• No results found

Extended Reverse Superficial sural Artery Flaps: A Clinical Study

N/A
N/A
Protected

Academic year: 2019

Share "Extended Reverse Superficial sural Artery Flaps: A Clinical Study"

Copied!
82
0
0

Loading.... (view fulltext now)

Full text

(1)
(2)

!

" # $%%& ' (

)

! !

! ! " #$$ $$%&

!

!

(3)

%

' ( ) " ( "

! ! " * "

" &

'

"

! ! " ) " "

& ' " ( "

" &

' + ! !

! ! ! ! "

&

' " ( !

! ! ! ! ! " # ! !

$ %! ! ! " & ! !

! " ) ( &

, + " ' " ( ) " " "

(4)

-" " "

& '

& . " %

%& "

--& ) , /

0& 1 . 2

#& ( 3 4 " 5

-/& 3 + %0

2&

-6& ! -6

$& 7 + "

&

(5)

0

( " ) " ( "

) ) " (

" & 4"

+ " " +

( " 8 & 4"

+ " ) " "

" & 4" " " +

5 ( ) " " "

+ " &

" + + "

+ "

" % 0 % %6 -# %$ -2 0$ 0 ) "

" " " "

) " ( "

" %# -# -/ -2 -6 0$ 0 &

)

" " " +

) " " + " " 9

(6)

#

; " " "

" ) " ) " &

< " " 5 = ) >? = )

>? ) " " + ) "

(7)

/

• 4 " + "

" ) " ( "

&

• 4 " " 5 ) "

+

" "

+ &

• 4 " " (

" 5 ) " "

( " 5 ) " "

(8)

2

4" ) " $$0

. $$/& 4" "

" ) "

" " + ( "

( " ) " " ) )

" " +

" &

. + # ) " ) "

+ " ) "

" " "

" & . " (

" ) ) ) "

+ &

% ) + " " + 5

(9)

6

' * " + "

" # & ;5 + 9 : ) "

" ) + "

& . + " ) "

) ( + " &

INCLUSION CRITERIA

• ) " " $ #$ &

• ) " " ) "

" " "

) )

" &

& "

& ! 8

%& @ " ( 8

-& A +

(10)

$

#& ; +

/& '

2& 3

• ) " + ( +

" )

" &

EXCLUSION CRITERIA:

• ) " " $ " #$

&

• ) " + "

(11)

4" + "

) + ( ) " ) " + "

62% , & & 9 622: + " "

=. + "

?& ' " " " "

0 "

9% 0: + 9- 0:

" ( " " )

& 4" " +

+ ) " " " +

&

" 9 626:/ "

) /

& , 9 66$: + "

) " " B "

) &

4" = ( + "

" "

(12)

" "

+ " " "

) " "

& 4" " ( )

"

&

( ( 9 66-:0 " ) " "

) " 4 " +

& ' ) " " " ) "

" + &

& ' 8 " &

& ' " ) " ) "

&

%& ' + ) "

" &

-& 4" + ) " "

"&

) 9 66-:% " +

(13)

%

" ) & ' " 9 $

% : " & ' " ) " )

) " " " ) " "

&

. " )

) + , , 9 660:- & 4"

( ) +

8 " 0$ ) " & 4"

) ) C

& 4"

+ &

4" " ) " +

" &

& 4" "

"

22&#D " ) & 4"

" $&#% $& 6 &

%& 4" %&0 E F "&

(14)

-" "

&

-& ! " " " +

" ) &

0& 7 "

+ " " (

+ & ) " "

" " " " )

" " ) &

' 660 3 + -# - ) " " " "

+ & 8

9 66#:0 " ) " " &

4" " " " " ) + +

" ( 8 " ) +

" " " "

" + &

G 9 66/:%6 + " " +

( & 4"

" ) 6 & )

(15)

0

) " ( ) "

) " + " " & . " )

" ) " + " " & . ) &

. " " " " &

. " ) + +

! " H % 66/& . " " "

"

) " " + & 4"

)

) " " " " + &

4" " & 4" "

