Reverse Dermis Flap for Coverage of Distal Leg and Ankle Defects.

Soft tissue defects of the distal third of the leg and ankle, which frequently expose tendon, bone or osteosynthesis material, are difficult to cover and pose a major challenge to the plastic surgeon. Traditional reconstructive options for this region usually require complex flaps which made them unsuitable for elderly patients or those with multiple comorbidities. We hereby present the reverse dermis flap as an easy and reliable choice to cover this type of wounds and refer our experience in 9 cases in which clinical, operative, and follow-up data were recorded. Of the 9 flaps performed, 8 survived completely and 1 presented a partial flap necrosis, requiring additional surgery. No other operative procedure was required. In conclusion, the reversed dermis flap is a simple, quick, noninvasive, and safe technique for coverage of noble structures such as tendon or bone in the distal third of the leg that every plastic surgeon should incorporate in his surgical armamentary.

Punctual Breast Implant Rupture following Lipofilling: Only a Myth?

BACKGROUND: Lipofilling techniques are widespread in clinical practice as a complement to breast reconstruction, despite posing some risk. Punctual implant rupture following a fat transfer is one of the possible complications, which has not been properly reported yet and is probably being underdiagnosed. The aim of this paper is to report key facts for appropriate diagnosis of this clinical chart. CASE REPORT: We present the case of a 47-year-old woman with a bilateral prosthetic breast reconstruction who was treated with autologous fat graft for upper pole enhancing and scar improvement. The patient developed an early unilateral breast capsular contracture after the fat graft procedure, with normal radiological exploration. Surgical findings showed intraprosthetic fat deposits and a punctual implant rupture. CONCLUSIONS: Punctual breast implant rupture is a possible complication of lipofilling that is usually not suspected at first consultation and might be underdiagnosed based on radiological findings, so investigating clinical signs should necessarily be a prerequisite to diagnosis.

Circumferential Pharyngoesophageal Reconstruction and Total Larynx Preservation with Extra-anatomical Free Flaps.

Reconstruction of total circumferential pharyngeal defects following caustic or stenosant lesions of the pharynx present major challenges with respect to minimizing surgical morbidity and restoring functional deficits. With recent advances in microvascular free tissue transfer, the options for pharyngeal reconstruction have multiplied in order to maximize swallowing and voice. There is long experience in the reconstruction of the pharynx and the cervical esophagus in oncological patients after total pharyngolaryngectomy, but there are not many publications concerning circumferential pharyngeal reconstruction preserving the larynx. Here, we discuss 2 new techniques for total circumferential pharyngeal reconstruction respecting swallowing and voice by means of extra-anatomical bypasses (visceral or fasciocutaneous), upholding the larynx in its original placement.