1: 27 y/o woman with Ref. OD -9.75; 2.75*177 VA. CC: 20/60 KR OD: 41.86*77 39.86 * 168 & partial amblyopia due to anisometropia. Case No. 2: 38 y/o woman with Ref OD. -9.50 1.0*177 VA CC: 20/30 KR OD: 42.06*77 40.99 * 167. Results: In both patients during LASIK surgery FREE cap complication occurred and after Laser therapy FREE cap positioned over the stromal bed, but the next day after operation FLAPs were lost. For case NO.1only medical management performed and after 4.5 years F/U cornea has 2° central haziness. For case NO.2 another corneal FLAP from donor globe cut and sutured with Nylon 10/0 and after 18 months F/U cornea is clear. Conclusion: In patients with flat keratometry less than 41.0 Diopter rate of FREE cap are high and after laser therapy for high myopia the keratometry became more flat. If surgeon doesn't suture FLAP the rate of FLAP loss increase so for prevent of corneal haziness and corneal ectazia this evaluation suppose to perform donor corneal FLAP graft.      

BACKGROUND Diabetes is a leading cause of foot ulcers and lower limb amputation throughout the world. Adequate wound debridement and cover is the standard of care, but lack of adequate vascularised local tissue poses a major challenge. The gracilis FLAP offers various advantages in this respect, which we would like to discuss in this study, and hence makes it an attractive option in diabetic foot patients. MATERIAL AND METHODS This retrospective study was conducted over a period of 2 years, from 2018 to 2020 in the Department of Plastic Surgery, Kauvery Hospital, Trichy, India. The FLAP harvest time, total operation time, FLAP take and complications associated with the procedure were noted. RESULTS Overall, 56 patients were enrolled. The average FLAP harvest time was 55 +/-10 min and the average overall operation time was 240+/-30 minutes. There was complete FLAP survival in 42 (75%) patients, a partial survival in 12 (21. 42%) patients and complete FLAP loss in 2 (3. 57%) patients. In the donor site complications hypertrophic scarring was reported in 5 (8. 92%) and donor site seroma in 3(5. 3%) patients. CONCLUSION The FREE gracilis FLAP offers good wound healing and excellent foot contour besides being safe and effective in small to medium sized defects makes it an excellent FREE FLAP in diabetic foot reconstruction.

Background: The aim of the study was to compare the root coverage percentage and other clinical outcomes in Millers Class I and Class II gingival recessions (GR) treated with modified coronally advanced FLAP (MCAF) combined with connective tissue graft (CTG) using macro and MICROSURGICAL approaches. Materials and Methods: In this controlled clinical trial, a total of 32 Miller’, s Class I and Class II GR defects were randomly assigned to the control and test groups (16 in each group). All the patients were treated with MCAF with CTG as the root coverage procedure. For the control and test groups, the procedure was performed using a macro and MICROSURGICAL approach, respectively. Clinical parameters were assessed at baseline and in 6th month. Wilcoxon signed–, rank test was used to compare the values between baseline and 6 months. Statistical significance was set at P < 0. 05. 1 week after surgery, wound healing index (WHI) and Visual Analog Scale (VAS) scores were recorded. Results: Intragroup comparisons revealed significant improvement in all the parameters in both the groups at 6 months. The proportion of root coverage achieved in the control and test groups was 78% and 86%, respectively. At 6 months, the root coverage percentage between the study groups showed no significant difference (P = 0. 207). Intergroup analysis of WHI and VAS scores showed better healing and less postoperative pain in the MICROSURGICAL group compared to macrosurgical group (P < 0. 05). Conclusion: At 6 months, there were no significant differences in root coverage percentage or other clinical parameters between the groups based on whether a macro or MICROSURGICAL method was used. However, better wound healing, less pain, and discomfort were observed in the MICROSURGICAL group.

Background: We aimed to assess the effect of hirudotherapy on FLAP congestion and thrombosis in adult female patients who underwent microvascular breast reconstruction.  Methods:  A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed. Results: Twelve studies were included, pooling 34 female patients with ages ranging from 28 to 64 years old, having received medical leech therapy to breast FLAP following MICROSURGICAL breast reconstruction for a duration ranging from 1 to 10 days. The most common FLAP in our patient population was the Transverse Abdominis (TRAM) FLAP, followed by the Deep Inferior Epigastric (DIEP) FLAP and lastly, the Latissimus Dorsi FLAP. Nine patients experienced FLAP loss (26.5%), 9 experienced infections (26.5%), 19 had some degree of FLAP necrosis (55.9%), and 8 patients had to return to the operating room for revision surgeries (23.5%). Of the 9 reported cases of infection, 6 grew cultures specific to leech pathogens, confirming hirudotherapy as the cause (17.6%).   Conclusion:  Presently, this systematic review provides an overview of the role that hirudotherapy has played in the management of congestion in breast microvascular reconstruction in the literature. Clinicians should be aware of the complications associated with this choice of therapy for their patients, especially infection. Despite their established use in FLAP congestion, the limited evidence available for hirudotherapy to treat FLAP complications in autologous breast reconstruction calls for more studies to be conducted on the matter.

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.

The distally based sural fasciocutaneous FLAP has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several FLAP modifications have been reported to improve FLAP viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural FLAP from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural FLAP from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the FLAPs were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural FLAPs from the proximal and middle third of the leg were designed in 13 patients who had large defects on their foot. No FLAP necrosis or split thickness skin graft loss occurred. The FLAPs healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and FLAP necrosis. Proximal extended and large distally based sural FLAP is an alternative to FREE tissue transfer for large defect reconstruction of the foot.