&

I * 9 662:%$ + " '

) " " " ( "

" &

< ( 8 9 666: " %

" ) " & 4"

" " " ) &

' " 9 666:%2 " =

(16)

#

"

?& ' " " ") "

+ "

"

" " )

" " &

" " " )

+ " "

" " &

4" ) " " "

+ " "

&

4" " " +

) + + G 9 666:%6& 4" "

+ " ) " " +

" ) " "

(17)

/

4" ( " + "

" ) " " "

" & . + "

) +

" & ' / "

" " &

J 9 666:%# " + " "

+ " "

" ) "

&

' + 9 $$$:%/ " =4"

) )

? " " " #0

) " " " + "

& + " "

(18)

2

4 9 $$$:-# " )

+ " )

" " ( ) " " " /

- +

&

: + )

+ " &

: " " &

%: A &

-: " " (

" " &

0: " +

"

" 5 &

' " " "

$ + " ) " " "

(19)

6

! & & " 9 $$0:-2 " +

"

+ ) "

" $ # +

&

' $$ . 4 -/ J 8 0

"

& 3 " + "

" + + (

" " ) + & 4"

"

+ "

+ &

A " H & & 9 $$0:-6

+ ) "

& 4" " "

" + & 4" "

" ) " "

" " ) 5 )

(20)

$

" , ! " 0$ $$# + +

"

" )

" & 4" "

" " "

+ " ) " "

" "

" & 4"

+ "

+ " ( " +

+ " + ) " "

" &

. ( " & 9 $$#:0 "

2-"

) " " " &

4" " 0 0 "

-) " ## ) "

)

& 4" " & 4"

) + + "

(21)

4" "

• 4" +

+

) " " " &

• 4" " 5 "

(22)

4" + " +

"

" " )

" " &

4" " + " "

" " " "

" " & @ " " " "

" ) " + " &

4"

+ "& 3 ) "

) " "

+ " & 4"

" + ) " ) "

+ " " "

& ' ) " " "

(23)

%

4" " + ) " "

) +

+ # " ) & '

< . ) +

" " " " +

" + " & ' "

9-2D : 9%6D :

" 9 %D :& 4"

% + 8 "

+ ) " ) " " & ' ) "

. " &

. " "

+ + ) " ) " "

" " 8

" " "

" ) ) " " "

" " " & 4"

" " " "

" ) " " + "

" + & "

(24)

-" ) ) " ) " "

& 4"

" ) " & A

) " " &

4" ) " " 8

) " " )

" " "

+ ) " +

+ ) " " ) " & 4"

( ) "

" " &

4" )

" ) " " " + &

'

" " "

( " & 4" "

" + ( & 4"

) " " "

" & 4"

(25)

0

+ " "

% + " &

4" "

* " "

" " " ) "

"

" " + "

+ + "

& 4" + "

" + "

* + ) & 1 + ) (

" " ) " +

" " " &

. "

" ) "

" "

( & . " "

+ " " ) " 8

" & 4"

" " "

(26)

#

+ ) " ) (

" +

+ & 4" + ) "

" ) "

& ' " ) ) " " "

" + ) "

" "

+ " " & 4" )

" &

4" ) " "

" "

" " " & 4"

+ " " " "

& 4" ) " " +

+ " " & 4" + " "

" + +

" K 5

+ " ) " " & ' " "

(27)

/

4"

) "

& 4" " ) " "

+ " "

&

4" " ( "

" " " & '

" + " & . "

8 " " " "

" ) " "

(28)

2 THE COURSE OF THE SURAL NERVE

4"

"

+ + " " &

A " C + ) "

) + &

" C " &

, ) " C

" + ) " +

(29)

6

L

a

t

e

r

a

l

M

e

d

i

a

l

1. Lateral head of Gastrocnemius

2. Peroneal communicating branch of sural nerve

3. Short Saphenous vein

4. Medial head of Gastrocnemius

5. Sural Nerve

6. Tendinous portion of Gastrocnemius

7. Soleus

8. Peroneus longus

9. Deep fascia over Tendo Achilles

(30)

