Background Free fascial flaps from the anterolateral thigh (ALT) were used to reconstruct soft tissue defects after trauma to the ankle. This modification was compared to the conventional fasciocutaneous method. Material and methods The defect size, the thickness of the subcutaneous fat layer on the thigh and the extent of the soft tissue covering the ankle were determined retrospectively. The evaluations were compared between fascial (Fo) and fasciocutaneous flaps (Fc). The foot and ankle outcome score (FAOS) was used. Esthetic outcome surveys were carried out. Results A total of 18 isolated fractures of the ankle were evaluated. In 94% of the cases a closed soft tissue damage predominated. After fracture fixation using a plate, soft tissue defects with a mean area of 40.4 +/- 13.1 cm(2) (28-76 cm(2)) developed. The thickness of the soft tissue covering over the affected malleoli increased significantly in both groups as a result of the flap surgery (4.5 +/- 0.7 vs. 21.1 +/- 6.4 mm, p < 0.05). A significant difference was found when comparing the body mass index (BMI) between the groups (Fc 26.3 +/- 3.4 kg/m(2) vs. Fo 30.1 +/- 4.2 kg/m(2), p < 0.05). For both groups there was a positive correlation (r = 0.843) between the BMI and the thickness of the epifascial fat layer of the thigh. The FOAS survey revealed 75.9 +/- 28.9 and 47.9 +/- 32.4 points, respectively, for "function in daily life" and "foot and ankle-related quality of life". The esthetic reconstruction result was rated as "acceptable" by 55% and as "good" by 45%. Discussion The modified method of a free fascial flap from the ALT can be useful in situations where a bulky flap makes it difficult to fit it into the defect.

Verletzungen von Lymphgefäßen können nach Trauma oder infolge einer Operation entstehen und für die Patienten eine nicht unwesentliche Problematik darstellen. Sie können zur Ausbildung von schwerwiegenden Wundheilungsstörungen mit komplexer Therapiebedürftigkeit führen. Wir berichten über eine Lymphkollektorläsion nach Entfernung eines Hauttumors in der Axillarregion und die mikrochirurgische Versorgung mittels lymphovenöser Anastomosierung

Bei der klinischen Untersuchung zeigt sich eine 2cm große Narbe prätibial am Übergang vom mittleren zum distalen Drittel des Unterschenkels mit klarer Sekretion aus einer Fistel (. Abb. 1a). Lokale oder fortgeleitete Zeichen einerWundinfektion fehlten. Die periphere Durchblutung, Motorik und Sensibilität distal der Verletzung waren intakt. Es bestanden keine Nebenerkrankungen. Der bakteriologische Befund des Wundabstriches blieb ohne Keimnachweis.

Zur Rekonstruktion von Weichteildefekten nach sprunggelenknahen Frakturen wurden freie Faszienlappen aus dem anterolateralen Oberschenkel (ALT) verwendet. Diese Modifikation wurde mit der herkömmlichen fasziokutanen Methode verglichen. Defektgröße, Dicke der subkutanen Fettschicht des Oberschenkels und des Weichteilmantels am Sprunggelenk wurden retrospektiv bestimmt. Die Auswertungen wurden zwischen faszialen (Fo) und fasziokutanen Lappen (Fc) verglichen. Der Foot and Ankle Outcome Score (FAOS) wurde verwendet. Umfragen zum ästhetischen Ergebnis wurden durchgeführt. Bei insgesamt 18 Frakturen lag in 94

The incidence of infections caused by the anaerobic bacterium Eggerthia catenaformis and its role as a human pathogen are mostly unknown. We present a case of extensive necrotizing fasciitis of the abdominal wall and groin area with reporting of clinical, surgical and intensive-care treatments. Lukas Wellkamp1, Boris Pfannkuchen2, Dustin Schilawa3, Pascal Kirchhoff1, Mutaz Al Shakhanbeh1, Sebastian Bushart1, Niklas Dellmann1, Martin Bauer2 and Andrej Ring4* 1Department of Plastic Surgery, St. Rochus-Hospital, Germany 2Department of Anesthesiology and Intensive Care Medicine, St. Rochus-Hospital, Germany 3Department of General Surgery, St. Rochus-Hospital, Germany

