British journal of plastic surgery最新文献

We present reconstruction of a wide anterior abdominal defect measuring 30×45 cm², the result of necrotising pancreatitis. After serial debridements and reconstruction of the peritoneum using a Prolene mesh support, a delayed extended groin flap was transposed. No complications were encountered afterwards. An extended groin flap can be used safely to cover a full-thickness defect of the abdominal wall encompassing all of the anatomic subunits.

One hundred and eighty patients with 240 trigger digits were treated by percutaneous release using a ‘lift-cut’ technique. All patients were reviewed at 3 months following release. Overall, 94% achieved an excellent or good result. Ten patients experienced recurrent symptoms and required a subsequent open release. There was no clinical evidence of digital nerve or flexor tendon injury. We recommend this technique as a safe and effective outpatient procedure.

Hypospadias is more common than cleft lip and palate. However, in comparison to the latter, few units have dedicated any team to its correction. Hence, urologists, paediatric surgeons, plastic surgeons, general surgeons and paediatric urologists keep trying various methods of correcting this deformity. That more than 350 procedures have been described for the correction of one anomaly speaks volumes of dissatisfaction with the results. We describe our humble experience with this anomaly over a period of 10 years during which time we were able to treat 1415 cases. However, this paper only describes results of 1206 patients. We use universally only one technique for hypospadias repair and perform this in two stages. This technique has been described by many but lately popularised by Aivar Bracka from UK [Bracka A. A versatile two-stage hypospadias repair. Br J Plast Surg 1995;48:345–52].¹ Our overall fistula rate has been 3.8% though most of the fistulae occurred in the earlier period. Other complications included repeated UTI (3%) and hair growth in the urethra (0.2%).

Heterotopic brain tissue in a cleft palate is a very rare developmental anomaly. We present the eighth case reported worldwide with a review of the literature and suggestions on the management of this unusual condition.

The absence of nipple–areola complex is a rare entity and is always associated with other anomalies. This paper described a case of bilateral athelia without other alterations.

The atrophy of the dense mesenchyme due to absence of parathyroid hormone-related protein produced in epithelium may lead to nipple involution. Further cases should be studied to corroborate this theory.

Introduction

Burns of the hands may result in the formation of web space contractures—post burn syndactyly. We present our experience using the three-square technique originally described by Bandoh for minor syndactyly.

Method

Tissues of the contracted web are regard as forming three facets of a cube. If elevated and transposed 90° on their base the facets will fall into place and line the interior of the cube creating a deepened web-space. The first flap is based on the web itself either dorsally or volarly. The second flap is based distally on one of the fingers. The third flap is based laterally on the other finger. Surgery is followed by a splinting regimen.

Results

The design of the flaps is simple and the operation is easy to perform. This technique has achieved good functional and cosmetic results; there have been no flap losses or significant complications.

Conclusion

The three-square-flip-flap is a simple reliable and safe method for the treatment of post burn syndactyly.

A vertical rectus abdominis myocutaneous flap was used to provide cover for a recurrent angiosarcoma in the abdominal skin. Of note, the patient had 9 years previously undergone formal abdominoplasty to allow closure following excision of the primary tumour.

This flap is normally reliant on myocutaneous perforators originating from the deep epigastric system, which are divided during abdominoplasty. Despite this, the flap survived well, implying that a new blood supply had formed during the intervening years. This flap can, therefore, be considered a possible option in reconstructive cases where other options are limited, despite a preceding abdominoplasty. In the future because of the increasingly common occurrence of abdominoplasty in young females, this procedure may need to be considered.

We present a case of a large full thickness abdominal wall defect following excision of a huge basal cell carcinoma, uniquely reconstructed with a sandwich omental flap, vicryl/prolene (vypro II) mesh and split thickness skin graft.

Now-a-days, high-resolution ultrasound allows an accurate and relatively early diagnosis of congenital malformations. In a limited number of such conditions foetal surgery may be lifesaving. However, premature labour has been the major drawback for open foetal surgery. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Main clinical application of fetoscopic procedures today is the treatment of feto-foetal transfusion syndrome.

Although still in development, feto-endoscopic surgery seems to offer new hope for surgical foetal therapy not only in cases of life threatening conditions. Experimental intrauterine correction of cleft lip and palate (CLP) has been lately performed using the feto-endoscopic approach. This procedure offers two major advantages: first, scarless foetal wound healing and bone healing without callus formation, which would also allow a better/normal maxillary growth, and second, significant decrease of foetal and maternal morbidity.

Herein, we report the current status of experimental and clinical foetal surgery and propose possible directions for continuing research to make intrauterine procedures safer. Furthermore, we discuss current knowledge and new perspectives of experimental foetal cleft lip and palate repair, which in the future may lead to such excellent results in the operative treatment of clefts, that less or no secondary corrections and therapies, such as orthodontic, dental, logopedic, etc. would be needed. Only if these conditions can be fulfilled, will we be able to improve substantially our therapy for the human foetus with a cleft lip and palate. In spite of all efforts, however, it must be considered that it may not ever be possible to find the optimal treatment method for this or other craniofacial malformations.

Prediction of necrosis has a clinical relevance in all fields of plastic surgery. The new application of indocyanine green (ICG) fluoroscopy in plastic surgery allows an objective quantification of skin perfusion and a high topographical resolution. The aim of the present study is to determine threshold values for flap perfusion under well-defined experimental conditions.

Twenty random pattern flaps with a length to width ratio of 4:1 (8×2 cm²) were dissected on the anterior abdominal wall of 20 male Sprague–Dawley rats. ICG fluoroscopy was performed at the end of the operation. The animals were sacrificed at the seventh postoperative day with a reliable necrosis of the distal part of the flaps. Postoperative ICG fluoroscopy then was analysed both in regions that will survive and undergo necrosis.

At day 7 a mean area of 5.5 cm² (57% of the total flap area) survived and a mean of 3.8 cm² (43%) became necrotic. The surviving part of the flap had a mean perfusion index of 62% compared to reference skin. The distal parts of the flap that necrotised showed an average perfusion index of only 19% postoperatively. Differences were statistically highly significant (p<0.001).

Indocyanine green fluoroscopy is a useful tool to evaluate perfusion topographically and predict necrosis. From a statistical point of view a perfusion index of less than 25% of the reference skin can be considered as a sign of developing flap necrosis.