%$ CONVENTIONAL METHOD

. " ) "

" + ) " + 4 . "

" " &

. " " "

" ) " " & ) "

" ( & & "

+ "

(31)
(32)

% MODIFIED METHOD:

4" + ) " "

" " "

5 & . " ) + ) " )

" ) " ) " " " & 1 "

+ " + ) " ) + "

& . " ) " ) "

" 8 ) " "

+ ) " " + "

4 . " & " " "

" ) " " ) "

" ) " &

4" " "

" 5 " " "

(33)

%%

(34)

%-CONVENTIONAL METHOD:

4" " ) " " " &

. 5 & (

+ " "

" + ) " & . " (

" ) + ) " . " "

" ( " + ) " )

" " &

4" " + " "

& . ( " " "

" " " " "

& 4" "

+ ) " &

4" + " ( "

& 4 " * 0

% + " " & ;

" " ) " "

" & . " "

(35)

%0

" ) " " "

& 4" ( " ( " +

8 + ) " &

" ( " ) " "

) " & .

( " ( " + ) "

" + 5 " "

+ &

4" ) " " + - & . )

" " (

+ & 4" "

5 " ( & 4" " " + "

* " &

4" " " "

( & 4" ( ) "

+ " " "

( + & . " "

" " " " + "

(36)

%#

" + & 4"

) " " " &

4" + ) " + &

4" + "

& 4 ( ( % $ " "

" ) " " + "

" + & 4" " 5

" " &

4" + ) " ) " "

" & . ) "

( " " ( &

" "

& 4" )

&

4" "

& .

" " "

" & 4" +

" "

(37)

%/

" ( "

+ * " &

4" "

" + " & ' + "

+ " 8 " +

+ "& < "

) " " ( " &

. 0 " " )

" & 4" "

" )

&

4" ( " )

" + ) " "

" ( & 4" " ) "

" ( ( & + " +

& . "

+ " +

" & '

(38)

%2 MODIFIED METHOD

) " " "

" ( " " & @ "

+ " ( "

" " "

( " " " &

" " + ) " )

" " &

7 " " + " "

5 ) 5

) " "& ! ( ( "

5 + " " ( & 4" "

" " " " &

( " (

( ) " ( "

" " " ( + ) "

+ " " " " & 4" (

" ( & 4" + " "

" + % - ) "

(39)

%6

) " " " + & 4" " +

" "

) " " ) "

" " "

&

"

5 & 4" " " & '

( & , "

" " + + +

" ) " " &

4" " 8 "

" ( & 4" " " +

) " " ( "

" & ' " "

" " "

" " & ! (

" " " " &

< ) " " "

+ " & ' " " "

(40)

-$

8 " " "

" &

! ) " " "

" " & . "

) " "

) " " ) ) " " ) +

" ) " + " &

" +

" ( " "

( + " + ) "

+ & ; "

) " " " ( "

& 3 " " " "

+ " & "

" " &

" + "

+ + + "

" ) " " "

(41)
(42)

-; 5 %

& ' " " " " "

+ " (

" + & /

" + ) " " ) "

+ " "

( & - /

" " " (

" " " &

' + * "

(43)

-%

' " + # )

) " " % ) + (

" " + 5 % ) +

" ( &

SEX DISTRIBUTION:

' + " + &

" & '( ) *

( + , " ,& - ",)

$

%

(44)

--AGE INCIDENCE:

@ $

#$ ) " ) " &

" & '( . / ( , , ( (

#

0 0 # 0 0 #

$ $ 0D 0D

%$ 0D % %D

% -$ 0D - % D

- 0$ % %D 2D

(45)

-0 AETIOLOGY OF THE DEFECTS:

' " ) (

" + 8

( + & 4"

8 " ) " &

" & '( ) 12 ( ",) ') 3 ) 4 ( 4( "

0 0 # 0 0 #

"

# -#D 2 # D

A +

0D 0D

(

0D 0D

! 8 2D 2D

; 7 2D $ $D

(46)

-# REGIONS INVOLVED

' " ) "

