Reconstruction of the chin using an expanded deltopectoral flap following multiple recurrences of oral cancer.

An important alternative to free tissue transfer in patients requiring correction of soft tissue chin defects are local and regional flaps, such as the pectoralis major myocutaneous flap and deltopectoral flap. With predictable vascular supply, potential for large size, and good aesthetic match for facial and cervical skin, the deltopectoral flap can offer the reconstructive surgeon additional options in patients who lack vessels suitable for free tissue transfer. The use of an expanded deltopectoral flap for a staged reconstruction of the chin in a patient with cancer recurrences, concomitant resections, radiation and multiple reconstructions is reported.

Les lambeaux locaux et régionaux, tels que le lambeau myocutané du grand pectoral et le lambeau deltopectoral, constituent une solution de rechange importante au transfert de tissus libres chez les patients qui ont besoin de faire corriger des anomalies des tissus mous du menton. Étant donné son alimentation vasculaire prévisible, sa grande dimension potentielle et sa correspondance esthétique avec la peau du visage et du cou, le lambeau deltopectoral peut offrir au chirurgien en reconstruction des possibilités supplémentaires auprès des patients dont les vaisseaux ne conviennent pas au transfert de tissus libres. Les auteurs décrivent le recours à un lambeau deltopectoralé largi dans le cadre d'une reconstruction graduelle du menton chez un patient subissant des récurrences de cancer, des résections concomitantes, une radiation et des reconstructions multiples.

Giant lipomas of the upper extremity: Case reports and a literature review.

Giant fibrolipomas involving the upper extremities are rare tumours. These large masses grow slowly and produce symptoms due to their size, location and compression of adjacent structures. Surgical excision usually leads to complete recovery from symptoms.

Les fibrolipomes géants des membres supérieurs sont des tumeurs rares. Ces grosses masses croissent lentement et provoquent des symptômes imputables à leur dimension, à leur foyer et à leur compression des structures adjacentes. En général, l'excision chirurgicale s'associe à une résolution complète des symptômes.

Intraneural lipoma of the ulnar nerve at the elbow: A case report and literature review.

Intraneural lipomas of the ulnar nerve or its branches are rare benign tumours. Although most intraneural lipomas present as asymptomatic tumours, some may present as compression neuropathies due to their location. In the majority of cases these tumours can be enucleated without damage to the nerve fibres.

Les lipomes intraneuraux du nerf ulnaire ou de ses branches sont des tumeurs bénignes rares. Même si la plupart des lipomes intraneuraux sont asymptomatiques, certains peuvent s'associer à des neuropathies de compression attribuables à leur foyer. Dans la majorité des cas, on peut énucléer ces tumeurs sans endommager les fibres nerveuses.

Acute carpal tunnel syndrome from burns of the hand and wrist.

Acute median nerve compression usually occurs from increased pressure within the carpal tunnel and forearm compartments. Although the hyperesthesia from burns may mimic symptoms of acute compression neuropathy, clinical diagnosis should be made from history, clinical signs and symptoms. Early recognition and decompression of the carpal tunnel either as part of the burn excision or along with escharotomy usually leads to full recovery.

Intraneural lipoma of the radial nerve presenting as Wartenberg syndrome: A case report and review of literature.

The superficial branch of the radial nerve is highly vulnerable to trauma, irritation and compression due to its anatomical location. Intraneural lipomas and fibrolipomas arising from the supporting tissues of this peripheral nerve can cause compression of the adjacent nerve leading to symptoms of neuritis of the radial nerve or Wartenberg syndrome.

Reversed dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe.

Soft tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. A distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to cover the soft tissue defect following wide excision of melanoma of the big toe, is reported.

Reconstruction of sacral defects following necrosis of buttocks due to embolization of internal iliac artery using a transverse lumbar flap.

Fractures of the pelvis associated with uncontrollable hypotension are managed by stabilization of fractures and arteriographic embolization of the bleeding vessels. Embolization of these arteries may result in necrosis of the buttocks. The use of a transverse lumbar artery-based flap can be used for repair of these defects.

Acute carpal tunnel syndrome as a result of spontaneous bleeding.

Acute carpal tunnel syndrome is the most common compression neuropathy of the upper extremity following trauma. A rare occurence of spontaneous bleeding into the carpal tunnel, presenting as acute carpal tunnel syndrome, is presented.

Closure of orocutanous fistula using a pedicled expanded deltopectoral flap.

Orocutaneous fistulas are associated with considerable morbidity. Closures of these fistulas are a challenge to the reconstructing surgeon. The aim of treatment is to provide healthy tissue to repair both the oral and cutaneous defects. The use of an expanded pedicled deltopectoral flap for the closure of an orocutaneous fistula in a patient who has undergone bilateral neck dissection and radiation is reported.

Dupuytren's contracture following burn injury of the hand: A case report and review of literature.

In burn patients, scar contractures adjacent to or across the joints lead to disabling deformities. In Dupuytren's disease, the proliferative process involves the fascia of the palm and fingers, resulting in disabling flexion contractures of the fingers and the palm. A single insult involving the hand or even a more proximal injury may lead to Dupuytren's disease.

Post-traumatic osteomyelitis of the clavicle: A case report and review of literature.

Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap.

The utility of deep soft-tissue cultures in diagnosing the causative agent of sternal osteomyelitis following median sternotomy.

