Steam burn as a late complication of nonsensate DIEP flap after breast reconstruction

The breast is an erogenous, sexual sensory region. Autologous breastreconstruction operations have increased, but studies continue toexamine tissue innervation (Magarakis et al., 2013). As some sensesare regained with the regeneration of nerves from the adjacent residual postmastectomy skin, this avoids an additional operationrequired for nerve coaptation (Spiegel, Menn, Eldor, Kaufman, &Dellon, 2013).This letter presents a late burn injury of a patient with an autologous breast reconstruction with a Deep Inferior Epigastric ArteryPerforator flap.A 40-year-old woman with nonspecific invasive breast cancerunderwent a mastectomy and immediate reconstruction with a DIEPflap. Postoperative follow-up was performed routinely. The patientwas admitted 1.5 years later when her reconstructed right breast wasburned by steam. While the patient was using a pressure cooker, shewas exposed to the steam for less than a minute. The steam penetrated through the skin directly. After a few hours when she took offher clothes, she realized that she had burns. The working principle ofa pressure cooker is that the temperature of the steam must beabove 100C. On physical examination, there was 8 × 6 cm necroticeschar and third degree burn (Figure 1). The patient stated that shedid not feel any pain when she was burned. Burn escharectomy wasperformed and the defect was left to heal secondarily. Wound healing was complete by 4 weeks and patient was followed up for2 months.

Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer

Background: Reconstruction of small joints of fingers is still challenging in handsurgery. Implant arthroplasty and arthrodesis have some limitations in the reconstruction of small finger joints. Free vascularized PIP joint transfer from second toeto finger is a promising autogenous reconstructive alternative.Methods: In this prospective study, 7 cases of free vascularized PIP joint transferwere analyzed. The measurements for active and passive range of motion (ROM),grip, and pinch strength has been done preoperatively and 1-year postoperatively.The functional change in daily life quality and work-related activities was evaluatedwith Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.Results: Mean follow-up period was 20.3 months (12–25). Preoperative mean active and passive ROM values were 3.6º (0–14º) and 11.9º (0–29º), respectively.Postoperative 1-year measurements revealed a mean active ROM of 24.1º and amean passive ROM of 31.6º. Mean grip and pinch strength increased from 52.1 to58.6 lbs and from 5.1 to 5.9 lbs, respectively. Mean preoperative and postoperativeDASH-scores were 41.3 and 30.3.Conclusion: The improvement in ROM, increasing grip strength, and declining DASHscores in our study support that free vascularized joint transfer improves patients’ dailylife quality and work-related activities via providing a functional joint if performed withappropriate indications, careful planning, and meticulous surgical execution. Free vascularized joint transfer provides an autogenous, painless, mobile, and stable joint. Italso has the advantages of composite tissue reconstruction and lacks the disadvantagesof arthrodesis and synthetic joint implants. (Plast Reconstr Surg Glob Open 2018;6:e1775;doi: 10.1097/GOX.0000000000001775; Published online 9 July 2018.)

The planning of propeller perforator flap on previously transferred musculocutaneous flap via multidetector computed tomography for the reconstruction of tissue defect overlying Achilles tendon

The mapping of peripheral vascular system and imaging perforatorsare essential before perforator flap surgery. Magnetic resonance imaging (MRI), Doppler ultrasonography (US), and computed tomography(CT) are widely used techniques to determine the location of recipientvessels and perforators in donor site (Demirtas, Cifci, Kelahmetoglu,Demir, & Danacı, 2009). CT imaging is found to be an effectivemethod for perforator selection at donor site prior to autologousbreast reconstruction (Hamdi, Van Landuyt, Van Hedent, & Duyck,2007). Backup perforator flap was described as the use of a perforatorflap derived from a previously transferred free musculocutaneous flap(Topalan, Guven, & Demirtas, 2010). This letter presents the reconstruction of a tissue defect on Achilles tendon using a backup propeller perforator flap, three-dimensional (3-D) CT imaging was used todetermine the perforators of previously transferred free latissimusdorsi musculo-cutaneous flap (LDMC).

Double-Layer Reconstruction of the Achilles’ Tendon Using a Modified Lindholm’s Technique and Vascularized Fascia Lata

Loss of the Achilles’ tendon with overlying soft tissue and skin defects remains acomplex reconstructive challenge. Herein we present our experience using a freecomposite anterolateral thigh (ALT) flap with vascularized fascia lata and a modifiedLindholm’s technique to repair the Achilles’ tendon. A 37-year-old man suffered fromtertiary Achilles’ tendon rupture. For reconstruction, the free composite ALT flap withvascularized fascia lata was used to wrap Achilles’ tendon. A modified Lindholm’stechnique was used to cover overlying soft tissue defects. The patient was followed upfor 12 months. No wound healing problems were reported, and the patient was able towalk and return to his daily ambulating activities without any support after 5 monthspostoperatively. This technique may be useful to achieve satisfactory outcomes inpatients with ruptured Achilles’ tendons following tertiary repair.


Lower extremity reconstruction is one of the challengingareas for reconstructive surgeons. The reliability of thevascularity of a perforator flap is important in reconstructive surgery. To increase flap viability and to preventvenous insufficiency we performed an extra vein anastomosis in pedicled propeller perforator flap concept.This letter presents the reconstruction of a tissuedefect after radical excision of an acute variant type ofMarjolin’s ulcer in the lower extremity using a superdrained propeller perforator flap.A 61 year old male was referred to dermatology outpatient clinic with a leg ulcer. Six months earlier, he had acar accident and two ulcers developed on his leg: one healedwithin a few weeks, while the other persisted. Initially, theulceration was deep. With time, the ulcer changed shape; thebase of the ulcer rose toward the surface and became wartlike in appearance. Clinically, there was a 3-cm diameter,yellow, verrucous, indurated mass on the right anterior tibia.A 4-mm punch biopsy was taken from the lesion. Thepatient’s history and histopathological findings led to a diagnosis of Marjolin’s ulcer. The patient underwent surgicaltreatment at the Department of Plastic Surgery