" ) " " ( & ' 8 "

) ) &

" & '( ) 51 ( ,) , ) ' (

#

0 0 # 0 0 #

- % D % %D

% %D % %D

, 0D 2D

4 " 2D 0D

0D % %D

2D 2D

3 % + " "

) " " &

"

% & 4" ) / 2 ) " "

# & 4" ) $ # ) " "

(47)

-/

' " ) " " " ) " "

" ) + "

" ) & ' " $ ) " "

" "

) " " + 5 0

) " " % & ' "

) " " ) ) "

-&0 &

' " " % + " " "

) " " " &

" "

% 2&0 & 4" ) # 2 ) "

" - " ) $ 2 ) "

" # &

' " ) " " " ) " "

" " ) + " ) & '

$ ) " " " " "

) " " + 5 "

(48)

-2

" ) " " $ 2 ) " " )

) " &

)

) " " ) + ) " "

(49)
(50)
(51)
(52)
(53)
(54)
(55)
(56)
(57)
(58)

02

( "

( & 4" +

" " (

) " (

) " ( 8 #&

! ) " ) " " +

&

4" + "

) & 4" " ) &

. " "

8 " &

4" " " +

+ + -& A

) " ) " " + " "

+ ?&

4" 5

" & '

+ " " + +

(59)

06

' 66 5 $ " +

( " "

" & 4" + "

" & 4" + "

& )

"

" + + &

) " " "

" + ) "

" &

4" + ) "

" )

+ + " + "

" ) ( #&

7 " "

" "

+ ) "

" ) + "

(60)

#$

4" ) (

" " ) " " " & 4"

+ "

" -& 4" "

) &

5 $ " (

66 & ) % " " 5 & I * %$

" " 5 + ) " )

+ & 4" +

) % " ) " $ " % & 4"

" " " " & 4"

" &

5 $ " " "

" + + "

+ & G @ #

" + "

" " " +

(61)

#

' 662 I * %$ " "

" 0 ) " " " ) " +

662& ' $$ . -/ "

-) " " / #

" & ' "

) $ 2 ) " " " ) ) "

" &

' % ) (

+ " ) " + ) " "

) " " ) " " " & 7 ) " $

" "

) " ) " "

) " " " )

& @ " %

" - & @ " -&0

" $ # * ) " " ) &

@ + " ) & ) " "

( " ) " " )

" "

) " " ) " " (

(62)

#

+ " ) " " " &

4" " + 5 " "

+ &

) " ) " "

" + ) " "

) " " ) + " " "

" + " " "

" + & 4" (

+ ) " " " "

+ ) " " ) " "

" ) &

4" " ( ) "

( " " 5 "

+ 5 % & @ " " " 5 " ) +

" ) " " ) " "

& ' " " $ ) " " (

% # ) " " ) ) "

) " " ) "

(63)

#%

3 " " " " )

8 ) " " ) "

" " ) " " ) " "

) " " & @ "

" ) " " ) + " " "

+ " " &

' " " ) " " $ 2

) " " ) + + +

+ " " " " ) "

" ) " " )

+ " " "

+ &

4" ) 2& D + "

" " ) " " " + " "

+ " " " " & 4"

) 0-&0D " ) "

2& D " ) " " ) &

4" ) " +

+ " ) & ( ) " "

(64)

#-" + 8 + "

" 5 +

8 " " &

) " " " 5

" +

" ) " + ) "

" " ( "

+ " +

" " " ) " " " & 4"

( " "

+ ) " " ) " "

" + " + "

&

' " + . 9 $$ :-/ "

-" ) " " % )

) " & 4" "

) " " 0D

(65)

#0

' " + A " H 9 $$-: "

) " K ) "

/ 0 & 4" 6 6

" / ) "& 4" %

9 /&%D :& 4" " ) "

+ ) " " ) " )

" "

" + "

(66)

## • ;

" "

&

• 4"

" " ) " "

8

) 5

&

• 4" + "

" + " "

&

• 4" " +

"

) " " &

• " + ( "

+ ( " " "

(67)

#/

) " " "

