Dr. Nedhal Abdullah Alqumber

Consultant - Plastic surgeon
  Pediatric Plastic and Adult Craniofacial, Head and Neck Microsurgeon.
Hand & upper extremities, brachial plexus, peripheral nerve and reconstructive microsurgeon.
Prince Sultan Military Medical City 

Algorithmic guide for flap selection in reconstructing multiple digital hand defects in the era of advanced microsurgery and unlimited flap options
The Key to success in managing multidigital defects is choosing an appropriate reconstructive option and modifying its design to a achieve the best aesthetic and functional result with the least donor site morbidity. In this article, we discussed the methods of defect and flap modification and propose an algorithm to guide in flap selection. Method We retrospectively analyzed the data from 35 patients each underwent abridged free flap to reconstruct mutidigital defects in Gwangmyong Sungai Hospital Seoul from March 2013 to November 2017. We assessed the best use of different bridge free flaps. Result We manage 35 patients (M: F-33:2) the median age at presentation was 45years. The median number of involved digit in each case was 3 (range: 2-5 fingers). (50%) underwent ALT, (22.8%) thenar, (8.5%) IRASP, (17%) miscellaneous free flaps ALT adipofascial free flap provide a thin coverage for dorsal multidigital defect, medial plantar flap achieve an excellent match for volar defect, but more donor site morbidity in comparison with a thin ALT free flap, thenar free flap show impressive result in mutidigital tips defect ,venous free flap successfully used for simultaneous digital artery reconstruction and soft tissue coverage. Conclusion Syndactylizations simplify multidigital defects by converting them into one defect but it required a second stage for flap division. for dorsal defect an adipofascial free flap provides a thin , robust blood supply, and gliding surface for the tendons. for volar defects medial plantar artery free flap give the best matching but for those who can’t tolerate the donor site morbidity a thin ALT free flap achieve good result with less donor site morbidity . For fingertips our first choice is the thenar free flap.

The management and prognosis of facial and scalp angiosarcoma: a retrospective analysis of 15 patients
Angiosarcomas are extremely aggressive malignant tumors that arise from vascular endothelial cells. The risk factors, etiology, prognostic factors, and optimal management strategies for angiosarcomas are as yet unknown. Methods We retrospectively analyzed data from 15 patients who were treated in Asan Medical Center, Seoul, Republic of Korea, in the past 12 years, to assess the effect of different treatment modalities on locoregional recurrence, metastasis, and overall survival Results A total of 15 patients were identified (The median age at diagnosis was 72 years (range: 61–82 years). Median tumor size was 6 cm. Median follow-up was 287days. The median overall survival was 14.96 months; a total of 13 patients, (87%) had died by the end of the study. The median loco regional recurrence, metastasis, and overall survival 7.3, 6.5, 16.7 months respectively. On univariate analysis, On univariate analysis, the use of adjuvant therapy after surgery (vs surgery without adjuvant therapy) was associated with delayed recurrence 3.1 vs 7.9 months respectively (P value: 0.825), delayed metastasis 3.1 vs 8.7 months respectively (P value : 0.191) and better overall survival 3.1 vs 7.3 months respectively (P value: 0.078) The use flap vs skin graft as reconstructive method was associated with delayed recurrence 8.75 vs 7.32 months respectively (P value: 0.274), earlier metastasis 3.75 vs 6.53 months respectively (P value: 0.365), but the same overall survival 16.7 months (P value: 0.945), tumor smaller vs bigger than 5 cm show a median recurrence of 4.17,7.32 months respectively (P value:0.41) ,median metastasis of 3.75,6.53 months respectively (P value: 0.651), and better overall survival of 18.21 vs 16.7 months respectively (P value: 0.111). Conclusions Angiosarcoma is a malignant difficult to eradicate with surgery alone, so multimodal treatments that combine surgery with adjuvant therapy is the best management strategy that influence survival positively. Patients with angiosarcoma tend to be old and fragile, with comorbidities, and generally cannot tolerate aggressive treatment. So it is better to choose the simplest suitable resection and reconstructive method with the least complications. And to avoid unnecessary procedures.