摘要:

Nasal reconstructions with midline forehead flaps are often plagued by inadequate tip projection and excessively thick alar rims. These problems can be overcome by a combination of preliminary tissue expansion, which gains extra length, and delayed pedicle separation, which allows aggressive thinning of alar rims and shaping of the tip while its blood supply is still fully intact. Only when tip-shaping is completed is the pedicle divided and the reconstruction completed. In our experience this combination of increased flap length and improved tip shape has led to better tip projection and superior overall results. Three representative cases that demonstrate these principles are presented.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We present a patient in whom scapulectomy was performed to treat a huge malignant fibrous hystiocytoma of the back. Computed tomographic examination showed the tumor to have invaded the musculature of the upper back and about the scapula. To achieve adequate surgical excision, a major portion of the skin and soft tissue of the upper back was excised in conjunction with subtotal scapulectomy. The defect, with exposed vertebral spines and transected scapula, was covered with an ipsilateral latissimus dorsi musculocutaneous flap. Now, four years postoperatively, the patient has no evidence of recurrent disease and has good use of his arm. Total or partial excision of the scapula is rarely performed and poses unique problems. As our case demonstrates, scapulectomy (combined with musculocutaneous flap) is well tolerated, and surgeons should not be discouraged from using it when appropriate.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A massive cavernous hemangioma of the face has been resected using a combination of old and new techniques. The ability of the neodymium: YAG laser to cut with excellent hemostasis formed the basis for the resection. Adjuncts to the surgical excision included such high-technology modalities as laser Doppler flowmeters and tissue expanders. Flap viability was salvaged by the lowly but essential common leech. This case is presented to illustrate the fantastic array of modalities available to plastic surgeons for major resections and reconstructions.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

An interesting case of acne vulgaris complicating a free vascularized latissimus dorsi musculocutaneous flap used for heel reconstruction is presented. The development of acne in a free musculocutaneous island transfer has not been described before, and we speculate as to its cause. We conclude that quiescent donor site acne scarring may be a contraindication to the use of free skin flap transfer for soft tissue reconstruction.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A 54-year-old, right-handed man developed spontaneous rupture of his flexor digitorium profundus at the level of the lumbrical. There was no history to suggest rheumatoid arthritis, abnormality of the carpal bones, fractures, or gout. No evidence of any of these disorders was found at the time of surgery. He was treated with a “mini” interposition flexor tendon graft and regained normal motion. Although the cause of his tendon rupture is unclear, we postulate that the blood supply to the tendon at the level of the lumbrical was compromised by an undefined mechanism.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Free flaps are usually the first choice for soft tissue coverage in the distal leg. There continue to be, however, some clinical situations in which a cross-leg flap is the best choice. Use of the cross-leg flap has previously been limited by the difficulty of immobilizing both legs during the early healing stage (2 to 3 weeks). The traditional plaster immobilization or multibar external fixator system is time consuming to apply, difficult to adjust, cumbersome for nursing care, and uncomfortable for the patient. We have used the Orthofix external fixator to immobilize a cross-leg flap in 3 patients with refractory distal tibial osteomyelitis. The Orthofix dynamic axial fixator (DAF) is a single frame external fixator which, when used in a cross-leg fashion, is quick and easy to apply. It provides the necessary strength for immobilization and overhead suspension. It has few parts and is therefore lighter and less awkward both for the patient and nursing personnel and is easy to adjust on the ward or in the clinic. The DAF has two modes: locked (static) and released (dynamic). The locked mode can be easily adjusted to alter tension on the healing flap. As the flap matures the dynamic mode allows the frame to slide, decreasing muscle spasms and increasing flap movement. The DAF also provides better soft tissue access for flap observation and nursing care. Few transfixation pins are needed, decreasing the chance of pin tract infection. When a cross-leg flap is required, use of the DAF for immobilization circumvents many of the previous problems with both-leg immobilization.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Werner's syndrome is a rare condition of autosomal recessive inheritance associated with features of accelerated aging. We describe 2 patients whose elbow defects were repaired with muscle flap or distally based ulnar recurrent artery flap. Protein analysis for the biopsied skin showed a remarkable increase of abnormal proteins in the range from 40,000 to 60,000 molecular weight. An abnormally low-molecular-weight protein in serum was also detected in the patient, but no abnormal proteins were seen in the urine. It is suggested that Werner's trophic ulcer can be repaired by ordinary skin flap, and we conclude that some abnormal proteins are produced in the Werner's skin and serum.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Aggressive thinning of the muscle from the pedicle of a gastrocnemius musculocutaneous flap can change the nature of that pedicle radically. Instead of being bulky and causing contour deformity, the pedicle is reduced to a vascular leash that has virtually no effect on contour at all. Radical thinning of this type was performed on the pedicle of a medial gastrocnemius flap in one patient and on a lateral gastrocnemius flap in another. Both flaps survived, suggesting that such aggressive muscle thinning is feasible and that a more moderate degree of muscle thinning, which is all that most flaps probably require, entails only minimal risk.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Two patients with an ear defect, each reconstructed with a reverse-flow postauricular arterial flap are presented; one defect was caused by accidental exposure of bare cartilage at the posterior helix and the other by traumatic loss of earlobe. After the flaps were transposed, a line of auditory signals was dictated by Doppler probing, which suggested the presence of reverse blood flow in the flaps from the anteroauricular vessels. We believe that the reverse-flow postauricular arterial flap is a reliable and convenient optional tool in the reconstruction of auricular defects.

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1989

数据来源: OVID