" &

• 4" ( "

" 5 "

" + "

&

• " " ( ) "

) ) "

) " + "

(68)

#2

< C . C C C

! + C

F. C

. C

* " 9 :C

( " C! F

" 9 :C

( " 9 :C

F ) " C

! C

(69)

#6

& . & & ! & & 3 ( ) &I & )

& & & $6C02%& $$ &

& . ! &;& ! ,&7 & 4"

( & ! & & & /C

#-6 $$$&

%& 7 + . + 4& " ;& , 3 * ! & 4

< & 5 * * & " + +

+ &

& $ 9 :C /# 2 662 G &

-& 7 " . & & . & 7 & ! ;

& +

C4) " "

& . & & & -0C 2- $$$&

0& ! &! & 7 ;& )

" 9, :& & & & 62C6$ 66#&

#& ! " < " &G& ! " +

&

(70)

/$

/& ! G& & . & ,& ! "

" & & & & 6-C

20$ 66-&

2& ! . & G& " ! & . & . G&

4" + C

) " %# & . & -# 9%: C

%$2 % $$ &

6& ( H '& +

& G

& 62%K /C 6 6#&

$& " 4& H ; < $&

' ( * ( (

; & " & ( " & & ! " %%C $2

$$ &

& & 1 J & & 4" +

C 3 "

) & . & & & -0C % $$$&

& " & 4" + " ( " C

(71)

/

%& ) 4 H " & 4" +

& & & & 66-K6%C $ $ $&

-& &,& & 8( , ) G&

7 & 4" + & . & & & 662C

- C02 #0&

0& ( ( 4 ) & ) " 4

" + & &

& & 66-K6%C2/ 2/#&

#& G & & @ &! & +

( & & & & 66C/--& 66/&

/& G & & @ &! & H I & "

" + & . & & & -%C

-66 666&

2& , 7 & J < & & +

C .

& & & & $/C#/ $$ &

6& , & G&! & ! " &! & ! " & & ;&

& ! " I L M M" $C 6%

(72)

/

$& 5 . &! & &! & @ $K (

+ " " C

. " K

26K 0 66 &

& " &G& . 7 & & ! " < & A "

" C ; &

& & & #6C2 0 62 &

& < ( 8 & ' < & ( * & + 4& ( I &

( 4& H 4& . & 8 4& .

" C

& K

& $% 9 :C $- $ 666 G &

%& 3 4! & . * & H . & . "

+ & 0$ 9 : C 0% 6

$$ G &

-& 7 & 4" C

(73)

/%

0& 8 < & ) " & G ( " H& J &H& G 8

& 4" +

" ) & 7 & G& & & -6C%2% 66#&

#& G@ 4 J '& . 8

" 5 & 62#C//C - --&

/& " H ( & . & 3 * ( 4& , )

& . & &

& %C6/ 626&

2& " + J J & 4"

"

" " = ? ) 9

J :& ! " #2C /$ 66/&

6& 4 ! & " & 7 " . & 3 + ! &

! ) +

" ) "

" " ( " & & & & $/C%2%

(74)

/-%$& I * & H 3 & 7 . & 4" +

C !

& & & & $ C %02 662&

% & ! " ! " & "K

! " H K " 4 ! " $ 9-: 6% 2 66/ &

% & ! " I , M " 7 J M" G K "

( " & . 0 9-: C

% % 2 620 3 &

%%& ! ( H 1 1 " & 1 & & M

" )

&

%-& & H& H ) &< H ) ( & 4 &H H ) & 4"

0 9-: C /0 20

62-&

%0& "& G, 4" ) "

. -$ 90:C0 $

662 &

%#& J +

(75)

/0

%/& ' + G & 4"

) ) &

G . ( %6 9 :C-- 2 $$$ G +&

%2& ' " & < & < ( 8 G ( * & K

" + "

" &

$% 9 :K-6- 2 666 +&

%6& G " " +

& . -% 90:K -66 0$0

666 < &

-$& G " ; "

+ " ( & G

% 9%: %% - 62/ . &

- & , , . + "

