Bilateral below knee amputation following septicaemic foot gangrene may be avoided by limited amputation and bilateral immediate free flap reconstruction. This technique results in reduction in morbidity and early mobilisation.
Bilateral below knee amputation following septicaemic foot gangrene may be avoided by limited amputation and bilateral immediate free flap reconstruction. This technique results in reduction in morbidity and early mobilisation.
The purpose of this study was to confirm whether lower scleral show is caused by the disinsertion of the levator aponeurosis from the tarsus. Aponeurotic advancement by vascular clips or by surgery involving the orbital septum significantly lowered the global position in the orbit and significantly diminished the degree of retraction of the lower eyelid, resulting in satisfactory improvement of lower scleral show in 100 patients with various aponeurotic blepharoptosis. Therefore, we propose the pathogenesis of lower scleral show as follows: additional contraction of the levator muscle to compensate for the disinsertion of the levator aponeurosis from the tarsus for maintenance of an adequate visual field is accompanied by additional contraction of the superior rectus muscle through the strong intermuscular fascia, resulting in upward rotation of the globe. To maintain the horizontal visual axis and foveation without inclination of the head in the primary gaze position, additional contraction of the inferior rectus muscle is induced, which pulls upon the inferior suspensory ligament of Lockwood and the capsulopalpebral fascia. The former displaces the globe upwards and the latter retracts the lower eyelid, resulting in dynamic lower scleral show as a sign of disinsertion of the levator aponeurosis from the tarsus, which can be surgically corrected.
Necrotising fasciitis is a fulminant and life-threatening infection. It is associated with a high mortality rate and is often seen in the aged and immunocompromised patients. Liver cirrhosis is regarded as a risk factor of necrotising fasciitis. From January 1995 to December 2003, 17 cirrhotic patients who had been admitted to our hospital for necrotising fasciitis were identified. The infection all developed in the lower extremities. Only six patients survived, and the overall case fatality rate was 64.7%. The cases were divided into two groups: survivors and nonsurvivors. Comparisons were made on age, gender, presenting symptoms, underlying medical diseases, laboratory data and clinical course. Underlying diabetes mellitus and grade C liver cirrhosis were the only statistically significant factors that led to poor prognosis (p<0.05).
Repair of scalp defects using a superficial temporal fascia pedicle VY advancement scalp flap, which is supplied by superficial temporal vessels, is reported. This method has been used in seven cases of scalp defects, and enables us to provide primary closure of the defects with hair-bearing scalp skin. This method is simple, easy, and reliable.
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