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

We describe a rare case of plexiform malignant peripheral nerve sheath tumour (MPNST) of infancy and childhood in a 3.5-year-old girl. The tumour was located in the proximal phalanx of the left index finger. After initial excisions and a ray amputation, exarticulation of the third and fourth rays was required.

Ischaemic preconditioning increases the survival of flaps. Random-pattern McFarlane dorsal flaps were raised in 30 female Wistar rats, which were divided into three groups. An ischaemic conditioning protocol with clamping of the pedicle was used. No clamping was used in the control group, and the pedicle was clamped for 15 minutes in the second group and 20 minutes in the third group daily to see if the duration of ischaemia had any effects on the viability of the flaps. The pedicles were divided earlier in the clamped groups than in the control group. The size of necrotic areas of the flaps in the clamped groups was smaller than on the control group. Daily postoperative intermittent ischaemic conditioning in the pedicles of the flaps had a protective effect on their survival and led to earlier division of the pedicles.

We describe a boy with Apert syndrome, including cranial deformities and syndactyly (acrocephalosyndactyly), though intracranial hypertension, exophthalmos, and midfacial hypoplasia were mild. We treated him by mandibular distraction, in addition to fronto-orbital distraction, and Le Fort III midfacial distraction, with good results.

For the repair of syndactyly of the foot, skin grafting is often used to close the skin defect, but open treatment is not common. However, with grafting, an additional scar at the donor site and patchwork-like scar at the recipient site are inevitable. Our aim was to describe the process of epithelialisation and define the indications for open treatment of syndactyly of the foot. The open treatment was used on 16 webs. The texture of epithelialised surface resembled volar skin; the visible scar was mainly at the dorsal edge; and web creep occurred predominantly on the volar side and resembled the natural slope of the commissure. Open treatment is better than skin grafting because of better match of texture without a patchwork-like scar, and it is indicated in cases of simple incomplete syndactyly of the foot that extends proximal to the distal interphalangeal joint.

Our aim was to assess the effects of magnesium sulphate given by iontophoresis on the viability of random skin flaps in rats. Endovenous magnesium sulphate is used to treat pre-eclampsia and diseases of blood vessels. Iontophoresis is an electrotherapeutic method which has shown satisfactory results in controlling ischaemia within the boundaries of the area in which it was given. Forty-five adult male Wistar rats, weighing 300 to 440 g were randomly divided into three groups of 15 animals each: random skin flap (control); random skin flap treated with magnesium sulphate without electrical stimulation; and random skin flap treated with magnesium sulphate with electrical stimulation of 4 mA for 20 minutes. The treatments were applied immediately after the operation and repeated on the following two days. The percentage of necrotic area was measured on the seventh postoperative day using a paper template. For each group, the mean percentage of flap necrosis was as follows: control, 46%; magnesium sulphate without electrical stimulation, 34%; and magnesium sulphate with electrical stimulation, 42%. There was no significant difference among the groups (p = 0.18). Magnesium sulphate given by iontophoresis does not increase the viability of random skin flaps in rats.

We describe a mammary myocutaneous-glandular flap, which is a simple, convenient, reliable, and speedy reconstructive technique applicable for women that combines little or no morbidity with excellent cosmetic outcome and provides a simple solution to an extremely difficult problem.

Saethre-Chotzen syndrome is one of the most common craniosynostosis syndromes. It is an autosomal dominantly inherited disorder with variable expression that is caused by germline mutations in the TWIST1 gene or more rarely in the FGFR2 or FGFR3 genes. We have previously reported that patients with Saethre-Chotzen syndrome have an increased risk of developing breast cancer. Here we have analysed a cohort of 26 women with BRCA1/2-negative hereditary breast cancer to study whether a proportion of these families might have mutations in Saethre-Chotzen-associated genes. DNA sequence analysis of TWIST1 showed no pathogenic mutations in the coding sequence in any of the 26 patients. MLPA (multiplex ligation-dependent probe amplification)-analysis also showed no alterations in copy numbers in any of the craniofacial disorder genes MSX2, ALX4, RUNX2, EFNB1, TWIST1, FGFR1, FGFR2,FGFR3, or FGFR4. Taken together, our findings indicate that mutations in Saethre-Chotzen-associated genes are uncommon or absent in BRCA1/2-negative patients with hereditary breast cancer.

Breast reconstruction with submuscular tissue implants is associated with substantial postoperative pain. High pain scores despite large doses of opioids were described in earlier studies, which indicated that opioids alone or together with paracetamol are insufficient. In the present placebo-controlled study we aimed to evaluate the analgesic efficacy of local anaesthesia as a supplement. Forty-three women who had previously been operated on for breast cancer and were listed for unilateral secondary breast reconstruction were assigned at random to one of two groups. The patients received 2.5 mg/ml levobupivacaine (Chirocaine) 15 ml or placebo in a double-blind manner through an indwelling catheter in the operation site every three hours for 45 hours. All patients were given oral paracetamol 1 g x 4 orally and morphine intravenously as patient-controlled analgesia. A visual analogue scale (VAS) was used to assess the intensity of the postoperative pain. Amount of morphine used was recorded. The women in the levobupivacaine group (n=21) reported significantly less pain at rest during the first 15 hours postoperatively (p<0.05). During mobilisation the intensity of pain was lower for the first six hours (p=0.01) and for the interval 18-24 hours (p=0.045) in the same group. Total mean (SD) consumption of opioids in the levobupivacaine and placebo groups was 24.6 mg (22.88) and 33.8 mg (30.82), respectively (p=0.28). After reconstruction, levobupivacaine injected locally every third hour as a supplement to paracetamol orally and morphine given by PCA resulted in improved pain relief at rest and during mobilisation. Morphine consumption was reduced, but this was not significant (p=0.28).

The lateral thoracodorsal flap and the pedicled latissimus dorsi flap have been extensively described for breast reconstruction. In search of an alternative, non-microsurgical, autologous method of breast reconstruction we used both flaps combined to achieve adequate volume. The technique was used on three patients who had had a mastectomy at least two years previously. All flaps healed uneventfully with the appearance of an ordinary latissimus dorsi breast reconstruction. The method shows promising initial results and can be used as an alternative when reconstruction with autologous tissue is preferred.

The active cellular component in Dupuytren disease (DD) is the alpha-smooth muscle actin (alpha-SMA) containing myofibroblast. The underlying regulatory processes in activation of myofibroblasts resemble the pathophysiology of certain types of cancer. Accumulation of beta-catenin has been shown in many fibroproliferative processes, including DD and, recent findings attributed a possible role to the Zic1 transcription factor. To assess Zic1 expression in DD and investigate its relation with the accumulation of beta-catenin, neighbouring tissue samples in 20 patients with DD were stained immunohistochemically with monoclonal antibodies for beta-catenin, alpha-SMA, and Zic1. Histological appearance was staged according to Luck. Cell-rich areas with accumulation of beta-catenin in myofibroblasts that stained for alpha-SMA and showed apparent Zic1 coexpression were obvious. This coexpression seemed independent of proliferative or involutional histological staging. We found only Zic1 expression in residual stages. A different pattern of expression of protein in the residual stage may support earlier suggestions of a cellular heterogeneity with the existence of different cell (sub-)populations in nodules and cords. On the other hand coexpression of Zic1 and beta-catenin may indicate a relation between Zic1 and the Wnt-pathway. Further studies are needed to elucidate cellular origin, potential heterogeneity and activity of the myofibroblasts in DD, and to define the exact role of Zic1 in fibroproliferative processes, wound healing, and cancer. The fibroblast in DD is an interesting model for future experiments.