PMC3745119_01
Case 18, flap used to treat wound gape with underlying leg ischaemia. Sixty-nine year lady with CABG presenting with (a) breakdown of leg wound following harvesting a vein graft. (b) Defect after debridement. (c) Closure with type II A flap
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F10
Type 2A KDIPFlap from the adjacent calf. The wound went on to heal smoothly [Figure 10].
Primary closure of ALT flap donor area using type IIA Keystone flap. Intraoperative views of a 55 year male presenting with avulsion injury R heel. (a) Free ALT flap harvested and awaiting inset. (b) Flap donor area closed primarily to the maximum, residual defect of 7 x 10 cm. (c) 8 x 18 cm flap incised on medial side. (d) Flap transferred as a Type II A flap after V-Y advancement. (e) Complete closure of flap and donor area. (f) Sound healing at 12 weeks post-op. (g) Contrast scenario - high tension with edge necrosis after direct closure of ALT donor area
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F11
This was closed using a Type II A KDPIF to achieve a smooth, pain-free wound healing and early mobilization [Figure 11].
Case 37 bilateral elbow PBC corrected in single stage. Intraoperative views of a 32 year lady with bilateral elbow postburn contracture. Upper row (a-e); L side, Lower row (f-j), R side. (a) & (f) Initial deformity, (b) & (g) After defect creation and flap incisions, (c) & (h) After flap transfer into defect, (d) & (i) and (e) & (j) Postoperative views - in full flexion and extension
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F12
Case 37 [Figure 12] that involved a post burn elbow flexion contracture on both the limbs in a 32-year lady. Conventional skin grafts with or without a local flap would involve significant scarring, post op immobilization, physiotherapy, graft pressure therapy, etc.,
PMC3745119_02
Diagram of modified type A-D and type E flap
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F2
It is in this scenario that our Type E modification of the KDPIF offers a higher margin of safety, by limiting the V-Y maneuver to the upper end of the flap [Figure 2], either as a single (Case 3) or double [Figure 14, Case 28] flap.
Case 12, volar digital defect and flap. Fifty-eight year old lady with benign palmar skin nodule. (a) On presentation. (b) 5 x 6 mm defect after excision. (c) 14 x 7 mm type I flap incised. (d) Transferred and inset. (e) and (f) Full ROM maintained in postoperative period
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F13
For example, the smallest flap in our series involved a 4 x 6 mm defect on the volar proximal phalanx of the dominant hand middle finger of a 65-year-old lady, due to excision of an enlarging skin nodule [Figure 13].
Case 28, unstable scar on the Tendo Achilles (a) Initial lesion (b, c & d); Defect created, lateral & medial flaps incised; (e & f) -flaps mobilised to move into defect and sutured in final place; (g & h) final outcome 8 months later with full ankle range of motion
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F14
It is in this scenario that our Type E modification of the KDPIF offers a higher margin of safety, by limiting the V-Y maneuver to the upper end of the flap [Figure 2], either as a single (Case 3) or double [Figure 14, Case 28] flap.