Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap.

Anterior neck burns represent a major reconstructive challenge due to severe sequalae including restriction in movement and poor aesthetic outcomes. Common treatment options include skin grafting with/without dermal matrices, and loco-regional and distant free flap transfers with/without prior tissue expansion. Such variation in technique is largely influenced by the extent of burn injury requiring resurfacing. In order to optimize like-for-like reconstruction of the anterior neck, use of wide, thin and long flaps such as the anterolateral thigh (ALT) perforator flap have been reported with promising results. Of note, some patients have a tendency towards severe scar contractures, which may be contributed by the greater extent of inflammation during wound healing. We report our experience at 4 years' follow-up after secondary reconstruction of severe, anterior neck burn contractures in two patients by harvesting the ALT flap with a butterfly design. This technique provides adequate wound resurfacing of the burned neck and surrounding areas, and provides good neck extensibility by addressing both anterior and lateral aspects of the scar defect simultaneously. Such a flap design reduces tension on wound edges and thus, the risk of contracture recurrence in what remains a particularly challenging type of burn reconstruction.

Calvarial metastasis of renal cell carcinoma.

The calvarium is an extremely unusual site of metastasis of renal cell carcinoma. We report a 62-year-old man who was enrolled for palliative medical management for an exophytic calvarial metastasis. His quality of life was greatly compromised with everyday local care and bandages due to recurrent events of infection and bleeding, limiting his social life. Surgical palliative surgery was carried out to improve the patient's quality of life. After tumour resection, the resultant defects of the calvarium and the scalp were covered by a muscular latissimus dorsi free flap and a fascia lata graft as dural substitute. There was no evidence of local recurrence or distant metastasis during the 3 years follow-up. Consequently, resection of solitary metastasis in the early stage is the treatment of choice with a chance to cure the metastasis and avoid associated morbidity that may occur if the lesion is left untreated.

Best choice of perforator vessel in autologous breast reconstruction: Virtual reality navigation vs radiologist analysis. A prospective study.

BACKGROUND: Computed tomographic angiography (CTA) is being considered as the current "gold standard" for the preoperative planning of DIEP flaps. The aim of the study was to demonstrate the concordance between the preoperative choice of the best perforator vessel by the radiologist using CTA and the surgeon using the VirSSPA software. METHODS: A prospective and comparative study was conducted in patients needing immediate or secondary breast reconstruction. The radiologist (CTA) and the surgeon (VirSSPA software) analyzed the number of perforators, their course, their location, and then determined the best perforator of the DIEP flap. RESULTS: Best perforator concordance was 33% between the radiologist and the surgeon. The perforator used for reconstruction was chosen by the radiologist in 16 cases (53%) and in 10 cases (33%) by the surgeon. In only nine cases was the same perforator chosen by both of them. Distances of the best perforator from the umbilicus measured by VirSSPA showed an error margin varying from 1-47 mm from the real distances measured by CTA. The Pearson product-moment correlation coefficient was found to be 0.0235 (p = 0.94), reflecting a non-linear relationship. CONCLUSIONS: CTA with a well-trained radiologists continues to be, for us, the gold standard for the preoperative choice of the best perforator.

Treatment of sphenoid dysplasia with a titanium-reinforced porous polyethylene implant in orbitofrontal neurofibroma: report of three cases.

Orbital manifestations occur in less than 1% of patients with neurofibromatosis type 1 (NF1). These manifestations are frequently associated with sphenoid wing dysplasia. The typical radiologic feature is partial or total loss of the greater wing of the sphenoid bone, which leads to herniation of the temporal lobe through the orbital cavity resulting in proptosis and pulsating exophthalmos. Traditional reconstruction of this bone defect involves split bone grafting or titanium mesh. However, these techniques have some limitations due to bone resorption and infection risk. We report the use of 0.85 mm titanium-reinforced porous polyethylene implant sheet in three cases of orbital neurofibromatosis with sphenoid dysplasia. The role of this material was to create a barrier between the brain and orbital cavity. The implant sheet was modeled intraoperatively to reconstruct the orbital cavity anatomy and fitted without any screws. The malleability of the implant allows quick reconstruction of the curved orbital skeleton. Furthermore, the implant doesn't interfere with postoperative imaging and may decrease risk infection.