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

We present an unusual case of immediate bilateral acute carpal tunnel syndrome that followed combined pancreatic and renal transplantation and responded to decompression after failed conservative treatment.

Reports about congenital symmastia and its surgical treatment are few. We report two patients - a mother and daughter - with congenital symmastia in whom breast and fatty tissue was found to be mobile adhering poorly to the chest wall. Although histological examination showed no abnormality of the tissue bridge between the breasts, ultrastructural investigation of breast tissue (including Cooper's ligaments) showed an abnormal arrangement of collagen fibres. Satisfying aesthetic results were achieved by resection of excess soft tissue in the cleavage area through a submammary incision and fixation of the skin with subcutaneous interrupted sutures to the sternal periosteum.

Cryptotia is the fourth most common congenital auricular deformity, and it is more prevalent among Asians. A number of techniques for its correction have been introduced, and relatively favourable results have been achieved. We describe our experience with a technique for its correction using the square flap method designed on the temporal scalp and skin over the auricle. From 2001 to 2006 a total of 19 examples in 12 patients were treated. Seven patients had bilateral, and five had unilateral, cryptotia. Traction was applied to the upper part of the auricle to draw it away from the scalp, and the square flap method, consisting of two triangular flaps and one square flap, were designed on the temporal scalp and skin over the auricle. After the skin had been incised, the three flaps were freed completely, and the abnormal insertion of the auricular intrinsic muscles was detached. The flaps were then transposed, advanced, and sutured. There were no problems of viability in any patient, and all healed well. The follow-up period was 3 months to 2 years, with relatively favourable results. Function and appearance were satisfactory in all patients. The length of the helix was extended, and it was possible to increase the width of the upper part of the auricle. This technique is indicated in cases of mild to moderate cryptotia, and has many advantages, including simple and easy design, provision of enough skin for the upper and posterior portions of the auricle, sufficient depth of the auriculocephalic sulcus, and no additional skin grafting.

Incomplete recovery of function and neuropathic pain are common problems after peripheral nerve injury. To develop new treatment strategies for peripheral nerve injuries we investigated whether the neurotrophic factor artemin could improve outcome after sciatic nerve injuries in rats. Artemin is a member of the glial cell line-derived neurotrophic factor (GDNF) family and exerts neuroprotective effects on sensory neurons as well as influencing behavioural thermal sensitivity. We additionally evaluated if fibrin sealant, which is sometimes used as a nerve glue, had any effects on neuropathic pain-related behaviour. After the sciatic nerve had been transected, 30 animals were randomised to one of three groups: treatment with a fibrin sealant that contained artemin in conjunction with sutures; fibrin sealant with no artemin (sham) in conjunction with sutures; or sutures alone (n=10 in each group). Motor function, sensory function, and autotomy were evaluated from 1 to 12 weeks after injury. Retrograde flourogold tracing 12 weeks after injury showed that the addition of artemin increased the number of regenerating motor neurons. However, it did not improve their performance, as measured by the Sciatic Function Index, compared with sham or suture alone. Animals treated with artemin had a non-significant increase in motor nerve conduction velocity compared with sham. However, artemin did not reverse nerve injury-induced pain behaviour such as cold or heat hypersensitivity. Fibrin sealant in itself did not ameliorate motor performance, or regeneration of motor neurons, or give rise to nerve injury-induced pain behaviour. The results indicate that artemin is of value as a treatment for peripheral nerve injuries, although the effects were limited. As the artemin high-affinity receptor GFRalpha-3 is present in Schwann cells and not in motor neurons, the effect on motor neuron axon regeneration may result from an indirect effect through Schwann cells in the injured nerve.

Our aim was to find out if a modified intravenous regional anaesthetic block technique, used for invasive surgical procedures on the distal forearm and hand, results in a drier operative field than traditional methods. Twenty consenting adult (age > 18) patients who were to have an operation on the distal forearm or hand were randomised into two groups (n=10 in each). The first group was using a traditional bier block, with a double upper arm tourniquet. The second group was using a modified regional anaesthetic block technique, with a single upper arm tourniquet, and a single forearm tourniquet. All operative fields were recorded photographically and judged by the operating surgeon as "wet" or "dry". Analgesic requirements and subjective pain were recorded. Plasma lignocaine concentrations were measured. "Wet" operative fields were seen in 6 of the conventional and 0 of the modified group (p=0.01). Patients in the modified group were more comfortable during the procedures (p=0.004). This benefit was not sustained postoperatively (p=0.57). Plasma lignocaine concentrations were higher in the conventional group (p=0.004). The modified technique was as safe as the conventional technique but has the benefits of a drier surgical field and improved intraoperative comfort for patients.

