Salvage of total loss of DIEP and skin envelope in breast reconstruction with tissue expansion.

We present two cases of breast reconstruction using abdominal tissue expansion as a salvage procedure for those patients who have had multiple sequential complications using the traditional free flap techniques yet still request some form of reliable breast reconstruction.

The Acticoat glove-an effective dressing for the completely burnt hand: how we do it.

The choice of the silver impregnated Acticoat dressing (Smith & Nephew, UK) for burns is well documented due to its recognised sustained bactericidal activity, reduction of inflammation and ability to promote healing. Its use in the burnt hand, however, is a compromise between adequate dressing cover of this injury and the ability to splint and perform hand therapy on the injured limb. Trying to wrap individual fingers, maintaining web spaces and keep a relatively light dressing for the hand therapists is often difficult and time consuming. We introduce a simple, effective method of creating a custom made Acticoat glove which provides a thin, light dressing covering the hands allowing full mobilisation of the wrist and finger joints.

Novel method of closing a tracheo-oesophageal fistula using a de-epithelialized deltopectoral flap.

The authors describe a novel use of a de-epithelialized deltopectoral flap for the closure of tracheo-oesophageal fistulae, which have been resistant to other methods of closure.

Investigating the mechanical shear-plane between core and sheath elements of peripheral nerves.

The mechanical architecture of rat sciatic nerve has been described as a central core surrounded by a sheath, although the way in which these structures contribute to the overall mechanical properties of the nerve is unknown. We have studied the retraction responses of the core and sheath following transection, together with their tensile properties and the interface between them. Nerves were harvested and maintained at their in situ tension and then either transected entirely, through the sheath only, or through an exposed section of the core. The retraction of each component was measured within 5 min and again after 45 min. Post mortem loss of retraction was tested 0 min or 60 min after excision. For fresh nerves, immediate retraction was 12.68% (whole nerve), 5.35% (sheath) and 4% (core), with a total retraction of 15%, 7.21% and 5.26% respectively. For stored nerves, immediate retraction was 5.33% (whole nerve) and 5.87% (sheath), with an extension of 0.78% for core, and a total retraction of 6.71% and 7.87% and an extension of 1.74%, respectively. Tensile extension and pullout force profiles were obtained for the sheath, the core and the interface between them. These showed a consistent hierarchy of break strengths that would, under increasing load, result in failure of the interface, then the core and finally the sheath. These data reflect the contributions of material tension and fluid swelling pressure to total retraction, and the involvement of an energy-dependent process that runs down rapidly post mortem. This study increases our understanding of the composite nature of peripheral nerve tissue architecture and quantifies the material properties of the distinct elements that contribute to overall mechanical function.

Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial.

PURPOSE: To compare 2 methods of wound closure-metallic staples or 3-0 undyed vicryl-according to postoperative wound complication rates. METHODS: Patients who underwent surgery for proximal femoral fractures were randomised to have wound closure with metallic staples or with subcuticular vicryl suture. Wounds were regularly examined postoperatively and only those with positive wound swabs were regarded as wound infections. RESULTS: Five infections and one superficial wound dehiscence occurred in the patients who had wound closure with metallic staples. The complication rate was significantly higher for this group compared with the group who had wound closure with subcuticular vicryl suture (p<0.025). CONCLUSION: Superficial wound complication rates are higher for wounds closed with metallic staples compared to wounds closed with subcuticular vicryl.

The horn shaped fascio-cutaneous flap usage in cutaneous malignancy of the leg.

The cover of defects in the leg is a surgical challenge, especially in the elderly patient. We report our experience in 24 patients, who underwent excision of a cutaneous malignancy and subsequent cover of the defect with a horn shaped fascio-cutaneous flap. The patients' average age was 77 with a range of 61-89 years. The average size of the defect covered was 4x4 cm, with a range from 3x3 to 8x8 cm. There were no flap losses. Two complications presented following discharge from hospital, one required further surgery. These findings indicate that this technically simple flap is reliable, with a low complication rate (8%), and produces an aesthetic result. It provides an alternative to split skin grafting for cutaneous malignancy defects of the leg.

Lateral digital photography with computer-aided goniometry versus standard goniometry for recording finger joint angles.

This study compares the accuracy of computer-aided goniometry with standard goniometry. 109 finger joint angles at the extremes of flexion and extension were measured by a senior hand therapist using standard goniometry. Lateral digital photographs were then taken of the hands and the same angles were read from these by computer. There was good correlation (r(2)=0.975) between the results. Computer goniometry averaged 1 degrees (95%Cl=0 degrees -+2 degrees ) more than the standard goniometry. We feel that computer goniometry of finger joints is accurate and compares well with standard goniometry.

A case report of cutis laxa in one of identical twins.

A 29-year-old man with cutis laxa presented requesting surgery to improve his appearance. The patient had an unaffected identical twin brother which allowed us to compare how he had changed over the years in relation to his sibling and this also provided us with a gold standard for any surgery performed. The patient underwent staged surgery including upper lid blepharoplasties and two facelifts.

Groin dissections in epidermolysis bullosa: a report of groin dissection for the control of metastatic squamous carcinoma in patients with epidermolysis bullosa.

Epidermolysis bullosa predisposes to the development of squamous cell carcinoma. Despite regular surveillance, the majority of severely affected epidermolysis bullosa patients die from metastatic spread. There are no reports on regional control of metastatic spread. We describe our experience with two cases of groin dissection in epidermolysis bullosa. By anticipating the pitfalls in the perioperative care of patients with epidermolysis bullosa, we feel confident that they should make a full recovery.