Background: Post-traumatic osteomyelitis (PTO) of the lower extremity is among the most demanding problems in orthoplastic reconstructive surgery. It typically follows open fractures, failed osteosynthesis, or implant infection. Effective management requires coordinated infection control, stable skeletal fixation, and timely vascularized soft-tissue coverage. Methods: We conducted a retrospective case series of 20 consecutive patients with PTO of the lower limb treated between 2021 and 2024 at a tertiary orthoplastic center. All patients underwent radical debridement, culture-directed intravenous antibiotic administration, and soft-tissue reconstruction using local muscle, fasciocutaneous, or free flaps; vascularized bone flaps were used to select nonunion cases. The primary outcomes were flap survival, complications, infection resolution, and limb salvage. Exploratory analyses included descriptive subgroup summaries by flap category. Results: Among 20 patients (15 men, 5 women; mean age 53.6 years), reconstructions included reverse/pedicled sural flaps (n = 9), hemisoleus muscle flaps (n = 7), medial gastrocnemius muscle flaps (n = 2), peroneus brevis muscle flaps (n = 2), and free flaps (n = 6), which comprised anterolateral thigh (ALT), medial femoral condyle (MFC) osteoperiosteal, deep circumflex iliac artery (DCIA) osteocutaneous, and radial forearm free flaps (RFFFs). Single-flap reconstructions were performed in 13 cases, whereas multistage/multiflap strategies were used in 7. Overall flap survival was 90%. Major flap complications comprised partial necrosis in two reverse sural flaps and one complete loss of a reverse sural flap; two patients had minor wound dehiscence. Infection resolved in 18/20 patients (90%; 95% CI ≈ 0.70–0.97). One patient requested below-knee amputation due to persistent nonunion associated with a pathological fracture. At a mean 10-month follow-up, all limb-salvaged patients were ambulatory. Conclusions: Effective reconstruction of PTO is improved by using a patient-specific algorithm that considers the defect location, vascular status, and host comorbidities. Local muscle and fasciocutaneous flaps remain dependable for most defects, with free or vascularized bone flaps reserved for composite or recalcitrant cases. Early referral to high-volume centers, radical debridement, and orthoplastic collaboration are critical for optimizing limb salvage. Our findings should be interpreted in light of the study’s retrospective design and small sample size.

Background: Upper extremity reconstruction poses a significant challenge due to the complex anatomical and functional requirements of the hand and forearm. While free flaps have become the gold standard, pedicled abdominal flaps remain a valuable alternative, especially in cases where microsurgical anastomosis is contraindicated or unfeasible. This study evaluates the efficacy and outcomes of free-style pedicled abdominal flaps in reconstructing complex upper limb defects. Methods: A retrospective review was conducted on 20 patients who underwent soft tissue reconstruction of the upper extremity using free-style pedicled abdominal flaps between January 2019 and June 2024. Patient demographics, injury mechanisms, flap design, postoperative complications, and clinical outcomes were analyzed. Flap design was customized to defect size and location, utilizing single, double, triple, and tunneled flap configurations where necessary. Results: Stable soft tissue coverage was achieved in all cases without the need for additional free flap procedures. Complications included surgical site infections (n = 2), marginal necrosis (n = 2), partial flap necrosis (n = 2), and complete necrosis (n = 2), with no cases requiring free flap conversion. Long-term follow-up revealed no finger stiffness or loss of hand function. Donor site morbidity was minimal, with only one case requiring a split-thickness skin graft for closure. Conclusions: Despite advancements in microsurgical techniques, free-style pedicled abdominal flaps remain a vital reconstructive option for upper limb defects, particularly in patients with complex, large, or circumferential injuries. Their versatility, reliable vascularity, and ability to conform to various defect shapes underscore their enduring relevance in modern reconstructive surgery.

Background: The thumb accounts for 40–50% of hand function. Traumatic amputation of the thumb results in significant disability and necessitates a structured approach to management. Methods: We conducted a retrospective review of 144 patients treated for thumb amputations between 2004 and 2025 at a specialist hand surgery unit. Over 21 years, an institutional algorithm was developed and refined to guide treatment decisions based on amputation level, injury mechanism and patient factors. Results: Out of the 144 cases, 118 patients underwent replantation, achieving an 82% success rate. Alternative reconstructive procedures included toe-to-thumb transfers (eight cases), index finger pollicisation (six cases) and fourth finger pollicisation (five cases). Functional outcomes showed that 90% of patients returned to work, 83% regained temperature and touch sensation, and 94% could lift a 0.5 L bottle. Conclusions: Implementing a structured treatment algorithm facilitates personalised care and leads to favourable functional outcomes in patients with traumatic thumb amputations.

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes.

Background: Six-strand flexor tendon repairs offer superior biomechanical strength, yet commonly used techniques often require looped sutures or proprietary materials that limit global accessibility. The Elsaftawy repair technique was developed as a six-strand construct using universally available braided polyester, aiming to provide high strength without reliance on specialty sutures. Methods: Sixty porcine digital flexor tendons were randomized into four groups: Elsaftawy 6-strand, Jin Bo Tang 6-strand, FiberLoop^®, and modified Kessler 4-strand. Core repairs only were performed by a single experienced surgeon. Tendons were biomechanically tested for 2 mm gap formation force, ultimate tensile strength, suturing time, and failure mechanism. Results: All 60 tendons completed biomechanical testing without specimen loss. The Elsaftawy and Jin Bo Tang repairs demonstrated comparable biomechanical performance and significantly greater resistance to 2 mm gap formation and ultimate tensile strength than the Kessler repair (p < 0.05). FiberLoop^® showed significantly lower gap resistance and ultimate load compared with both six-strand techniques but did not differ significantly from the Kessler repair. FiberLoop^® was the fastest technique to perform (p < 0.05), whereas Elsaftawy and Jin Bo Tang repairs failed predominantly by suture rupture, in contrast to the pullout-dominant failure pattern observed with FiberLoop^®. Conclusions: The Elsaftawy repair uses an accessible suture and showed no statistically significant differences in the measured biomechanical outcomes compared with the Jin Bo Tang technique. Its initial mechanical performance and use of standard non-looped sutures support further investigation, including assessment of reproducibility across surgeons and clinical outcomes.