Objective: To investigate the feasibility and treatment outcomes of primary repair for amputated lower legs and GustiloIIIB-C injuries with the superficial area of vastus lateralis muscle. Methods: A total of 49 cases who underwent emergency primary repair for their seriously injured lower legs through chimeric flaps in the superficial area of the vastus lateralis muscle. Circumferential avulsion or defect was found in all cases, and the defect size ranged from 10cm×6cm to 60cm×40cm. The chimeric flap of the superficial area of the vastus lateralis muscle was used in 31 cases, chimeric flap and fascia in 17 cases, and chimeric flap in 1 case. The change in flap color and texture, the function of the affected limb, and the knee extension of the donor limb were recorded at six months after surgery and every three months thereafter. Results: The transplanted muscles all survived. The average follow-up period was 42.5 (3-86) months.According to the LEFS score (out of 80), 23 cases had a score of 70 or more, 21 cases had a score of 61-70, and 3 cases had a score of 51-60. The limb salvage rate was up to 91.8%, and the infection rate was 8.1%. Conclusion: The precise excision of the vastus lateralis muscle and combination with the skin flap or fascial flap is an effective method for emergency primary repair of severely injured lower legs, with the advantages of flexibility to handle tissues, easy repair of irregular tissue defects, minimal damage to the donor area, and no complications.

Background: The free scapular artery perforator (FSAP) flap is widely used for soft tissue defects after burns and trauma. The purpose of this report is to evaluate FSAP flap to reconstruct traumatic limb soft tissue defects for immediate and secondary reconstruction.
Patients and methods: A total of 14 cases of limb soft tissue defects undergoing reconstruction of FSAP flap transfer were evaluated from August 2022 to January 2023 in our institute. The locations of defects included the palm and wrist (4 cases), foot (6 cases), crus and ankle (4 cases). The sizes of defect varied from 10 × 6 cm to 21 × 10 cm (122.8 cm2 in average). Flaps were harvested based on the scapular perforator vessels, initially marked using hand-held Doppler.
Results: Average size of harvested flap was 16.8 × 9.6 cm (ranging from 14 × 7 cm to 21 × 13 cm). All perforators were harvested from the scapular artery and the arterial diameter ranged from 0.8 to 1.8 mm. The average pedicle length was 3.56 cm (range, 2.85-4.83 cm). Two vascular thrombosis were found including one cases of arterial thrombosis and one cases of venous thrombosis which were successfully salvaged by re-operation and vein graft. All flaps survived and satisfying functional outcome and acceptable appearance were achieved.
Conclusions: The FSAP flap is a reliable flap, which can be used for repairing limb soft tissue defects. The FSAP flap can be used for covering defects with various appearances, locations, and sizes with immediate or secondary reconstruction.

Traumatic amputation of multiple digits of hand is devastating injury to patient with functional limitations and aesthetic affection.
Fingerless hand or post traumatic metacarpal hand classified by Wei et al .
The goals of reconstruction of metacarpal hand are to provide at least 2 or more opposable .stabl finge.This paper describ a reconstruction of post-traumatic right dominant metacarpal hand .20 year old male sustained amputaion of all digits at the level of distal metacarpal Wei type ||.
Groin flap was done befor and pinning of metacarpal to maintain thumb metacarpal position .first stage operation we do second toe transfer from left foot to thumb and second stage after 10 months we do transfer the second and third toe as monobloc from the right foot to index and long finger,no post operative reexploration of microvasculation . assessment of outcomes by Tamai score_ pinch strengths pulp to pulp.and sensation by British Medical Research and two point discrimination.patients underwent assessment by Tamai scores (60)Good.
Sensation in the transferred toes,skin touch ,pain and temperature sensation was S2,2PD of 10 mm.the patient able to do key pinch,all toes achieved complet bony union .fellowup of the patient is 20 months.Patient heigthly satisfied with prehensile function and normal gait.
Microsurgical toe transfer are the standard option for post Traumatic metacarpal hand reconstruction. Combined second and third toe monobloc transfer is better choice to reconstruct two adjacent digits ,Wei et al.this case demonstrate restoring useful function to metacarpal hand with high level of satisification .

