Perforation of the small intestine in a non reducible spigelian hernia, by a foreign body.

An 87 yr man was referred for abdominal pain over a pre-existing hernia in the right iliac fossa. Physical examination revealed a red painful palpable mass in the right lower abdominal quadrant. Abdominal CT scan revealed a loop of small intestine trapped into the abdominal wall. The patient underwent emergency laparotomy and the intraoperative findings consisted of a spigelian hernia, with perforation of the contained small intestine by a chicken bone (clavicle). The intestinal perforation was sutured and a polypropylene mesh plug and patch repair of the hernia was executed. The patient had an uneventful recovery and was discharged in stable condition. Our patient had a rare type of hernia with a rare complication. The arrow-shaped chicken bone led to irreducibility of the hernia and eventually to intestinal perforation. The diagnosis of spigelian hernias by history and physical examination is notoriously difficult. Recently, imaging modalities have increased preoperative diagnostic yield.

Integrating imaging techniques in lower limb microsurgical reconstruction: focusing on ultrasonography versus computed tomography angiography.

Recent developments in the field of biomedical imaging have facilitated the use of various imaging techniques as adjunctive tools in microsurgical lower limb reconstructions. Frequently-used imaging modalities in reconstructive microsurgery are colour-Doppler ultrasound and computed tomography angiography. Here, we present basic principles of the above applied techniques and analyze the surgical rationale of integrating imaging techniques in lower limb reconstruction.

Impact of portable duplex ultrasonography in head and neck reconstruction.

We have reviewed the use of portable duplex ultrasonography (PDU) in 12 patients who underwent soft tissue/bone head and neck reconstruction, aiming to determine its role in the design and management of such complex cases. According to our data, there were modifications either of the surgical plan or of patient's management, based on PDU findings, in 9 (75%) of 12 patients. The use of ultrasound directed to subtle modifications in 3 patients (25%) but to significant changes of the surgical plan in the other 3 patients (25%). Also, the use of duplex ultrasound impacted significantly the postoperative management in 4 patients (33.33%). Thus, significant impact of PDU in patient's treatment was recorded in 58.33% of cases. Portable ultrasound represents generally available method for preoperative, intraoperative, and postoperative diagnosis and decision making in free tissue transfer, hence could replace in the future the unidirectional Doppler in the hands of head and neck surgeons.

Changes in arterial blood flow of free flaps after the administration of sildenafil in swine.

We evaluated blood flow changes after experimental free tissue transfer and the potential hemodynamic effect of sildenafil on the free flap. Sixteen swine were used for free transfer of a latissimus dorsi myocutaneous flap to the chest that was anastomosed to the internal mammary vessels, and were randomized into controls and study group. The latter received a single dose of sildenafil, 6 hours following flap revascularization. Doppler ultrasonography revealed that arterial flow was mainly systolic postoperatively. Diastolic flow patterns were gradually restored after the first postoperative day. Pulsatility index (PI) significantly increased and flow volume decreased in all animals postoperatively. In the sildenafil group, PI significantly decreased and flow volume increased, while diastolic flow patterns were restored earlier on compared to controls, postoperatively. In conclusion, the administration of sildenafil after free tissue transfer increases flow volume and facilitates the restoration of diastolic blood flow patterns in the early critical postoperative period.

Foucher first dorsal metacarpal artery flap versus littler heterodigital neurovascular flap in resurfacing thumb pulp loss defects.

Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.