[Technical information: The 'so called' Camille Bernard lower lip reconstruction: An eponymous confusion clarified]. / La reconstruction de lèvre inférieure selon Camille Bernard : mise au point sur une confusion éponymique.

The use of eponyms honours those who have contributed to the development of medicine and facilitates communication between colleagues. Eponyms are based on historical knowledge to know who was the first to use a given technique. In the previous century, two different operative procedures have been attached to the 'so called' Bernard lower lip reconstruction. This historical literature on lip reconstruction with a focus on the years 1853-1855 elucidates the roles of Bernard, Saeman, Desgranges and Burow, and gives suggestions for eponyms that do justice to the innovating surgeons Bernard, Burow and Desgranges.

Perforator-based flaps for the treatment of burn scar contractures: a review.

Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.

[Jean-Louis-Paul Denucé (1824-1889): A forgotten pioneer of plastic surgery]. / Jean-Louis-Paul Denucé (1824-1889): un pionnier oublié de la chirurgie plastique.

The authors propose to define as main characterization of plastic reconstructive surgery the conceptual thinking that leads to a rational choice of an operative treatment. Conceptual thinking in plastic surgery started halfway the nineteenth century with the first schematic representations of the operative procedures available at that time, in which Von Ammon and Baumgarten, Szymanowski and Denucé played a prominent role. These four authors and their works are presented with special attention for the less known of them, Jean-Paul Denucé, surgeon in Bordeaux.

Protecting children from taking up smoking: parents' views on what would help.

ISSUE ADDRESSED: The present study investigated what factors the parents of children in low-income areas of Auckland, New Zealand, thought could help protect their children from smoking initiation. METHODS: Participants in a large quasi-experimental trial that tested a community-, school- and family-based smoking-initiation intervention were asked in a questionnaire 'What could we do to help you protect your children from smoke and taking up smoking?' Free-text responses were divided into distinct meaning units and categorised independently by two of the researchers. RESULTS: 1806 participants (70% of parents who returned the questionnaire) completed the question. The majority of respondents (80%) were either Pacific Island or Maori mothers and 25% were current smokers. Five main categories of suggested strategies for preventing smoking initiation were identified: building children's knowledge of the ill-effects of smoking; denormalising smoking; reducing access to tobacco; building children's resilience; and health promotion activities. The most common suggestion was to educate children about smoking. CONCLUSION: Building children's knowledge of smoking risks was the main strategy parents proposed. There was some support for banning smoking in most public areas and for tougher moves to stop tobacco sales to minors. Few parents suggested innovative or radical strategies, such as banning the sale of tobacco, fining children for smoking or use of competitions. So what? To ensure reductions in smoking initiation for lower socioeconomic and Maori and Pacific Island people, further research should engage Maori, Pacific Island and lower socioeconomic parents in a process that elicits innovative thinking about culturally acceptable strategies.

Early outcome of noma surgery.

INTRODUCTION: Reconstructive noma surgery is performed on many short-term medical missions. The treatment outcome, however, has rarely been studied. MATERIALS AND METHODS: We studied complications and clinical outcome of reconstructive noma surgery performed during four short-term medical missions. Logistic regression analysis was used to determine which factors influenced treatment outcome. RESULTS: A total of 74 treatments were performed on 63 patients. We found a complication rate of 64% (n=47) and a success percentage of 59% (n=44). Complexity of treatment procedure and occurrence of complete trismus were independent significant factors negatively influencing the outcome. Only 14 of the 36 complex procedures had a good outcome. CONCLUSIONS: Our study is one of the first to evaluate the early clinical outcome of reconstructive noma surgery in short-term medical missions. It shows that the outcome is not always favourable, particularly in complex reconstructions and in the subgroup of patients with complete trismus.

[Correction of body contour in an obese man after large weight loss following a bariatric procedure]. / Correctie van de lichaamscontour bij een obese man die sterk was afgevallen door een bariatrische ingreep.

A 42-year-old man was referred to the plastic surgery outpatient clinic with the request for body contouring surgery after previous bariatric surgery elsewhere. With help of the bariatric interventions he had lost 109 kg and now weighed 227 kg. At this stable weight he had a large surplus of abdominal wall skin with functional hindrance and inflammation due to chafing. After treating his comorbidity we eventually performed an extended abdominal dermolipectomy and excised 32.8 kg of skin surplus. There was some temporary wound dehiscence which was treated conservatively. The patient was very satisfied with the improvement in his body contour.

Cancrum oris and noma: some etymological and historical remarks.

Necrotising ulcerative stomatitis is used in the International Statistical Classification of the WHO for orofacial gangrene in children, that is known in medical literature as cancrum oris or noma. The many historical synonyms for this disease together with other historical data indicate that orofacial gangrene in children was a common affection in Europe in previous centuries. The etymological and historical backgrounds of the names "noma" and "cancrum oris" indicate that "cancrum oris" is based on the incorrect use of the Latin term "cancer oris" and maybe on tradition, for which reasons the use of "noma" as medical term for necrotising ulcerative stomatitis should be preferred.

[Some similarities between the work of M.C. Escher and plastic surgery]. / Enkele overeenkomsten tussen het werk van M.C. Escher en de plastische chirurgie.

