Bilateral closed flexor pollicis longus musculotendinous junction ruptures.

We present a case of bilateral closed flexor pollicis longus musculotendinous junction ruptures. Our case suggests multifactorial aetiology and provides further evidence for genetic influences in musculotendinous junction injuries.

The super thin external pudendal artery (STEPA) flap.

BACKGROUND: The need for improved microsurgical reconstructive techniques is ongoing given the "ideal" free flap still does not exist. When reconstruction requires a thin flap, options have remained limited and flaps with minimal donor site morbidity that do not require secondary de-bulking have been elusive thus far. The importance of a thin and supple flap cannot be understated when dealing with challenging cases such as the dorsum of the hand or foot. This also applies to other areas such as the head and neck and over the large joints of the knee and elbow. The authors propose a previously un-described free tissue transfer based on the external pudendal artery that fulfills many of the aforementioned goals. An anatomical cadaveric study has been performed describing the super thin external pudendal artery (STEPA) flap. METHODS: Six fresh cadavers were used in the raising of eight hemiscrotal flaps and two bipedicled scrotal flaps based on the external pudendal vessels. 2 hemipelvises underwent cannulation of the external pudendal artery followed by injection of a barium sulphate/gelatin mixture and three-dimensional computed tomographic angiography to evaluate vascular anatomy. Colored-latex was injected into two raised hemiscrotal flaps. Measurements were made on the cadaveric dissections and on a computed tomography workstation. RESULTS: The average external diameter of the external pudendal artery measured 2.81 mm at its origin from the femoral artery, the vein 4.44 mm. The mean pedicle length measured 11 cm (range, 10-12 cm). The mean thickness of the flap measured 1.1 mm. CONCLUSIONS: A new free flap, the STEPA flap, has been described that is the thinnest myocutaneous free flap with over 80% of the thickness of the flap less than 1.1 mm. It has been demonstrated to have reliable anatomy with more than adequate vessel caliber. It has a large surface area and a generous pedicle length for free tissue transfer. Donor site morbidity is favorable. It is accepted that there may be cosmetic issues regarding flap pigmentation and a variable degree of hair in patients where the reconstruction is visible. We would contend that there exist many successful techniques which address pigmentation and depilation, and that this trade-off is acceptable given the functionality and characteristics of this uniquely thin flap. It has the potential to be used in many clinical scenarios where thin supple reconstruction is a high priority.

Versatility of the anterolateral thigh free flap: the four seasons flap.

UNLABELLED: Presented at the following academic meetings:○ 56th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) Fasano (Brindisi), Italy, September 26-29, 2007○ 42nd Meeting of the European Society for Surgical Research (ESSR), Warsaw, Poland, May 21-24, 2008○ Winter Meeting, British Association of Plastic, Reconstructive and Aesthetic Surgeons, (BAPRAS) London, December 1-3, 2009BACKGROUND: The anterolateral free flap has become increasingly popular at our institution year on year. We decided to review our experience with this flap and study the reasons for this trend. METHODS: A retrospective review of all anterolateral thigh free flaps performed at Addenbrooke's University Hospital from the available charts was carried out. This chart review included patients' demographics, indications, flap size, recipient vessels used, ischemia time, flap, and donor site outcomes. All flap perforator vessels were located preoperatively using a handheld Doppler ultrasound probe. RESULTS: From October 1999 to December 2008, 55 anterolateral thigh flaps were performed in 55 patients to reconstruct a variety of soft-tissue defects (upper and lower limbs, chest wall, skull base, head and neck). Flap size ranged 12 to 35 cm in length and 4 to 11 cm in width. During flap elevation, the main supply to the flap was found to be a direct septocutaneous perforator in 41% (n = 23) of the cases as opposed to a musculocutaneous perforator, which was found in 59% (n = 32). The mean ischemia time was 82 minutes (range, 62-103). The overall flap success rate was 100%. Two flaps were successfully salvaged after reexploration for venous congestion. The donor site morbidity was minimal. The mean follow-up time was 18 months (range, 2-48). DISCUSSION AND CONCLUSION: The anterolateral thigh free flap was found to be a very reliable flap (100% success) across a wide range of clinical indications. It facilitates microvascular anastomoses as evidenced by the short ischemia time. It provided ample skin with volume that could be tailored to the defect. These advantages have led to its widespread use by different consultants and trainees in our department.

Rhytidectomy approach for recurrent Madelung disease.

Benign symmetrical lipomatosis (Madelung disease) is a rare metabolic disorder characterized by the presence of multiple, symmetric, nonencapsulated fat masses in the face, neck, and shoulders. The clinical course is slow, typically one of slow progressive enlargement with cosmetic and functional sequelae. The authors describe a case in which an open surgical approach was performed to treat this disorder, with good results. There are many aspects of treatment currently lacking a consensus, and the authors discuss these, principally in relation to the location of the fat, the role of liposuction versus surgery, the staging of surgical procedures, and the placement of the incisions.