ABSTRACT
AIM: To identify and characterise the ideal-sized (defined as at least 2.7 mm based on the experience of plastic surgeons at Hull Royal Infirmary) perforators using magnetic resonance angiography (MRA). The study also evaluated a presumption that perforators on the left are generally larger than on the right. MATERIALS AND METHODS: Fifty consecutive patients who had undergone MRA prior to deep inferior epigastric perforator (DIEP) reconstruction were included. MRA acquisition sequences, MRA images, radiologist reports, and surgical entry database were reviewed retrospectively. Intraoperative findings were compared. The diameter and characteristics of the perforators fulfilling the criteria of being "ideal-sized", at least 2.7 mm were collected. Wilcoxon's test was used to compare the size of the left and right perforators. RESULTS: Ninety-three ideal-sized perforators were identified (diameter of 2.8-4.2 mm). Fifty-one of these were located on the left, and 42 on the right. The left perforators were indeed larger than the right (Wilcoxon's test, p=0.017). Most of the perforators were found in the superior region and medial rows. Additionally, lateral row perforators were observed to have a shorter intramuscular course. CONCLUSION: Contrast-enhanced MRA is a useful preoperative imaging technique to locate ideal DIEPs for breast reconstruction. Perforators on the left were found to be larger than the right, and more ideal-sized perforators were located on the left.
Subject(s)
Contrast Media , Epigastric Arteries/diagnostic imaging , Image Enhancement/methods , Magnetic Resonance Angiography/methods , Mammaplasty/methods , Perforator Flap , Adult , Aged , Epigastric Arteries/surgery , Female , Humans , Middle Aged , Retrospective StudiesABSTRACT
Anomalies of the flexor digitorum superficialis are rare and can present a diagnostic dilemma. Patients present with a painful or palpable mass, or symptoms of carpal tunnel syndrome. This review article summarizes previously reported anomalies of the flexor digitorum superficialis, reports a further case, and proposes a new classification.
Subject(s)
Tendons/abnormalities , Adult , Female , Hand Deformities, Congenital/classification , Hand Deformities, Congenital/surgery , Humans , Tendons/anatomy & histology , Tendons/surgerySubject(s)
Calcaneus/injuries , Fractures, Open/surgery , Myocutaneous Flap/transplantation , Soft Tissue Injuries/surgery , Adult , Debridement , Foot , Fractures, Open/complications , Humans , Male , Myocutaneous Flap/surgery , Necrosis/etiology , Necrosis/surgery , Osteomyelitis/etiology , Osteomyelitis/surgery , Soft Tissue Injuries/complicationsABSTRACT
We report a case of a 30-year-old lady who became pregnant 3 months after undergoing a DIEP breast reconstruction. There are reports of pregnancy following TRAM, DIEP flap breast reconstruction and abdominoplasty performed after breast reconstruction, however this is the only case in the literature of a pregnancy within 3 months of DIEP breast reconstruction. The literature on breast reconstruction and pregnancy is reviewed.
Subject(s)
Abdominal Muscles/transplantation , Mammaplasty/methods , Mastectomy/adverse effects , Pregnancy Complications/surgery , Surgical Flaps , Adult , Female , Follow-Up Studies , Humans , Patient Satisfaction , PregnancyABSTRACT
A case of circumferential digital skin loss with exposed tendons from the proximal phalanx to the distal interphalangeal joint is presented. This was treated with a two-layer heterodigital cross-finger ("open book") flap from the adjacent digit, utilising a skin-only cross-finger flap to cover the palmar defect and an adipofascial flap to cover the dorsal defect.
Subject(s)
Finger Injuries/surgery , Microsurgery/methods , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Surgical Flaps/blood supply , Debridement , Esthetics , Follow-Up Studies , Humans , Male , Middle Aged , Tissue and Organ Harvesting/methods , Wound Healing/physiologyABSTRACT
Fluoroquinolone antibiotics are increasingly being recognized as a cause of Achilles tendinitis and rupture. We report the case of a 62-year old man who developed bilateral Achilles tendon rupture six days following commencement of ciprofloxacin. Tendon exploration and repair was accomplished with the use of a prosthetic substitute (Leeds-Keio ligament) but healing was complicated by left wound breakdown that was successfully repaired with a perforator-based fasciocutaneous flap. A review of the current literature on fluoroquinolone associated achilles ruptures and the various methods of tendon and soft tissue management of the primary or complicated injuries are discussed.