Background: Spontaneous recovery of elbow flexion in obstetric brachial plexus palsy (OBPP) at 4-6 months old is sufficient to exclude the child from the early microsurgical intervention. However, lack of complete active external rotation of shoulder is a common finding in such cases despite ongoing other arm and shoulder functions. Nerve transfer is proposed to manage such cases before the age of 18 months. Aim: The aim of this study was to study the distal transfer of the spinal accessory nerve to the suprascapular nerve through posterior approach and its effect on the shoulder reanimation in patients with OBPP who had spontaneously recovered biceps function but not shoulder function before the age of 18 months. Patients and methods: this prospective study included twenty patients with OBPP aged between 10 to 18 months old with spontaneous recovery of biceps function, weak active shoulder abduction grade 4 or 5 and deficient active shoulder external rotation. All patients were assessed pre and post-operative by AMS. Results: active shoulder external rotation improved in all patients at the end of follow up period, while the shoulder abduction improved in 80%. Early surgery in patient < 16 months old shows better results. Conclusion: The distal transfer of spinal accessory nerve to suprascapular nerve is an effective method for active shoulder abduction and external rotation recovery in spontaneously recovered elbow flexion in OBPP. Better results are obtained in patients less than 16 months old. early transfer balance the forces around shoulder joint preventing shoulder internal rotation contracture.

Introduction: soft tissue defects around the ankle joint are challenging to reconstructive surgeons. paucity of local soft tissue and blood supply make reconstruction of these defects difficult and usually require free flaps which are complex procedures requiring experience in microsurgery. perforator flap concept has been introduced based on the angiosome concept. they have revolutionized soft tissue reconstruction in difficult areas. perforator propellar flaps are based on identification of a nearby suitable perforator and are harvested as a fasciocutaneous flaps which are rotated 180 degrees around the perforator to cover soft tissue defects around the ankle joint. Materials and methods: 12 patients with soft tissue defects around the ankle have been reconstructed using pedicled perforator propellar flaps. planning was done preoperatively using duplex ultrasonography to assess the perforator vessel as regard size and flow pattern.

Introduction: post traumatic tibial bone defects are a major therapeutic challenge particularly when associated with extensive soft tissue loss and vascular insufficiency. The option of free tissue transfer is often limited by lack of recipient vessels suitable for vascular anastomosis. This makes salvage of the limb unsuccessful and eventually ends in amputation. Methods: Retrospective analysis of data of 22 patients with post-traumatic complex long tibial bone defects (average=14.4cm) associated with soft tissue defects (average=17.5×12.5cm). All limbs had vascular insufficiency as proofed by pre- operative CT arteriography. In all cases, free vascularized osteoseptocutaneus flap was used to overcome the bone and soft tissue defects. The transferred flap was nourished by anastomosis to the contralateral posterior tibial vessels. A tubed free radial forearm flap was used as a connecting bridge between the two legs and served as a vascular conduit between the posterior tibial vessels and the peroneal vessels of the flap. The connection was separated six weeks after the surgery by removing the radial forearm flap. Results: All flaps eventually survived. Time to bone union average 4.5 months. Average time to full weight bearing was 9 months. Graft hypertrophy occurred in all cases. Eight patients developed stress fractures and were treated by plates or casts. Four patients suffered from LLD >4cm and were treated by bone-lengthening techniques. Conclusion: cross leg vascularized osteoseptocutanous flap is a reliable technique for reconstruction of complex composite defects of the leg following severe trauma.

Cubital tunnel syndrome secondary to various intraneural lesions is a rare occurrence. Intraneural ulnar tuberculomas were previously reported but, to our knowledge, the presence of an ulnar nerve tuberculoma within the cubital tunnel was not reported before. We report an ulnar nerve tuberculoma discovered during an ulnar nerve release surgery for a 64-year-old male patient who presented with a picture of cubital tunnel syndrome. Tangential excision followed by antituberculous medication was followed by partial improvement of the condition.