Trapezoid advancement flap to reconstruct small to medium sized tissue defects-A series of clinical applications.

The choice between skin graft and local flap reconstruction depends upon the surgeon's experience and the facilities available. For skin cancers, our main objective is clear, oncologic clearance with preservation of function. For some patients, aesthetic outcome is often equally important. In our experience, majority of our trainees will often choose skin graft reconstruction as their primary choice of reconstruction due to the fact that there is a perceived idea that this is easier to perform than a local flap. However, for lower limb or head and neck reconstructions, skin graft may result in a significant contour defect which can potentially be avoided. We present a series of cases of an alternative flap, the trapezoid advancement, a very simple design that can be utilised in several areas of the body and technically very easily replicated. This technique allows for the advancement of tissue with a minimal tension closure as compared to other local flaps. Our results showed no flap loss and excellent cosmetic outcome.

Advancement flap to cover a defect between the junction of the alar base and the upper lip.

Reconstruction following excision of skin lesions at the cosmetically sensitive junction between the alar base and upper lip continues to be challenging for surgeons. We describe an advancement flap from the nasolabial fold area to reconstruct such defects. Our case demonstrates a gentleman with a clinically diagnosed BCC between the alar base and upper lip. An advancement flap from the nasolabial area was designed to reconstruct the defect, with two Burrow's triangles excised to prevent standing cones. The scar of the two Burrow's triangles falls over the nasolabial fold, resulting in the integration of the scar within the natural line. This flap design also maintains of the level of the upper lip, the shape and position of the nostril, and minimises flattening of the philtrum. Excellent cosmetic results were seen six weeks post-op.

Abdominoplasty in patients with and without pre-existing scars: a retrospective comparison.

BACKGROUND: Over the past decade, abdominoplasty has become an increasingly popular aesthetic procedure both in improving anterior abdominal contour and scar revisions. The associated post-operative complications have been widely reported. Many factors such as obesity, smoking and pre-existing abdominal wall scars are hypothesised to increase the risk of these problems. However, there are no published data analysing the effect of segmental interruption to the blood supply that may have been caused by pre-existing scars. This study attempted to quantify the effect of pre-existing scars on the incidence of complications after abdominoplasty. METHODS: All 123 abdominoplasties under the care of a single surgeon (2000-2007) were reviewed retrospectively with respect to indications, presence of abdominal scars, and post-operative complications. Patients with pre-existing scars were compared with unmatched 'controls' (no scars) by univariate analysis using the Student's t-tests, Mann-Whitney U, and Fisher's Exact tests and by multivariate analysis employing a simple logistic regression. RESULTS: One hundred and twenty-three patients (97% female, median age=40 years) underwent abdominoplasties for abdominal laxity (46%), multiple scars (22%) and 'diastasis recti' (11%). Seventy per cent (87/123) had pre-existing scars (29% single, 71% multiple) of which 32 patients have supraumbilical scars, fifty-five patients with infraumbilical scars and 36 patients with no pre-existing scar. A quarter of patients developed complications such as: infection (14.6%), delayed wound healing (8.1%) and wound dehiscence (4.9%). Smoking and diabetes were the only independent risk factors for complications following an abdominoplasty. CONCLUSION: Our study suggests that pre-existing scars, both supra-umbilical and infraumbilical, did not significantly predispose to abdominoplasty complications. Smoking and diabetes were independent risk factors, a finding of clinical importance.

Sciatic neuroma presenting forty years after above-knee amputation.

We report a case of a sciatic neuroma presenting forty years after above knee amputation. Patients developing neuroma following a limb amputation can present with stump pain which is commonly resistant to medical intervention. The length of interval from the initial injury to presentation is widely variable. Diagnosis relies on clinical suspicion and accurate assessment, radiological imaging and, if indicated, surgical exploration. MRI provides a better soft tissue definition than CT and is more accurate in identifying small lesions than ultrasound. The aim of treatment for symptomatic neuroma is pain relief and improvement of function. This is often achieved by surgical excision.