& $

9 :C0 % 662&

- & , &, , & M , & 4" )

K ! " 8

(76)

/#

-%& , * , , "

" ( & 7 " 8

-% 90:0-# 0$ 66$ &

--& 3 + & ! . * 7 & " &. "

" ( + C

- &

-0& 4 J ' @ . " &

& &

$ 9%:C066 # # # / 2 662&

-#& ! & 4 & & & " & & . & 7 " & & ! &

3 + & & ! ) +

" ) "

" ( " 6 $$$&

-/& . 4 ! " . &

" & & & &

$$ 6C %$/ %&

-2& ! & & " ! &! & , < & & H " & & 4 & & G &

+ "

(77)

//

. & 7 G $$0 02

0&

-6& A " H & & . & 7 " & & ;

( & & G H & & ;&

" & &

) & & & &

#C 6 $ $$0&

0$& " , ! " 4 ! " G @ & 4"

+

& G . $$#C06 2-# 200&

0 & . (" & . & 1 "

) " " &

(78)

/2

< C . C C C

! + C

F. C

. C

* " 9 :C

( " C! F

" 9 :C

( " 9 :C

F ) " C

! C

(79)

/6

CONVENTIONAL METHOD

#$%&'$ (&

) *+&, %#(' +%+ %$& -& &.$ %+/ #.$ +

%0& 1#2 .3 +/%' 2&--1&

4 %-$ , 1&'($ * $#1 1&'($ 1#2

/%' &,$&'+% '

%'$ $ & 522& 6*7

1&( .3

3 21%.#$% '+

& %2F " < 6 #F /

-1

) "

& 06F

" " 2 %F - % <

%& F " < 2 $F % % '

-& - F 3

) +

, ) " +

2 $F - < <

0& /F ! 8

4 "

"

(80)

2$

#& --F " < 6 0F #

-/& 0 F ! "

+ "

) " ! .

6 -F 0 % 1

2& %$F ; + < 2 -F #

6& #$F 5 < 2 $F 0 < <

$& %F " , < 6 %F -

-& %0F " < 2 %F # % 1

& - F A + < $ -F - 0

%

%& 0-F " ! . $ #F

-%

-&0

MODIFIED METHOD

(81)

2

0& 0 F ! "

+

+

2 0F - <

#& %F " , < 6 %F - - <

/& #$F &

7 " 6 -F # 0

1

2& % F A +

, ) "

< $ 0F - # <

6& F " < $ -F 0 - 1

$& %$F

+

+

, ) "

< 2 %F < <

& - F ! " 8 4 "

" < 2 $F % <

& /F " ,

" < 6 -F - 0 " (

(82)

2

-& F

( ) "

8

4 " < # 2 F - < <

0& %0F " < 6 #F - 0 <

#& %/F " @ " < $ 2 F #

2&0

References

Related documents

According to AAPOR’s recent mobile technologies task force report (2014), “a non-ignorable and growing percentage of respondents are now accessing online surveys via their mobile

to know the frequency of people on following this kind of news or information, there Exhibit 1: Number Responses of Public knowledge Exhibit 2: Percentage Responses... 6 | P a

Date: annually in June North Texas State Soccer Association hosts the Boys Developmental camp for players in the youngest ODP Player Pool.. It is held on the campus of

Regarding mid parent heterosis, all the crosses showed positive heterosis except the cross SVP-74 x Zam-04 which exhibited negative desirable heterosis (Table 3).. The

The story does not end there, the community continued to assert their right to the land; and in 1990, after the unbanning of the liberation movements and as the process

Normalized signal intensities of IgG and IgA responses to IpaB (A), IpaC (B), and IpaD (C) in serum and ALS samples from individuals prior to (shaded bars) and following (open

Hence, domination of non-Saudi to the private sector where most of the labor force are working proved lower opportunities for Saudi with significant impact on females who have

CDT: Combined disk test; cgMLST: core genome multilocus sequence type; CPPA: Carbapenemase-producing Pseudomonas aeruginosa ; ECDC: European Centre for Disease Prevention and