INTRODUCTION: A reliable transfer of vascularized lymph nodes helps sufficiently with regression of chronic lymohedema. A feared postoperative complication is the development of donor-site lymphedema and should be avoided at all costs. We introduce a laparoscopic-assisted surgical technic for vascularized lymphnode transfer from the terminal ileum for reconstruction of lymphatic extremity drainage. METHODS: The edema severity was preoperatively examined by indocyanin-green fluorescence lymphangiography and found to be at a “splash” and “stardust” stage. A sustainable donor region was identified via transillumination after laparoscopic mobilization of the mesentery. Microsurgical dissection of the lymphnode flap was done while preserving the peripheral intestinal arcades. In all cases a lymphovenous anastomosis was performed additionally to the lymph node transfer. RESULTS: A significant volume and circumferential reduction of the affected extremity, as well as subjective pressure relief could be observed and measured 7 days postoperatively and sustained in both cases during a follow-up for 3 months without the need for compression therapy. Donor-site complications did not occur. CONCLUSIONS: The laparoscopic-assisted vascularized lymph node transfer from the ileomesentery in combination with supermicrosurgical lymphovenous anastomosis is a safe and effective method for reconstruction of lymphatic extremity drainage as treatment for secondary lymphedema with the benefit of reduced risk for donor-site lymphedema.

INTRODUCTION: After oncological or general surgery interventions, therapy resistant lymphorrhea of incisions in inguinal area are troublesome and can have persistent complications. Traditional therapy options are usually destructive and not always successful therapies. They bear the risk of chronic lymphoedema of the affected limb. We present a supermicrosurgical reconstructive method. METHODS: Female patient 70 y received ultrasound guided inguinal lymphadenectomy of a lymph node suspicious of being a metastasis of a previously treated uterine carcinoma. Consequently, for three months persistent secretions occurred from a right inguinal skin-fistula requiring daily dressing changes. Following a negative histological result repetitive wound revisions were performed, with long lasting drainage after every attempt. Subsequently, frustrating radiation therapy was attempted to obliterate the fistula. RESULTS: Preoperative visualisation of the affected limb’s lymphatic system through ICG –FLAG was performed. We excised the lymphocele capsule and transposed a pedicled lymph node-adipofascial SIEA perforator flap and anastomosed two productive lymph vesselstumps to a bifurcated receiving vein of the flap.We were able to prove the patency of the anastomosis and the perfusion of the flap. We removed the ‘silent’ drains on the second day post operation. A significant circumference reduction without relapse could be observed in the postoperative course. CONCLUSION: Supermicrosurgical lymphovenous anastomosis is a valuable complement for the therapy of persistent lymphorrhea. The reconstructive method differs from the more traditional options with regards to the lymph-drainage function of the affected limb physiology.

Soft tissue sarcomas (STS) arising in the distal lower extremities pose a therapeutic challenge due to concerns of functional morbidity. The impact of surgical margins on local recurrence‑free survival (LRFS) and overall survival (OS) still remains controversial. The aim of this study was to identify prognostic indicators of survival and functional outcome in patients with STS of the distal lower extremities through a long‑term follow‑up. Between 1999 and 2014, 120 patients with STS of the foot, ankle and lower leg were treated surgically at our institution. The median follow‑up was 6.3 years. The results reveal that the 5‑year estimate of the OS rate was 80.0% [95% confidence interval (CI): 69.6‑87.1] for the entire series. Surgical margins attained at the resection of the primary tumor did not influence OS significantly [5‑year OS: R0 80.5% (69.7‑87.9) vs. R1 74.1% (28.9‑93.0); P=0.318]. Within the R0 subgroup, negative surgical margin widths ≤1 and >1 mm led to similar outcomes, as well as ≤5 and >5 mm, respectively. In the multivariate analysis, significant adverse prognostic features included male gender and age >60 years at the time point of primary diagnosis. In conclusion, the data from this study could not underscore the long‑term benefit of negative margins achieved at the resection of the primary tumor. Surgical efforts should aim at function‑sparing resections when feasible with negative margins. Here, close negative margins seem to be adequate.

INTRODUCTION:Solid malignancies at the foot and ankle region are rare and include mainly soft-tissue sarcomas, bone sarcomas, and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft-tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region.MATERIALS AND METHODS:This article is based on the review of the current literature and the evaluation of the author's own patient database.RESULTS:The local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft-tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh flap, parascapular flap, or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region.CONCLUSION:Soft-tissue reconstruction in the foot and ankle region is a vital component of limb-sparing surgery. It enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. Modern plastic surgical techniques should, therefore, be integrated in the multimodal treatment concept of malignancies in the foot and ankle region.