[Endoscopy and plastic surgery]. / Endoscopie et chirurgie plastique.

The advances of endoscopic techniques in plastic and reconstructive surgery are presented and compared to other specialties. Some typical applications of endoscopic plastic surgery are illustrated in details. Endoscopy is at the point of becoming a major new tool in the hands of the plastic and reconstructive surgeon, allowing him to take an important step towards minimal invasive surgery in an field that has always attempted to reduces trauma and scars.

[Leiomyosarcoma of the breast 16 years following successful treatment of a rhabdomyosarcoma of the orbit in childhood]. / Leiomyosarkom der Mamma 16 Jahre nach erfolgreicher Behandlung eines Rhabdomyosarkoms der Orbita im Kindesalter.

A case of a mammary leiomyosarcoma in a 23-year-old woman is presented. The tumor appeared 16 years after successful treatment of an embryonal rhabdomyosarcoma of the orbit. Rhabdomyosarcomas are the most frequent soft tissue tumors of childhood, the orbit and the paratesticular region being the most common primary site for this tumor. In contrast, leiomyosarcomas other than those evolving from the viscera or the urogenital organs are rare neoplasms at any age. With the improvement of cancer treatment and survival rates, the risk of late effects after successful treatment for malignant tumors during childhood is increasing. Growth, development and fertility may be impaired and cosmetically disturbing facial and dental complications are common. Development of novel primary tumors is a known further consequence of successful treatment of brain tumors, retinoblastoma and acute leukemias. This is the case when high dose local radiation therapy and/or chemotherapy, especially alkylating agents, were used. Development of novel primary tumors is also known after treatment of childhood rhabdomyosarcomas. This report is intended to show that a second primary tumor may occur many years after a first successfully treated malignant neoplasm, and that young people are at risk for development of tumors at sites that are uncommon to this age group.

The surgical anatomy of the dorsal carpal branch of the ulnar artery: basis for a neurovascular dorso-ulnar pedicled flap.

In order to design a neurovascular flap from the dorso-ulnar aspect of the midhand for pedicled transfer to adjacent or distant locations, the surgical anatomy of the dorsal carpal branch of the ulnar artery (DCBUA) was studied in 12 cadavers. The DCBUA was identified in all specimens. It originates from the ulnar artery 1.6 to 4.4 centimeters proximal to the ulnar styloid, passing deep to the flexor carpi ulnaris tendon, and spirals superficially to the extensor retinaculum around the ulnar border of the wrist. Its terminal branches supply an undetermined area of skin overlying the ulnar metacarpals and the ulnar hypothenar region, either by direct cutaneous supply (3/12 specimens) or by septo-cutaneous perforators (8/12 specimens). The DCBUA is closely related to the dorsal sensory branch of the ulnar nerve, with which it supplies a common neurovascular territory.

Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting.

Displaced, comminuted fractures of the thumb carpometacarpal joint were treated by intermetacarpal external fixation, anatomic reduction of the joint surfaces, bone grafting and adjunctive internal fixation in thirteen patients. Retrospectively, at an average follow-up time of 35 months, nine patients showed a good result and one patient had a fair result. All fractures had united without secondary displacement, but focal irregularities of the joint surface were commonly seen. As compared with the uninvolved side, axial rotation averaged 79%, radial abduction 89%, key pinch 88%, and grip strength 81%.

[Missed and iatrogenic nerve lesions in surgery]. / Die Problematik der übersehenen und iatrogenen Nervenläsionen in der Chirurgie.

Missed and iatrogenic nerve lesions are not encountered very often. Nevertheless, they represent an increasingly important subject because of their implications for the patient and the physician and their legal aspects. We present an overview of the patients with missed or iatrogenic nerve lesion treated at the Division for Plastic and Reconstructive Surgery of the Inselspital in Berne from 1980 to 1989. After a look at the legal aspects a few typical lesions and their treatments are illustrated. The diagnosis of a missed or iatrogenic nerve lesion differs in no way from that in other nerve lesions. Therefore, we favor an early surgical revision in all cases where the possibility of a transsected nerve must be suspected postoperatively.