Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery最新文献

We used endoscopy and ultrasonic liposuction to remove lipomas from the forehead to facilitate early return to work. The tumours were approached through a pair of small remote scalp incisions behind the frontal hairline, which continued to subperiosteal dissection, thereby avoiding injury to the supraorbital or supratrochlear neurovascular bundles. The deep surfaces of the lipomas were identified easily through the periosteum by well-illuminated and magnified endoscopic views, and protruded through the periosteal incisions. An ultrasonic cannula was introduced to emulsify and aspirate the lipomas. Parts of the lipomas were extracted by forceps as solid specimens for histopathological evaluation. Preservation of the neurovascular bundles and complete resection of the tumours in the bloodless operative fields were confirmed by direct endoscopic monitoring. Of five patients treated, three returned to their jobs within two postoperative days, with no protective dressings on their faces. There have, to our knowledge, been few reports describing this combination of endoscopy and ultrasonic treatment of forehead lipomas.

Haemangioma of the skull is usually encountered as a solitary lesion, so few separate cases have been reported, and the protocol for treatment has not been confirmed. Here we describe its treatment in five consecutive Japanese patients. Three men and two women aged from 36 to 40 years were studied. The lesions were noticed in the left frontal bone, one in the supraorbital region and the rest in the forehead; they were 1.5-2.5 cm in diameter. The preoperative diagnosis was made precisely by plain and tangential radiographs and computed tomographic (CT) views. Once the lesion was suspected, radical resection and immediate reconstruction were required to prevent recurrence. All five radical resections were reconstructed immediately by split calvarial bone harvested from the ipsilateral parietal bone in the same operative field. The postoperative course was uneventful in all cases, and the postoperative contour of the reconstructed site and the donor site were nearly perfect. There were no particular complications. Two to 10 years have passed without recurrence.

In a prospective, randomised trial of 54 hands in 47 patients incisions were randomised to be closed by either absorbable subcuticular (polyglytone 6211, Caprosyn), or non-absorbable interrupted (polybutester, Novafil), sutures after single-portal endoscopic release of the carpal tunnel. There was a significant reduction in pain scores on days 1 and 2 in the patients treated with an absorbable continuous subcuticular suture, and no difference in inflammation or infection. There was no difference in the cosmetic appearance between the two groups after three months.

The philtrum is an important aesthetic unit that contributes hugely to the characteristics of the human face. From March 2002 to May 2006 inclusive, a total of 16 patients with unilateral cleft lip nose were operated on to form a philtral column and obtain muscular continuity. Six of the patients were female and 12 were male, age range 5 to 30 years old. We used Millard's method, so rotation and advancement flaps were planned. A full thickness incision was made down to the orbicularis oris muscle and mucosa after the scar on the philtral column had been excised. The medial and lateral muscle flaps were exposed and split into two leaves at the coronal plane. The deepest part of the muscle flaps were sutured together to create a jack-like eversion. Skin and mucosa were then closed. The follow-up period ranged from 8 to 18 months (mean 11 months). Two visual analogue scales were used to assess the outcomes. Thirteen of 16 patients were satisfied with their good result. Three had moderate results. The advantages of the technique are: ease of use; the creation of an anatomically-natural philtrum while preserving the continuity and function of the muscle; sufficient augmentation of the philtral column by the jack-like eversion; and no donor-site morbidity.

Of women who seek reduction mammaplasty, up to a third have pathological degrees of anxiety or depression, or both. The psychological aspect of reduction mammaplasty is therefore an important consideration. We did a prospective randomised clinical trial to see how reduction mammaplasty affected macromastia patients' depression, anxiety, and self-esteem. Eighty-two patients were randomised, 40 to have the operation, and 42 patients to conservative treatment. Both groups were followed for six months. The patients completed the RBDI questionnaire (Raitasalo's modification of the short form of the Beck Depression Inventory). Twenty-nine patients in the operated group and 35 patients in the conservative group completed the study. At the second examination, the patients who had been operated on, had significantly less depression (p<0.01) and better self-esteem (p=0.03) than the conservative group. The proportions of depressed (p<0.01) and anxious (p=0.04) patients were also smaller in the group who were operated on. There is significantly less depression and anxiety after reduction mammaplasty, and patients' self-esteem is restored.

A 28-year-old man presented with a lipofibroma of the median nerve of the left hand. We released the carpal tunnel, did a neurolysis, and biopsied of the median nerve together with a distal fasciotomy of the forearm. Two years after the operation, the paraesthesiae of the middle finger had improved but was still present to a lesser degree. Initial considerations about treatment should be directed toward biopsy and alleviation of the compression neuropathy, rather than total excision.

Reconstructive procedures after resection of nasal basal cell carcinoma (BCC) vary depending on the subunit involved. The aim of the present study was to assess the influence of the location of the BCC on the rate of incomplete excisions, so we made a retrospective analysis of all nasal BCC excised at our hospital between 2002 and 2005. The incomplete excision rate was 24/148 (16%). More incomplete excision occurred on the alae (n=13) when compared to the dorsum (n=2) of the nose (p<0.05). Eight two-staged procedures resulted in incomplete resection, whereas 9 (6%) frozen section analyses were false-negative. BCC were most likely to be incompletely excised on the nasal tip and alae, and both subunits required more elaborate reconstructions. This, however, was not the result of poor estimation of the extent of the tumour and reluctance to excise more challenging areas widely for reconstruction, but to the method chosen to eradicate the tumour.

From 1989 to 2005, 13 patients aged between 5 and 18 years had testicular prostheses implanted at the Department of Plastic and Reconstructive Surgery, University Hospital, Malmö, Sweden. The most common indication for surgery was aplastic or vanishing testes. In 13 patients and 19 operations 7 unilateral and 12 bilateral testicular prostheses were implanted. Each prosthesis was implanted through an inguinal skin incision, inserted digitally, and fixed with purse-string sutures. Some years after the primary implant three of the patients have had a second operation in which the small prosthesis was exchanged for an adult one. There was only one minor postoperative complication, a superficial wound infection. No patient required reoperation. All patients were happy with the results of surgery at the follow-up. We recommend this operation for implantation of testicular prostheses.

There have been few reports about skeletal changes beneath a tissue expander in breast reconstruction. We present one, and surgeons should be cautious about the possibility of skeletal deformities in patients who are osteoporotic and postmenopausal who require prolonged tissue expansion.