In this setting, the cycle of repair followed by breakdown results in increasing scar formation with associated soft tissue contracture and a resultant increase in fistula size. This pernicious cycle of events renders random local tissue transfers obsolete. As such, the cleft surgeon must look to tongue flaps or local axial pattern flaps as a means of bringing well-vascularized, pliable tissue into the defect. In this report we present our clinical experience with recurrent palatal fistulas and highlight the effective use of the dorsalis pedis-first dorsal metatarsal artery free flap as a means of repair. In breast reconstruction with a free flap, the selection of suitable recipient vessels remains one of the most critical decisions for the surgeon.
Most surgeons use one of the branches of the axillary vascular system, the thoracodorsal vessels.
Because of a number of difficulties using this recipient site, the authors investigated the anatomy and availability of the internal mammary vessels for free flap breast reconstruction. This article describes the anatomic considerations, surgical technique, clinical experience, advantages, and limitations of using these vessels. In recent years, free autogenous tissue transfer for breast reconstruction has become increasingly common. A new method to cover a deep defect of the medial ankle with exposed bone, tendon, or metal implant is presented. In two cases a combined medialis pedis and abductor hallucis muscle flap, each based on separate vessels but linked by the musculocutaneous perforators, was used successfully as an island transposition flap.