BACKGROUND: The authors' goal was to determine whether the bacteria cultured from the mediastinal deep soft tissues matched those identified by the sternal bone cultures in cases of mediastinitis with clinically suspected sternal osteomyelitis, in hopes of eliminating the need for sternal bone biopsy. METHODS: The authors retrospectively reviewed the charts of 27 Detroit Medical Center patients who underwent median sternotomy and developed mediastinitis with clinical suspicion of osteomyelitis between 1996 and 2004. RESULTS: Although only 18 of 27 of the authors' patients had positive bone cultures, they demonstrate that in 94 percent (17 of 18) of these patients, the organisms cultured from the mediastinal deep soft-tissue cultures matched those cultured from the positive sternal bone cultures. CONCLUSIONS: With the results obtained from this study, the authors hope to promote a less-invasive means of investigating osteomyelitis in sternal wounds, to prevent the complications associated with obtaining a bone biopsy specimen in a contaminated soft-tissue setting. Instead, the authors suggest thoracic computed tomographic scanning as a noninvasive means of clinically demonstrating osteomyelitis of the sternum, and culture of the deep soft tissues of the mediastinum at the time of mediastinal debridement to determine the offending organism, if osteomyelitis is suggested by computed tomographic scan.

Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis.

BACKGROUND: The authors' goal was to demonstrate a technique of gaining added width from the right pectoralis major muscle flap through muscle fascia release, with the hope of attaining sturdier, tension-free dead space closure of the debrided mediastinum in cases of mediastinitis. METHODS: The authors measured the preincisional and postincisional widths of the right pectoralis major flap following release of the fascia in nine patients who underwent mediastinal reconstruction using pectoralis major muscle flaps from 2002 to 2004 at the Detroit Medical Center. RESULTS: The average width of the nine muscles was 16.3 +/- 1.7 cm before fascia release and 22.1 +/- 1.3 cm after release. The average increase in width was 5.8 +/- 1.3 cm, with a 95 percent confidence interval of 4.8 to 6.8 cm. A value of p < 0.0001 indicated that this increase in width was statistically significant. After fascial release, the width of the muscles increased by an average of 26.1 percent, with a 95 percent confidence interval of 21.6 to 30.6 percent. CONCLUSIONS: The authors present a new technique that can be used to gain additional width from the right pectoralis major muscle in cases of mediastinal reconstruction using the pectoralis major muscle flap. With the added 26 percent of width obtained from the right pectoralis major muscle with fascia release, the authors contend that a sturdier and tension-free closure of the mediastinal dead space can be obtained, further expanding the indications for use of the pectoralis major muscle flap as the sole closure modality in even the most complicated cases of mediastinitis.

Self-inflicted specific pattern burns in psychiatric patients.

Self-inflicted burns represent a major social and medical problem for society. Differences have been demonstrated between patients who attempt suicide and those who deliberately harm themselves without any intention of killing themselves. These self-inflicted injuries may resemble injuries that are intentionally inflicted by others and may require investigation by protective services. Little is known about these specific pattern burn injuries in psychiatric patients.

Soft tissue coverage of the knee joint following burns.

Full-thickness burns around the knee joint are usually associated with exposure of bone, tendon or ligaments. Following excision of the deep burns, there is no viable wound bed to which skin grafts can be applied. Although vacuum-assisted closure has been used to encourage granulation tissue, exposure of the tendons and ligaments following excision usually requires muscle flaps or fasciocutaneous flaps.

Use of bilateral groin flaps in the closure of defects of the perineum: A case report.

Reconstruction of perineal and groin defects is a challenging problem. Commonly used methods of reconstruction include skin grafts and local flaps. The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. Due to the location, the donor defect can usually be closed primarily, leaving an acceptable scar. The use of bilateral groin flaps for coverage of defects of the anterior perineum following excision of condylomas is reported.

Reconstruction of an abdominal wall defect following wide excision of metastatic squamous cell carcinoma at the percutaneous gastrostomy site in a head and neck cancer patient.

Cancer metastasis to an enterostomy site is a rare and serious complication. The incidence seems to be on the rise due to increased acceptance of the percutaneous endoscopic gastrostomy procedure. Because this may be associated with synchronous distant metastasis, full metastatic workup is required. Resections of these metastatic lesions require full-thickness abdominal wall reconstruction.

Intraneural lipoma of the ulnar nerve: A case report and review of literature.

Intraneural lipomas of the peripheral nerve or its cutaneous branches are rare benign tumours. These slow-growing tumours present as asymptomatic swelling, and diagnosis is usually made at the time of exploration. In most cases, these tumours can be enucleated without damage to the nerve fibres.

Acute ligation of the radial and ulnar arteries: A case report and review of literature.

Isolated injury to the radial or ulnar artery results in no significant complications in patients who undergo repair or ligation of the injured artery. However, ligation of both infrabrachial vessels of the upper extremity is associated with limb loss from ischemia due to lack of collateral circulation. A rare case of acute ligation of both the radial and ulnar arteries in a drug abuser where collateral vessels preserved the circulation to the hand is reported.

Les blessures isolées de l'artère radiale ou de l'artère cubitale n'entraînent pas de complications importantes chez les patients qui subissent une réparation ou une ligature de l'artère lésée. Par contre, la ligature des deux vaisseaux sous-brachiaux du membre supérieur se solde par la perte de celui-ci en raison de l'ischémie causée par l'absence de circulation collatérale. Voici un cas rare de ligature des artères radiale et cubitale, réalisée en urgence chez un utilisateur de drogues chez qui la circulation sanguine dans la main a été assurée par les vaisseaux collatéraux.