Aim: We prove the importance of the medial ligamentary system of the elbow for its stability and the usefulness of the ligamentoplasty by palmaris longus tendon as reconstructive technique.

Methods and patients: 9 patients aged between 17 and 58 (17,18,28,32,35,38,40,56,58,), 6 male, 3 female suffered the following injuries:1)elbow luxation or sub-luxation with rupture of the medial collateral elbow ligament, associated with: 1)Forearm bone fractures, 2)Ulnar nerve pulsy, 3)fracture of the coronoidal process, 4)Fracture of the radius head, 5)fracture of the humerus with radial and musculocutaneous nerve pulsy. The lesions happened since 2 week, 2 month and 2 yrs respectively. The 17 yrs old young man was injured during a weightlifting championship game and the next 4 suffered traffic and work accidents, while the 18 yrs old last one suffered an iatrogenic ligamentary lesion, the rest of the lesions have been caused to work accidents or to motor vehicle accidents

All patients were operated by ligamentoplasty with palmaris longus by medial incision, fenestration of the medial epicondyl and olecranon and transoseus pivoting of the palmaris longus which was enforced by 2 anchor sutures.

An elbow flexion-extension functional splint was applied postoperatively, initially fixated between 110–85 degrees. The splint was removed 2 months postoperatively, while full rang of motion has been obtained.

Results: Follow up was between 6 and 18 month. The 16 yrs old boy return in full sport activity and obtained at the elbow joint full range of motion. the second –young man-patient presents an extension defect of 15 degrees and the 56 yrs old women has a 25degreed deficit of both extension and flexion but she continues the therapy program.

Conclusion: The medial ligamentary system lesion with elbow instability must be repaired by medial ligamentoplasty and the well done technique followed by correct therapy program improved results.

Background: We presents the axial and via perforator vascularised flaps for covering lower limb posttraumatic, septic and diabetic necrosis.

Methods and patients: During the past 4 years we operated 23 patients, 20 males and 3 females with posttraumatic or septic lower limb necrosis: two of the external maleolar area, 6 of the dorsal foot, three of the Achilles tendon area, 2 anterior lower tibia, 4 of the calcaneal area. Osteomyelitis was present in 6 cases (tibia, metatarsals, calcaneus)

All traumatic cases happened almost 2 weeks before operation except three which caused between 2 and 6 months earlier. In the 2 diabetic cases the lesion appeared between 3 and 5 month ago.

We have performed: 9 sural flaps, 5 perforator-posterior tibial artery flap, 1 medial plantar, 4 based on distal perforators of the peroneal artery, 1 Saphenous, 2 muscular flaps.

All patients were between 17 and 81 years all and the follow up between 8 month and 2 years. Everywhere before the flap we performed surgical debridement.

As supplementary combined reconstructive technique we performed: 1. Mega papineau technique, 2. Bone filling, 3. Distraction osteogennesis, with spatial Taylor frame.

Results: We covered successfully the defects, with satisfactory aesthetical results, while the functional ability was not compromised.

Results: The above flaps have been proved effective for covering the lower limb defects.

These flaps are better tolerated by the patient than the traditional techniques and safer, less demanding and faster to perform than the free tissue transfers.