Avulsion of vascular anastomosis in free-flap breast reconstruction.

We report a case of anastomotic avulsion following a free deep inferior epigastric perforator (DIEP) flap reconstruction immediately after mastectomy for carcinoma of the breast. This occurred on the 5th postoperative day when the patient was allowed a shower and abducted her shoulders to wash her hair. The aim of this report is to make readers aware of such a possibility, and we suggest exercising caution in early mobilisation of the upper limb after free-flap breast reconstruction.

Unilateral reverse latissimus dorsi muscle flap for postoperative CSF leak and wound dehiscence in lumbosacral defects: a lifeboat approach.

A lumbosacral defect with cerebrospinal fluid (CSF) leak, particularly after breakdown of a repaired lipomeningomyelocele, is often a difficult problem to manage. Although several methods of local flap coverage have been used, local wound infection and tissue cellulitis associated with the wound dehiscence makes the repair prone to redehiscence. The associated CSF leak requires a good reliable closure as a matter of urgency. We describe two patients with lipomeningomyelocele, operated upon for tethered cord syndrome, who developed postoperative CSF leak and wound dehiscence. The associated wound infection and signs of meningitis made re-exploration, debridement and a dependable, well vascularized cover of the dura mandatory. The reverse latissimus dorsi flap provided a good vascularized seal. Both patients recovered rapidly.

Supernumerary limbs: a case report of a rare congenital anomaly.

We report a case of an 18-month-old female who presented with three supernumerary upper limbs of varying lengths on the right side. Each limb had a proximal, middle, and distal segment, and an intercalated elbow and wrist joint. A single digit was present in the superior limb, three digits in the middle limb, and two digits in the caudal-most limb. Right plagiocephaly, congenital torticollis, scoliosis involving the upper and mid thoracic region, and a hypoplastic right pectoralis major were the other abnormal features noted. Radiography showed two scapulae, humerus, a single forearm bone in each limb, and rudimentary metacarpals and phalanges. Limb duplication may rarely be encountered in parasitic conjoined twins. The role of mutagens, drugs, cellular contributions, and morphogens in the growth and differentiation of limbs has been studied in animals. It is rather difficult to deduce the time of action of the factors responsible for such a malformation.

Flexor carpi radialis opponensplasty.

Although numerous opponensplasties are described, the options are limited when the median and ulnar nerves and the flexor tendons are injured. We describe a new tendon transfer using the previously injured flexor carpi radialis combined with a fascia lata graft for opponensplasty in a patient who had a wrist injury resulting in division of all his flexor tendons, except flexor carpi ulnaris, and the median and ulnar nerves.

Z-plasty template: an innovation in Z-plasty fashioning.

Although Z-plasty is one of the basic skills in the armamentarium of a plastic surgeon, one is rarely found using a protractor to measure the exact angles. Two types of simple gadgets are described here to fashion Z-plasties with desired (fixed or variable) angles useful in various types of Z-plasties. These gadgets are made from transparent plastic sheets. They can be sterilized by formalin vapor or ethylene oxide gas. Since they are pliable, they can be adapted to the contours on the body. These are found to be particularly useful in cases where asymmetrical Z-plasties are needed.

Classification and comparison of five techniques of end-to-end microarterial anastomoses in rats: a new proposed technique.

We propose a new classification of five main techniques for microarterial anastomoses: Interrupted, autogenous cuff, continuous, sleeve and partial sleeve. The last method was developed by the authors. A study was performed on 48 albino rats and comprised 20 anastomoses of each type (for a total of 100), performed on femoral and carotid arteries of average size 0.83 mm. These were compared with respect to patency, anastomosis time, leak, bleeding time, number of sutures (bites), microangiography, histopathology and scanning electron microscopy. The overall patency was 88%, and that of the partial sleeve technique was 100%, associated with 30% incidence of aneurysms. Clinical, histopathological and scanning electron microscopy findings showed better results for techniques with predominantly extraluminal sutures (sleeve and partial sleeve), which was particularly relevant in our situation, in which a larger sized needle (150 microns) had to be used. An overall aneurysm incidence of 17% was noted.

Extended subgaleal fascia--pericranial temporalis flap for skull base reconstruction.

An extended subgaleal fascia pericranial flap based on the temporalis muscle is described. The flap receives its vascular nourishment from the arteries supplying the temporalis muscle and from the superficial temporal artery. The long length of the flap and the ease of its rotation was used effectively to close anterior skull basal defects.

Technique for experimental surgery: simple cautery for experimental microvascular surgery.

A simple and safe method of thermocoagulation of small vessels, particularly useful in an experimental microsurgical laboratory, is described. This thermocautery can be readily prepared, and the vessels can be cauterized as close as 0.5 mm from the origin.

An evaluation of serum and tissue bound immunoglobulins in prostatic diseases.

In forty-four patients with different prostatic lesions serum immunoglobulins and tissue deposited immunoglobulins were studied by single radial immunodiffusion technique, and direct immunofluorescence and immunoperoxidase (PAP) methods respectively. Serum IgM levels were found reduced only in patients with prostatic carcinomas (80% of cases) as compared to controls. Serum IgA levels showed stage dependence in prostatic carcinoma being more raised in advanced malignancy (stage C and D) than in localized ones (stage B). Localization of immunoglobulins particularly IgM, was characteristically found in stroma and lumen along with intracellular localization in prostatic carcinoma; while normal and benign lesions of prostate only showed characteristic 'necklace' pattern. Also the intensity of deposits of immunoglobulins in poorly differentiated prostatic carcinomas was markedly low as compared to well differentiated carcinomas indicating lowered local immunological response in former. In prostatitis, IgA was also found localized in lumen indicating the immunological defence against infection by secretory antibody (IgA).