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

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.

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).

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.

Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44-86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.

The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used for reconstruction of the breast. Partial loss of the flap is still a problem, however, and venous congestion may cause partial necrosis of the flap. There are few studies of the venous anatomy of the TRAM flap that compares with that of the arterial system, so the aim of this study was to investigate the venous anatomy of the TRAM flap and assess its drainage pathway using venography. A mixture of barium and gelatin were injected through the cutaneous veins such as the superficial inferior epigastric vein (SIEV), the superficial circumflex iliac vein (SCIV), or the perforating branch of the deep inferior epigastric vein (DIEV) in 11 hemiTRAM flaps. Venograms of TRAM flaps were taken, and the venous anatomy evaluated. The study showed that it consisted of the dominant superficial venous system, the SIEV and SCIV, and the secondary deep venous system, and the perforating vein of DIEV (DIEV perforator). In addition, we saw the large communicating veins between the SIEV and DIEV perforator near the umbilicus. We think that these communicating veins, which are considered as the DIEV perforators between the superficial and deep venous system, are an important venous drainage pathway after the TRAM flap has been raised.

After repair of a fractured zygoma, the fixed zygoma occasionally becomes displaced. This phenomenon--generally called "relapse"--is a complication that can be prevented by fixing plural sites with plates. However, this impairs blood supply to the bone, which causes atrophy. To solve this dilemma, we developed a new concept for fixing the zygoma. Fractured zygomas are fixed by combining plate fixation at a single site with transmalar fixation with Kirschner wires. This secures stability of the fixed zygoma without impairing its blood supply. We evaluated the stability of fractured zygomas fixed by our method by doing dynamic experiments using simulation models. The stresses at the screw-bone interfaces were significantly reduced by the additional transmalar fixation with wire, indicating that zygomas fixed by our method are less likely to relapse than zygomas fixed with a single plate. We also reviewed the outcomes of patients treated by our method, which indicates its clinical usefulness.

Curettage is the treatment of choice for enchondromas, the most common primary tumour of the hand. In contrast, additional bone grafting remains controversial. Between 1998 and 2004, we operated on 22 patients with monostotic enchondroma of the hand. Sixteen patients (eight of whom had no additional bone grafting, and eight who had) were evaluated at a mean of 68 (range 42-108) months (no) and 50 (range 29-65) months (bone grafts) postoperatively. Bone density was measured densitometrically on the radiographs, and the groups were compared with each other and within themselves with corresponding locations on the healthy opposite hand. Neither bone density nor functional results were significantly different. Additional bone grafting in the treatment of enchondromas is not necessary and should be reserved for particular indications.

We present an 81-year-old man with untreated bilateral syndactyly. Hand function and cosmesis did not concern him but long-term use of the hand resulted in chronic skin changes from friction, and the subsequent development of a squamous cell carcinoma.

We used a thin titanium mesh combined with a prelaminated free radial forearm flap to construct a framework to reconstruct a traumatic defect in an adult ear. The prelaminated forearm flap covered both the anterior and posterior aspects of the titanium framework. A raised ear could therefore be created.