A novel use for the biodegradable temporizing matrix.

Biodegradable Temporising Matrix (BTM), a skin substitute, has been recently developed as a novel adjunct to the plastic surgeon's reconstructive repertoire. Its use has been described in literature in a variety of settings and complex wounds, including those that previously would have been described as "non-graftable", with favourable outcomes. We present the case of a patient with a wound to the right foot and ankle following extravasation injury. Following surgical debridement, this injury was managed with BTM, which allowed granulation and production of a "neo-dermis". A split-thickness skin graft was subsequently applied. The characteristics of the BTM allowed the resulting skin graft and scar to be pliable, avoiding tendon tethering and joint contracture. To the authors' knowledge, this skin substitute has not been reported in a wound of this aetiology before. It is our hope that this report will provide evidence to colleagues that this is a valuable adjunct that may be used in complex wounds. Level of evidence: Level V, therapeutic study. Supplementary Information: The online version contains supplementary material available at 10.1007/s00238-022-01964-z.

A stacked technique of mastopexy: volume redistribution mastopexy with inferior flap and superomedially based pedicle.

BACKGROUND: Many mastopexy techniques focus on lifting the position of the nipple and excising the skin, with less attention paid to redistributing the uplifted volume of the ptotic breast. With the inferior pedicle technique, the onus is placed on skin taking the tension for the whole breast. Skin stretch then may lead to pseudoptosis. METHODS: With the advent of breast suturing, breast volume can be reshaped and lifted with less reliance on skin tension to maintain the lifted breast position. Since 2006, the senior author (G.J.O.) has applied these breast suturing and oncoplastic breast reconstructive techniques to mastopexy. By creating more than one flap/pedicle of the breast tissue, breast parenchyma can be redistributed more successfully towards the upper pole. The authors make no claim to originating this principle, which has been used by many plastic surgeons over the years, but they wish to explain their version of the technique that has evolved over the last 6 years. RESULTS: The authors present their arguments for this technique and discuss the relevance of improving upper-pole fullness and their concepts regarding skin re-draping. CONCLUSION: The key tenet for successful mastopexy is volume redistribution. Excision of skin is the secondary consideration. A natural-appearing breast shape can be achieved with this technique. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bilateral supraclavicular swelling: an unusual presentation of ruptured Poly Implant Prosthese (PIP) breast implants.

Breast implants manufactured by the French company Poly Implant Prosthese (PIP) have gained notoriety in the International media since the realisation that industrial grade silicone was used in their manufacture with consequent increased risk of implant rupture. At present, it is estimated that there are estimated to be over 40,000 women in the UK with PIP implants. We report an unusual presentation of PIP breast implant rupture as swelling in the supraclavicular fossae. This has not previously been reported in the literature.

The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma: Case Series and Literature Review.

SUMMARY: With advancing techniques, knowledge, and training, the decision to salvage a lower limb following severe trauma is becoming ever more popular and successful. However, in cases where amputation is inevitable due to extensive injury or infection, we encourage the use of the very long posterior tibial artery (VLPTA) flap when the sole of the foot and posterior tibial neurovasculature are intact. We report 3 patients who underwent below-knee amputation and reconstruction using the VLPTA flap. A literature review was also performed to identify the outcomes and any complications associated with VLPTA flap.