British journal of plastic surgery最新文献

Haemangiomas usually can be identified by their clinical course. They are characterised by presentation at birth or shortly thereafter, and a rapid proliferative phase over the first 12 months. The haemangioma then usually stabilises and slowly involutes over a period of 5–7 years. For a long time, surgery has been limited to complicated cases, and correcting after-effects following involution. Nevertheless, aesthetic, psychological or functional prejudices may justify early surgery.

We conducted a retrospective study of patients treated between 1995 and 2001. A total of 31 patients with facial and cervical haemangiomas were studied. For each, the type of lesion and its topography, age and operative indications, surgery, postoperative complications and aesthetic and functional results have been considered.

Thirty-one haemangiomas were operated. The average age was 30 months (1–60 months). After an average follow-up of 3 years, the results were very good in 20%, good in 66%, and fair in 14% of cases.

Early curative surgery of haemangioma before spontaneous involution, and before school-age is justified because of social and psychological considerations in infants and their family.

Objectives

This study aims to investigate the effect of collagen matrix impregnated with bone marrow on wound healing angiogenesis in an effective microcirculatory model and to describe our clinical experience.

Methods

We used a skinfold chamber of original design which visualises microcirculation following wound creation on the dorsal skin of the mouse to establish an in vivo experimental model to estimate angiogenesis. Animals were divided into two groups: a bone marrow group (n=6) in which bone marrow-impregnated collagen matrix was applied to the wound; and a control group (n=7), in which collagen immersed in saline was applied, and functional capillary density was quantified during the repair process.

Results

The increase rate in functional capillary density during wound healing significantly increased in the bone marrow group on days 3, 5 and 7 after creation of the wound but no significant difference was detected on day 10. A patient with a chronic leg ulcer that had not responded to conventional therapy for 1 year was treated with autogenous bone marrow-impregnated collagen matrix and successful wound closure was obtained.

Conclusion

The present study suggested that collagen matrix impregnated with bone marrow significantly promoted the repair process, especially in the early stage. The features of the treatment, including the possible use of a patient's own cells, simple method, immediate application without any processing procedure and preservation of the inclusive potentiality of bone marrow suspension, offer significant advantages in terms of the anticipated routine clinical use.

Venous malformations of the face and neck involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult; high recurrence rates and high morbidity are well documented. Various methods of treatment of uncertain value and risk of complications have been advocated. We present our experience in treating five patients with venous malformation in the face and neck by using direct percutaneous ethanol sclerotherapy. Four patients had large lesions (≥3 cm; one patient had two large lesions in the low eyelid), and the other had a mid-sized lesion (1.5–3 cm). Under general or local anaesthesia, one-third to one-quarter cavity volume of ethanol was injected percutaneously, directly into the malformation with under fluoroscopy [de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg 1995;30:188–93; Johnson PL, Eckard DA, Brecheisen MA, Girod DA, Tsue TT. Percutaneous ethanol sclerotherapy of venous malformations of the tongue. Am J Neuroradiol 2002;23:779–82; Pappas DC Jr, Persky MS, Berenstein A. Evaluation and treatment of head and neck venous vascular malformations. Ear Nose Throat J 1998;77:914–22; Lee CH, Chen SG. Direct percutaneous ethanol sclerotherapy for treatment of a recurrent venous malformation in the periorbital region. ANZ J Surg. 2004;74(12):1126–7. 1, 2, 3, 4]. Four patients required two injections. All patients had remission and alleviation of their symptoms, with no major complications. Direct percutaneous injection of absolute ethanol provides a simple and reliable alternative treatment for venous malformation in the face and neck.

A vascularised bone graft from the medial femoral condyle was used to correct a recurrent failed arthrodesis of the index finger distal interphalangeal joint. The flap was based upon the articular branch of the descending genicular artery. Union was confirmed 3 months after surgery.

Macrodactyly is a relatively rare congenital abnormality of the fingers and toes and is difficult to treat. We report a new method for treating toe macrodactyly in which a nail with a vascularised pedicle is raised, the toe is shortened to an appropriate length, and the nail transferred to an aesthetically appropriate proximal site. Although this technique is of a higher level of difficulty than conventional procedures involving pedicled nail flaps, allows aesthetically more favourable nail reconstruction by single-stage operation.

The technique of lengthening of the pedicles of the rectus abdominus and latissimus dorsi free flaps are described in five patients.

Lengthening of these pedicles allowed scalp reconstruction using the external carotid artery and internal jugular vein as the recipient vessels without the need for interpositional vein grafts or arterio-venous loops. Post-operative recovery was uneventful in all cases.

Therapeutic mammaplasty, the use of reduction mammaplasty and radiotherapy to surgically treat breast cancer, is an established technique for selected breast cancers and can extend the role of breast conserving surgery. Most frequently described is the use of a wise pattern reduction for tumours that lie within the expected mammaplasty excision. However, mammaplasty techniques can be safely adapted to treat patients with cancers in all areas of the breast. An approach to selection and planning surgery is presented which has evolved from the experience of other units and our first 50 clinical cases over a 3-year period. The outcomes of these 50 cases are found in the accompanying article.

Technique will vary depending upon the tumour position. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B). In scenario A, a range of recognised techniques can be performed without adaptation to widely excise the tumour and re-shape the breasts. In scenario B the techniques need to be adapted. Three decisions are needed for planning in scenario B; the skin incision, the nipple-aereola complex (NAC) pedicle orientation and finally the method of filling the cancer defect. The latter can be achieved by either extending the nipple pedicle or by creating a secondary pedicle within the breast dissection. Either method will move tissue that is normally excised into the cancer defect. For central tumours an inferior pedicle is usually used to both fill the defect and re-create the nipple.