The foot fillet flap for ischial pressure sore reconstruction: A new indication.

INTRODUCTION: The main cause of ischial pressure sores in paraplegic patients is prolonged sitting without pressure relief. These wounds are subject to recurrence and may need repeated reconstruction with local flaps. When all options are exhausted, the total thigh flap is the last resort. Disarticulation of the hip joint impairs stability even when sitting and causes subsequently very high discomfort. In this manuscript, we describe an alternative to the total thigh flap to avoid hip disarticulation: the foot fillet flap. MATERIALS & METHODS: This study was performed on four patients at the department of Plastic & Reconstructive Surgery of the Ghent University Hospital, Belgium. Inclusion criteria were the following: paraplegic patients affected by recurrent pressure sores, exhaustion of all local options and adequate vascular status of the lower extremities. RESULTS: All patients were kept in an air-fluidized bed for two weeks and progressed well during their post-operative course. Healing time varied from 12 to 29 days and suction drains were removed after 15 days as in any standard pressure sore flap. Hospital stay varied from 18 to 42 days. CONCLUSION: The pedicled foot fillet flap is a valuable alternative to the total thigh flap. Coverage of large, recurrent, pressure sores in the ischial, trochanteric or sacral region is ideal due to the thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue and underlying muscles provided by the sole of the foot. Furthermore, coxofemoral disarticulation, mandatory in a total thigh flap, that leads to instability while sitting, is avoided.

Thoraco-abdominal wall reconstruction after surgical debulking of a giant retroperitoneal liposarcoma: a case report.

A case of a patient with a recurrent dedifferentiated retroperitoneal liposarcoma with extensive invasion of the thoraco-abdominal wall including the skin, requiring reconstructive surgery after debulking of the tumor is reported.

Sigmoid volvulus caused by a large faecalith. Case report.

We describe a case in which the presence of a large faecalith in a 43-year-old man was the probable cause of a sigmoid volvulus.

A frontal mucocele caused by an immune reconstitution inflammatory syndrome in a patient with HIV infection.

We describe a 55-year-old bisexual Belgian man with a multi-drug resistant HIV infection who developed an Immune Reconstitution Inflammatory Syndrome (IRIS) presenting as a mucocele of the frontal sinus, one year after starting a new effective darunavir containing antiretroviral treatment regimen. His CD4+ lymphocyte count had increased from 3 cells/mm3 prior to the start of the latter treatment to 196 cells/mm3 just before he developed the IRIS phenomenon. IRIS is a paradoxical clinical deterioration during highly active antiretroviral treatment (HAART), due to an exaggerated immune-inflammatory reaction. With the increasing numbers of persons living with HIV infection and the increased use of HAART it is expected that in the future more otolaryngological manifestations of IRIS will be detected.

About two cases of Mycobacterium simiae infection in AIDS: review of the pathogenicity.

Mycobacterium simiae is an ubiquitous species rarely involved as a cause of human infection. Its pathogenicity remains therefore unclear and controversial. Disseminated infections with M. simiae occur rarely and only 7 cases have been reported in patients with acquired immunodeficiency syndrome (AIDS). At least, two were mixed infections caused by M. simiae and M. avium-intracellulare. We report the case of two AIDS patients presenting with pure M. simiae infections: one was a disseminated infection and the other a pulmonary infection. Epidemiology and pathogenicity of M. simiae in pulmonary, extra-pulmonary and disseminated infections are reviewed.