Hughes Tarsoconjunctival Flap

This flap takes upper eyelid tarsus and conjunctiva to reconstruct lower eyelid defects.

A skin graft is also required, to cover the borrowed tarsus.

It is divided at about 4 to 8 weeks.

Sacral Decubitus Pressure Sore

This is a stage 4 decub. There is exposed bone (in this picture with a light layer a fibrinous debris)

Classification
Stage 1 - Skin intact but remains reddened after >1 hour post relief of pressure
Stage 2 - Blister or other break in dermis with or without infection
Stage 3 - Subcutaneous destruction into muscle with or without infection
Stage 4 - Involvement of bone or joint with or without infection

Ulnar nerve transposition

The ulnar nerve can be compressed in the cubital tunnel. It runs past the medial epicondyle. A nerve release procedure can be either subcutaneous or submuscular. The goal is to alleviate compression of the nerve and place the nerve in a region without tension and without mobility that can cause discomfort.

Gustillo IIIb, Soleus Flap

Classification of lower extremity injuries is best put forth by Gustillo.

This wound is covered by a combination of rotational muscle flap (Soleus m.) plus STSG (skin graft. The tibial fx was previously fixed by orthopedic surgery.

Ventral Hernia Repair

Ventral hernia repair with a biologic matrix.
(actually a xenograft). Do you know the product?

Tib Fib Fracture

RLE tib fib fracture, s/p ORIF tibia.
Large soft tissue defect.
Important questions:
-what is the vascular status of the leg?
-will the knee joint be functional?
-can the soft tissue be reconstructed, if so how?

Median Nerve Repair

Here is the same nerve injury -- with neuroma resected followed by repair using several means.