Subject(s)
Achilles Tendon/drug effects , Achilles Tendon/injuries , Anti-Infective Agents/adverse effects , Ciprofloxacin/adverse effects , Achilles Tendon/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Rupture, Spontaneous/chemically induced , Rupture, Spontaneous/surgeryABSTRACT
A 30-year-old woman with known pseudoxanthoma elasticum was referred for surgical correction of extensive loose neck skin. She underwent a standard rhytidectomy, which produced minimal improvement. Revision surgery using a vertical elliptical skin excision, incorporating a Z-plasty was undertaken 3 months later and resulted in a satisfactory outcome.
Subject(s)
Neck/surgery , Pseudoxanthoma Elasticum/surgery , Adult , Female , Humans , Patient Satisfaction , Reoperation/methods , Rhytidoplasty/methodsABSTRACT
This study investigated the effect of a single intraoperative application of 5-fluorouracil, which may diminish peritendinous adhesion formation, on the tensile strength of repaired digital flexor tendons after 7, 14 and 21 days of healing. Twenty-seven deep flexor tendons from 14 rabbits were exposed to 5-fluorouracil (50 mg/ml) for 5 minutes immediately after repair whereas matched control tendons were exposed to normal saline. Tensile testing at 7, 14 and 21 days revealed no significant differences in the gap or ultimate strengths of the 5-fluorouracil treated and control tendons.
Subject(s)
Fluorouracil/pharmacology , Tendon Injuries/surgery , Wound Healing/drug effects , Animals , Male , Rabbits , Sutures , Tendon Injuries/physiopathology , Tensile Strength , Tissue Adhesions/physiopathologyABSTRACT
The formation of restrictive adhesions around the musculotendinous unit after injury is one of the most vexing processes faced by the surgeon. In flexor tendons it has been shown that the synovial tissue is the source of aggressive fibroblasts which contribute to this process. Using a rabbit model, we have examined the effects of treating the synovial sheath with the antimetabolite 5-fluorouracil (5-FU) for five minutes. Inflammatory, proliferative and molecular markers were compared in the response of the treated and control tendons to injury. Compared with a control group we found that the proliferative and inflammatory responses were significantly reduced (p < 0.001) in the treated tendons. Not only was there a reduction in the cellular and cytokine response, but there also was a significant (p < 0.001) reduction in the level of activity of the known pro-scarring agent, transforming growth factor beta 1 (TGF-beta1). These pilot studies indicate that the formation of restrictive adhesions may be modulated using a simple single-touch technique in the hope of producing a better return of function.
Subject(s)
Muscular Diseases/prevention & control , Tendon Injuries/complications , Animals , Cell Count , Disease Models, Animal , Fibroblasts/drug effects , Fibroblasts/physiology , Fluorouracil/therapeutic use , Hindlimb , Immunosuppressive Agents/therapeutic use , Macrophages/drug effects , Macrophages/pathology , Male , Microscopy, Electron , Pilot Projects , Proliferating Cell Nuclear Antigen/analysis , Rabbits , Random Allocation , Statistics, Nonparametric , Synovial Membrane/drug effects , Synovial Membrane/physiology , Tendon Injuries/physiopathology , Tendons/drug effects , Tissue Adhesions/prevention & control , Transforming Growth Factor beta/drug effects , Transforming Growth Factor beta1 , Vascular Cell Adhesion Molecule-1/analysis , Wound HealingABSTRACT
Using an animal model, the effect of a single intraoperative application of 5-fluorouracil on digital flexor tendon adhesions was assessed. After a standard partial division of the tendon and immobilization with a stitch, the synovial sheath in 30 rabbit tendons was treated with 5-fluorouracil solution (50 mg/ml)-soaked sponge pledgets for 5 minutes. Buffered saline was substituted for 5-fluorouracil in 30 control tendons. The tendons were harvested 1 week postoperatively, and histologic sections were assessed with a light microscope. There was a significant reduction in synovial sheath thickening (p < 0.001), cell counts (p < 0.001) and proportional length of adhesions (p < 0.001) in the treated tendons. The reduction in synovial reaction and adhesion formation using this "one touch" technique presents a novel strategy for the management of the clinical problem of postoperative adhesions complicating tendon injury and repair.