The dynamic anatomy and patterning of skin.

The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring skin movement and function is often ignored. It is fundamentally important that if skin is to be modelled or developed, we do not only focus on the biology of skin but also aim to understand its mechanical properties and structure in living dynamic tissue. In this review, we describe the architecture of skin and patterning seen in skin as viewed from a surgical perspective and highlight aspects of the microanatomy that have never fully been realized and provide evidence or concepts that support the importance of studying living skin's dynamic behaviour. We highlight how the structure of the skin has evolved to allow the body dynamic form and function, and how injury, disease or ageing results in a dramatic changes to the microarchitecture and changes physical characteristics of skin. Therefore, appreciating the dynamic microanatomy of skin from the deep fascia through to the skin surface is vitally important from a dermatological and surgical perspective. This focus provides an alternative perspective and approach to addressing skin pathologies and skin ageing.

Experimental and clinical experience with small composite tissue allotransplants and cryopreservation techniques.

Reconstruction surgery requires imagination, inventiveness, and creation-a quest that entails overcoming obstacles never before encountered. Over the past 25 years, with the advent in microsurgery of free revascularized transfers, it was believed that this fundamental breakthrough would be sufficient to resolve difficulties of whatever nature, and that little else would be necessary. Undoubtedly, the results obtained by using free autotransfers have been so remarkable that it is no longer possible to undertake reconstruction in plastic surgery without fully mastering these techniques. Nevertheless, limitations remain, especially with regard to form and shape, as there are areas where form and function merge. As a result, some clinical cases today continue to induce a sense of powerlessness, as was the case 25 years ago when surgeons were presented with large skin defects that are nowadays treated routinely and with a sense of confidence. The sense of powerlessness today clearly signals that another milepost needs to be reached; we believe this milepost should be allotransplantation. Yet allotransplantation should not remain within the realm of the exceptional; on the contrary, it should become routinely accessible. But in order for it to become so, cryopreservation, a pathway that has so far received little attention, and about which much remains to be learned, should be explored. Accordingly, in this article, we report our experience with xenotransplantation, a mainly clinical procedure in the area of hand surgery.

Use of the eponychial flap to restore the length of a short nail: a review of 30 cases.

BACKGROUND: Distal digital amputations may result in composite tissue loss, affecting both the fingertip and the nail complex. Most surgical procedures that are used for fingertip reconstruction do not restore the nail defect. METHODS: The eponychial flap is a new technique where a backward plication of the nail wall is used to expose the nail root and lengthen the visible part of the nail of the amputated digit. RESULTS: The authors describe the anatomical basis and the operative technique of this flap and also review a series of 30 eponychial flaps that were performed in 28 patients. All patients presented fingertip defects treated with volar advancement flaps. This procedure was followed by an eponychial flap that restored the length of the short fingernail. CONCLUSIONS: The eponychial flap procedure is an easy and reliable technique that is indicated in distal transverse digital amputations to lengthen the short injured nail. It can be associated with any method used for repairing the fingertip defect, thus enhancing the final cosmetic result of the digital reconstruction.