A reappraisal of axial and nonaxial lower leg fascial flaps: an anatomic study in human cadavers.

The aim of this study was to determine the sources of blood supply to the deep fascia of the lower leg and therefore to identify potential new sites where axial and nonaxial flaps might be raised. The deep fascia was harvested from 18 embalmed cadaver lower legs. The blood supply to the deep fascia was examined with the aid of a dissecting microscope. Four clinically important sources of supply to the deep fascia were identified. These were (1) axial and nonaxial fasciocutaneous perforators, (2) nonaxial musculocutaneous perforators, (3) axial cutaneous branches of the sural arteries, and (4) an axial fascial branch from the saphenous artery (present in 75 percent of the dissections). This study has highlighted the potential for utilizing not only the fasciocutaneous system and sural system of vessels but also the fascial branch of the saphenous artery in the design of lower leg axial fascial flaps. Nonaxial fascial island flaps may be raised utilizing not only the fasciocutaneous system of vessels but also the musculocutaneous system of vessels.

Investigation of the torque-tension characteristics of a flanged external fixator pin.

The torque-tension characteristics of standard, conical and flanged external fixator pins and a cortical screw were compared using a commercially available testing apparatus. The flanged pin and the screw were similar in behaviour, and converted torque into tension more efficiently than conical and standard external fixator pins.

The relationship between fasciocutaneous perforators and their fascial branches: an anatomical study in human cadaver lower legs.

Although a variety of lower leg fascial and fasciocutaneous flaps have been developed, the vascular anatomy of these flaps has not been established fully. The aim of this study was to determine the relationship between the size of a fasciocutaneous perforator and the size and number of its fascial branches. The deep fascia was harvested from five preserved cadaver lower legs. Fasciocutaneous vessels were studied with the aid of a dissecting microscope. There was a moderately strong positive correlation between the external diameter of a fasciocutaneous vessel and the external diameter of its largest fascial branch (correlation coefficient: r = 0.644; t = 6.072; 52 df; p < 0.001). There was a weakly positive correlation between the external diameter of a fasciocutaneous perforator and the number of its fascial branches (correlation coefficient: r = 0.217; t = 11.84; 52 df; p < 0.001). The results of this study establish an anatomical basis for using large fasciocutaneous perforators in the design of lower leg fascial flaps.

The anatomic basis for arteriovenous shunting in human lower leg fascial flaps.

Clinical experience has suggested that arteriovenous shunting may occur in fascial flaps. The anatomic basis for this has not been fully established. The aim of this study was to determine the size, location, and nature of arteriovenous shunts in human lower leg deep fascia. Deep fascia was harvested from the limbs of nine embalmed cadavers. Small pieces of fascial tissue were studied with the aid of three staining techniques (methylene blue, oil red-O triethyl phosphate, and Gomori's rapid one-stage trichrome technique), which were used to enable the microvascular anatomy to be visualized more clearly. Arteriovenous anastomoses proximal to the capillary bed and with an external diameter greater than 50 microns were identified in the suprafascial, subfascial, and intrafascial plexuses but were not found to be a common feature of the microvascular anatomy. Thoroughfare channels within the capillary bed and with an external diameter ranging from 12 to 25 microns were frequently identified in all three levels of the fascial plexus. The results of this study establish an anatomic basis for arteriovenous shunting in fascial flaps.

Motor vehicle-related burns: a review of 107 cases.

Motor vehicles are a major cause of morbidity and mortality. Burn injuries sustained from motor vehicles form a small but important subgroup. The authors have reviewed the case notes of 107 patients with motor vehicle-related burns over a 13-year period. The age ranged from 18 months to 65 years and the male to female ratio was 4:1. The mechanisms of injury were variable, although four major categories could be identified. These accounted for 83 per cent of the cases. Car fires following road traffic accidents was the largest group accounting for 48.5 per cent of cases. The remaining three groups were: motorcycle-related burns following road traffic accidents (6.5 per cent of cases), garage fire-related burns (15 per cent of cases) and car radiator-related burns (13 per cent of cases). Garage fire-related burns had the highest mortality of the four groups (25 per cent). This study demonstrated that garage fire burns are an important subgroup of motor vehicle-related burns.

Domestic iron burns in children: a cause for concern?

The case notes of 26 children with contact thermal burns to the hand who were treated in the Burn Unit at Stroke Mandeville Hospital as inpatients during the period 1987-92 have been reviewed. The burns were found to be caused by a variety of injuring agents, although the domestic iron was the single commonest cause accounting for 46 per cent of cases. Mechanisms of iron injuries were variable although leaving a hot iron on the floor or on a low table were identified as being two important causes. Fifteen children (58 per cent) underwent either primary or tangential excision of the burn skin and grafting. The majority of the children had a satisfactory outcome, although five children (19 per cent) developed hypertrophic scars. The results of this study demonstrate the relatively high incidence of domestic iron burns as a causative factor for contact hand burns in children. Parental vigilance and leaving a hot iron in a secure place are two factors which will help to reduce the incidence of this potentially serious injury.

Multiple breast papillomas in adolescence.

The condition of multiple breast duct papillomas although relatively common in adult women is not a well recognized clinical entity in adolescent females. The risk of adolescents with this condition developing carcinoma is presently unknown, although in adulthood it is regarded by some authorities as a precancerous condition. We report a case of a 14-year-old girl with such a lesion who remains well with no breast abnormalities 2 years after surgery. The clinicopathological features of the condition and the relevant literature are discussed.