The evolution of breast implants.

Female glandular hypomastia is a frequently encountered entity that occurs either developmentally or by postpartum involution. Historically, women have long sought breast enlargement to improve physical proportions, to foster a more feminine appearance, or to enhance self-image. This article explores the evolution of breast implants.

Reconstrução microcirúrgica de deformidades cervicais pós queimadura com o retalho anterolateral da coxa / Microsurgical reconstruction of post burn neck deformities with free anterolateral thogh flap

Deformidades cervicais pós queimadura apresentam problemas funcionais e estéticos que desafiam Cirurgiões Plásticos. Quando essas deformidades envolvem pequenas áreas nós podemos realizar z-plastias, retalhos locais e enxertos cutâneos, mas em áreas ex- tensas nós temos que considerar os retalhos microcirúrgicos. O retalho ânterolateral da coxa tem sido utilizado em casos severos de contratura cervical, com bons resultados estéticos e funcionais.

Introduction: post burn neck contractures present with function alanda esthetic problems thatare achallenge for Plastic Surgeons. When theses deformities involve small areas we can perform Z-plasties, local flaps and skin graft, but in extensive areas we have to consider free flaps transfer. Free anterolateral thigh flap has been used in severe cases of neck contractures, with good aesthetic and functional results. Materials and Methods: 8 patients with extensive anterior neck contractures underwent free flap reconstruction with anterolateral thigh flap. There were 3 women and 5 men with mean age of 24,4 years (range 10 to 51). All cases resulted from flame burns. We have included in these series, patients that underwent to another procedure before, functional deficit (limited extension and rotation) and aesthetic consideration. After 60 days of surgery, 7 patients have been submitted to deffating procedure (liposuction) of the flap. Results: in all patients, release of contractures was excellent. All flaps survived well. One case presented with marginal necrosis of 3 x 1 cm of the flap, and another case with a marginal necrosis of burned area (receptor site).

Dupuytren's disease or Cooper's contracture?: Kenneth Fitzpatrick Russell Memorial Lecture.

In his position as curator of the Cowlishaw collection of historical medical books in the Library of the College, Kenneth Russell prepared the definitive catalogue of the collection. This catalogue is comprehensive and for almost all entries there is an annotation that demonstrates his meticulous attention to detail and the love of the book collection that he managed to secure for the College. It is from this catalogue that I have chosen two books in particular that bring together two great surgeons of the turn of the 19th century. Although he was a pupil of the great John Hunter, the young Astley Cooper possessed good manners and a gift of oratory of which the Scot, his teacher, was devoid. After his apprenticeship with Henry Cline senior, Cooper came to share the podium with Cline at Guy's and St Thomas' hospitals and the two dominated surgical teaching in London for some 22 years, until Cline's retirement in 1811. It was the latter who was first to recognize the true nature of the condition now known as Dupuytren's disease. Later, in 1822, Cooper wrote a detailed description of the contracture of the palmar aponeurosis and recommended fasciotomy as being curative. His book A Treatise on Dislocations and Fractures of the Joints, which contains this description of Dupuytren's contracture, is held in the Cowlishaw Collection. On the other side of the English Channel, M. le Baron Dupuytren repeatedly misquoted Cooper and stated that Cooper believed that the disease was incurable. In his famous lecture given to the staff of the Hôtel Dieu in Paris on 5th December 1931, he admitted to having seen 30 or 40 cases over 20 years of practice. It seems likely that he was not aware of the true cause of the condition before 1831 when he treated his first case. This lecture, along with others, are recorded in his Leçons Orales de Clinique Chirurgicale, a copy of which is also to be found in the Cowlishaw Collection.

Contractures. A historical perspective.

Orthopedic history vividly documents the continuing battle between restoring tissue stability and preserving functional mobility. Prolonged and uninterrupted rest, popularized by Hilton and Thomas, but promoted by many before them and subsequently continued by Jones, Orr, and others, assures healing. Contractures that permanently limit function are not an uncommon consequence. Hippocrates, Hunter, Lucas-Championniere, and David advocated judicious motion. Timing and the interpretation of the patient's pathologic state have proved to be the critical criteria. Modern antibiotics, antiinflammatory medications, acute surgical repair, and techniques that combine stability and early motion provide today's orthopedic surgeons' great versatility and capability. Despite these advantages the threat of contractures remains. The dictum "rest until healed" persists. Physiologic posturing of inflamed or swollen joints to minimize tissue strain introduces resting positions of 15 degrees plantar flexion at the ankle, and 30 degrees flexion at the knee and hip. These will be perpetuated by contractures if not actively counteracted by timely mobilizing procedures. Each of these joint positions is a serious deterrent to walking without stressful substitutive posturing, and the patient's ability to function is impaired.