Super Digit: More Than a Complicated Syndactyly.

Super digits are a rare hand malformation, first described by Virchel Wood. Surgical intervention to try to make two fingers out of a super digit has been discouraged. Here, we present a variant of a super digit type IC2 and propose a revision of the characteristics in each super digit subtype. In our view, this adjustment in Wood's original description could facilitate the identification of super digits, which are a contraindication to syndactyly release.

XCM Biologic Tissue Matrix xenograft and autologous micromucosa graft for vaginal reconstruction in Mayer-Rokitansky-Küster-Hauser syndrome.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome can be treated through numerous surgical and nonsurgical methods. We present a surgical technique in which a neovagina was reconstructed and shaped by a vaginal expander with acellular porcine dermal matrix (XCM Biologic Tissue Matrix) and mucosal interposition using microfragments harvested from the hymen. In our case, we found this procedure to be safe and effective, resulting in satisfactory sexual function and good cosmetic results, without donor site morbidity. To our best knowledge, this tissue-engineered biomaterial has never been used for vaginal reconstruction before.

Giant fibroepithelial vulvar polyp in a pregnant woman.

Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.

Analysis of Extended Deep Fat Pad Excision in Abdominoplasty.

BACKGROUND: Because abdominoplasty flap's major vascularization is suprafascial, some surgeons perform excision of the deep fat pad below Scarpa's fascia to achieve a better abdominal contour and balance the lower abdominal projection above and below the scar. The dimensions of this excised adipose flap and its correlations to both the classic abdominoplasty flap and patient biometrics have not been studied yet and are the aim of this article. Short-term complication outcomes are also reported. METHODS: We performed a prospective case series study, operating 74 consecutive women using an otherwise standard abdominoplasty technique, and recorded patient variables, flap dimensions, and complications. RESULTS: Average values are as follows: BMI, 27.35 kg/m; total flap weight, 1868 g; adipose flap weight, 157 g (corresponding to 9% extra flap weight); adipose flap height, 7.2 cm; and preserved infraumbilical deep fat pad thickness, 7.7 mm. Statistical analysis of correlations between variables was performed. CONCLUSIONS: Increased patient weight, umbilical perimeter, BMI, and width of the operative specimen can be used to predict a heavier extra adipose flap. The extra fat excision is safe, preventing inadvertent invasion of the abdominoplasty flap's suprafascial plane that can happen with liposuction. No flap necroses were observed. The use of this technique may prove useful to achieve a slimmer abdominal contour and harmonize it with the pubic region.

Madelung Disease Affecting Scrotal Region.

Madelung disease is an uncommon disease characterized by large subcutaneous adipose masses. Mediterranean countries show higher disease incidence. We review the current concepts concerning this pathology, including etiology, diagnosis, and treatment. Madelung disease usually affects the upper half of the body, but we describe a patient with scrotal lipomas. As this location is rare, we review the cases found in literature, as well as the specific nuances regarding local symptoms and treatment.

Surgical resection of invasive adenoid cystic carcinoma of the lacrimal gland and wound closure using a vertical rectus abdominis myocutaneous free flap.

A 64-year-old man presented with a 3-month history of recurrent conjunctivitis. He was evaluated by an ophthalmologist and submitted to a CT scan that revealed an intraconic mass with invasion of the lateral orbital wall. He was operated, the mass was completely removed (with preservation of the intraorbital structures) and the lateral orbital wall rebuilt. The histopathological analysis revealed an adenoid cystic carcinoma of the lacrimal gland. 4 months later a painful recurrence of the lesion was diagnosed with invasion of the orbital roof and eyelids. After a multidisciplinary discussion and request from the patient, an exenteration of the orbit and removal of the lateral and superior orbital wall and dura mater was performed with the objective of a total resection. The wound and orbit were closed with a vertical rectus abdominis myocutaneous free flap to ensure closure.

Isolated Robin sequence in siblings: review of current concepts.

Robin sequence is a condition that includes the triad of micrognathia, glossoptosis and upper airway obstruction, although many authors now consider that cleft palate is also an important part of the sequence. It can be classified as isolated, syndromic or associated with other anomalies without an identifiable syndrome. A possible genetic cause for isolated Robin sequence is yet under preliminary investigation, and the finding of siblings with the same condition, as are the two children we present in this work, is extremely rare, with only nine similar cases previously described. Our article includes the description of the treatment plan and outcome for both children. We review the current concepts and trends of epidemiology, genetics, diagnosis and different treatment options available. We conclude that in cases of failure of more conservative measures in the first weeks, mandibular distraction osteogenesis may be a good and rational option for the management of isolated Robin sequence, as is currently supported in recent literature, providing a reliable way of avoiding tracheostomy.

[The use of endoscope in maxillo-facial trauma]. / O uso do endoscópio em traumatologia maxilo-facial.

The authors discuss the endoscopic techniques as an adjunctive in the evaluation and treatment of maxillo-facial fractures, particularly in the mandible, with special attention to the reduction and osteosynthesis near the condyle for those fractures with clear surgical indication. And also as a support in to the correct execution of the transbuccal techniques for treatment of body and angle fractures and in the repair of the orbital floor. The perspective of this work is the systematic search for quality, with diminution of iatrogenic effects and surgical risk, aims of modern surgery, even if with some technical difficulties and consumption of extra time, efforts.

[Edentulous mandible fractures osteosynthesis]. / Osteossíntese de fracturasem mandíbula edentúlea.

The edentulous mandible fractures are rare representing less then 5% in the majority of series. Their treatment represents nevertheless a challenge. The bone atrophy that happens in this situation is related with the higher incidence of treatment complications demanding some special attention to the therapeutic options. In contrast with the dentulous mandibles, tension and compression zones are in close proximity, allowing the application of only one plate for the fracture treatment. It is preferable to use screws without pretapping, and the rule that the weaker the bone, the stronger the plate must be is used, associated with the cautious use of cancellous bone grafting whenever the atrophy is marked or some bone is missing. Only with these measures is possible to reduce.