Flap repair: an effective strategy for minimising sexual morbidity associated with the surgical management of vulval intra epithelial neoplasia

Objective: To assess the sexual function after local excision and flap repair for symptomatic vulval intraepithelial neoplasia (Vin). Study Design: A retrospective analysis of five sexually active women who had persistent, symptomatic VIN diagnosed in a dedicated tertiary referral vulval clinic and treated with local excision and flap repair. Sexual function was assessed using a modified version of the Sabbatsberg Sexual Self-Rating Scoring (SRS) system. Results: The mean age of the cohort was 32 years (range 30 to 51). Four patients had previously been unsuccessfully treated with local excision. Follow up ranged from 5 to 33 months. The SRS scores were 90, 90, 81, 72 and 25. Endogenous depression may explain this last score. There has been no recurrence of VIN. Conclusion: In sexually active women with symptomatic VIN III, a flap reconstruction should be considered in addition to local excision as the treatment of choice (AU)

Surgical reconstruction of the rheumatoid hand

PATHOPHYSIOLOGY: The pathophysiology involved in rheumatoid arthritis of the hand will be discussed, focusing on the anatomical derangements of the joints that result from the disease process. The consequences of these deformities on overall had function will be addressed. SURGERY: The pioneering work in implant arthroplasty of the rheumatoid hand was done by Alfred B. Swanston, M.D., of Grand Rapids, Michigan in the 1960s. The paper will focus on the indications for surgery as well as the currently accepted surgical techniques utilized in surgical reconstruction of the rheumatoid hand and wrist. REHABILITATION: After reconstruction hand surgery, a properly supervised rehabilitation programme is essential to guarantee a satisfactory outcome in the restoration of hand function. ECONOMICS OF RECONSTRUCTIVE HAND SURGERY: In the current era of cost effective health care delivery, this type of surgery does not have to be performed in a major hospital setting. With effective regional anaesthesia and proper instrumentation, the surgery can be successfully performed in a free standing speciality clinic(AU)