Sclerotherapy is effective in the treatment of vascular malformations. However, in lesions with relatively high blood flow, its effect is not always adequate. We therefore developed a three-grade classification of vascular malformations to facilitate the selection of treatments according to vascular flow. We also developed the technique of embolosclerotherapy, in which transarterial embolisation is done before sclerotherapy to control blood flow in the lesion during sclerotherapy. We now have 14 years' experience with 112 cases of vascular malformations of the head and neck treated with sclerotherapy. Results were evaluated with pretreatment and post-treatment photographs, and reduction of volume was calculated on findings from magnetic resonance imaging. Clinical improvement in 110 cases was graded as excellent in 32 (29%), good in 48 (43%), fair in 19 (17%), and poor in 11 (10%). In 84 cases, mean rate of reduction of volume was 35%. The most common complication was haemolytic haemoglobinuria (n=37, 33%). Our results suggest that this three-grade classification is useful to judge resistance to sclerotherapy and decide on treatment. Our experience indicates that ethanolamine oleate (EO), with or without arterial embolisation, was effective using our classification of vascular dynamics. We consider EO to be equivalent or superior to other sclerosants such as ethanol.

We report two cases of disseminated blastomycotic infections with involvement of the hand occurring in the absence of identifiable risk factors.

We investigated the effects of direct gradual lengthening of the distal stump of a peripheral nerve and subsequent nerve regeneration in rats. A segment 10 mm long was resected from rat sciatic nerve. The distal nerve stump was fixed to a ring and pulled directly at a rate of 1 mm/day using an original external nerve distraction device. After distraction for 10, 15, and 20 days, the lengthened nerves were evaluated macroscopically and immunocytochemically. At day 20, the mean (SD) distances from the ring to the 3 mm and 6 mm distal part, which were marked with sutures on the epineurium, were 7 (0.5) mm and 12.1 (0.5) mm, respectively, and the number of Schwann cells in the lengthening group had increased to twice that of control group. The distal stump of a peripheral nerve including the epineurium, endoneurium, and proliferation of Schwann cells can be lengthened directly. This method also made it possible to lengthen the nerve stump longitudinally and to control both the rate and distance. We think that this method may be used in the treatment of peripheral nerve injury.

Forty-three women had reduction mammaplasty during the period 1992-2000 and the cosmetic outcome was evaluated using subjective and objective measures. The inferior pedicle technique was used in all cases. The mean (SD) weight of resected tissue was 1121 (415) g. All objective measurements were within the ideal range except for breast volume and nipple-to-inframammary-line distance, which were more than ideal. Overall, the median difference in measurements between the two breasts of each woman was less than 10%. However, the subjective evaluations given by both clinicians and the patients for overall symmetry and for general aesthetic appearance fell below the preset threshold. The shape of the breast correlated best with the grades of symmetry and general appearance. There was no correlation between the objective and subjective evaluations of symmetry. The disappointing subjective scores, which may be attributed to the specific characteristics of our sample group, are heavy breasts and overweight patients, a double team approach, and the inevitable pseudoptosis that develops with the inferior pedicle approach. These direct us to recommend searching for an alternative operative technique and to evaluate its long term results, as well as placing the nipple-areola complex lower than the standard inframammary fold projection.

To improve the shape of the cleft lip nose preoperatively, we have developed the nasal alar elevator. This has been used routinely since 1996 on all our cleft lip patients who have an asymmetrical nose, from the first week after birth until the date of primary lip surgery. We present our 11-year-long experience of using the device on patients born with complete, unilateral cleft lip. In this study 56 children, born between 1996 and 2006 inclusive, with complete unilateral cleft lip, had preoperative treatment with the elevator. During this 11-year period, continuous evaluation during the preoperative period, and its effects on the cleft lip nose, were evaluated, both preoperatively and postoperatively. Our results show that the preoperative use of the device has led to less need for primary nasal surgery. Instead of having to have a primary rhinoplasty (McComb) together with a lip plasty, as a routine, now only about 30% of the patients need primary surgical correction of the nose. If nasal correction is needed, a rather limited undermining of skin over the ala on the cleft side will often be sufficient. The use of a nasal elevator reduces both the length and the extent of the primary intervention, without compromising the final result.