At first sight there would appear to be no similarities between the work of the Dutch graphic artist M.C. Escher and plastic surgery. M.C. Escher was a gifted graphic artist who produced a large collection of work. Most of his fame is due to the works that play with symmetry, space and infinity and leave the viewer astounded. However, how Escher came to produce these works is less well known. A theory which he developed himself formed the basis of the regular plane division. It later became apparent that this theory almost completely agreed with the mathematics of plane division. Two movements (isometries) defined in mathematics, translation and rotation, are equivalent to two techniques for transferring local skin in plastic surgery, namely, advancement and transposition. Escher's performance on the plane of a sheet of paper and a plastic surgeon's performance on the plane of the skin, therefore have a similar mathematical background. Escher has visualised these mathematical rules in an unusual and artistic manner, whereas plastic surgeons apply these rules in the grace of an elastic and healing nature.

[Low 5-year recurrence rate after surgical excision of 126 basal cell carcinomas with frozen section analysis upon indication]. / Laag 5-jaarsrecidiefpercentage na operatieve behandeling van 126 basalecelcarcinomen met vriescoupeonderzoek op indicatie.

OBJECTIVE: To determine the recurrence rate of basal cell carcinoma (BCC) after surgical excision. DESIGN: Retrospective. METHOD: The records of all 139 patients treated for BCC at the Department of Plastic Surgery and Hand Surgery, Leeuwarden Medical Centre, Leeuwarden, the Netherlands, in 1992 were reviewed. This was done by examining case histories and additional information was obtained from dermatologists, general practitioners, patients and the Dutch National Automated Pathological-Anatomical Archive. One hundred and twenty-six BCCs were investigated in 108 patients: 51 men and 57 women, with a mean age of 66 years (range: 24-92). Of these BCCs, 114 had not been previously treated and 12 were a relapse. Freeze section analysis was carried out during the excision if a sprouting or deep growth was suspected and if a tight excision or reconstruction with transposed or rotated piece was desired. RESULTS: The mean follow-up was 59 months (range: 5-86). Sixty-one BCCs on which frozen section analysis was performed were excised completely. In 65 BCCs which were excised without frozen section analysis, a second operation was necessary on 11 occasions to obtain histologically free margins. In both groups a tumour recurred on one occasion (2/126; 1.6%). CONCLUSION: Surgical treatment of BCC aimed at free histological margins, results in a recurrence rate of 1.6%.

[Noma: Dutch history of a nearly forgotten disease]. / Noma: de Nederlandse geschiedenis van een inmiddels bijna vergeten aandoening.

Noma is an orofacial gangrene that may develop in malnourished and debilitated children. It was once a common disorder in the Netherlands. The medical history of noma has some important Dutch contributions. In 1595, Carel Baten was the first to describe noma as a clinical entity and in 1680, Cornelis van de Voorde coined the name 'noma' for this orofacial gangrene, thereby replacing the term 'water cancer' which was then in common usage. One of the first facial reconstruction operations on a noma patient was performed by Leendert Stelwagen in 1779. Noma gradually disappeared in the Netherlands during the second half of the nineteenth century due to an improved nutritional status amongst the poorest in society. Yet in other parts of the world approximately 110,000 children a year still die from this disorder, which has been largely forgotten in the Western world.

[Noma: 'the face of poverty']. / Noma: 'the face of poverty'.

Noma (cancrum oris, water cancer) is an orofacial gangrene that may develop in malnutritioned children debilitated by concomitant diseases as measles. It has been hypothesized that the gangrene originates from acute necrotizing gingivitis, common in malnourished children in developing countries. In previous centuries noma was common in the Western world. The affection disappeared when economical progress permitted the poorest to feed their children sufficiently. The yearly incidence of noma in the world is estimated as 140,000. The mortality is +/- 90%. The facial deformities of those who survive noma are generally serious. Beside facial mutilations, oral functions are hampered (trismus, oral incontinence, impaired speech). Both prevention (improved feeding, measles vaccination) as the treatment of those who contract and survive noma are a challenge for the 'global village' of the modern world.

[Transposition of the tendon of M. tibialis posterior an effective treatment of drop foot; retrospective study with follow-up in 12 patients]. / Transpositie van de pees van de M. tibialis posterior effectief bij een klapvoet; retrospectief onderzoek met follow-up bij 12 patiënten.

OBJECTIVE: To evaluate the results of transposition of the tendon of the M. tibialis posterior in patients with a drop foot. DESIGN: Descriptive, retrospective and follow-up investigation. METHODS: Surgical treatment was carried out in 12 patients with a drop foot (9 women and 3 men, with an average age of 37 years) in the period 1986-1998. The aetiology of the drop foot was a traumatic or iatrogenic lesion of the peroneal nerve or sciatic nerve in 9 patients and in 3 patients spina bifida occulta, leprosy and a herniation of a lumbar disc respectively. None of the patients had important comorbidity. Treatment consisted of lengthening the Achilles tendon according to Huckstep, transposition of the tibial posterior tendon in two tails to the dorsomedial and dorsolateral side of the foot, and six weeks of immobilisation in plaster of Paris. RESULTS: The postoperative period was without complications. The treatment improved the heel-toe steppage gait in all patients. None of the 10 patients who had used an orthosis preoperatively still used it at the time of the follow up. Fifty per cent of the patients acquired a dorsiflexion of the foot of more than 0 degree. The results were in accordance with those in the literature. CONCLUSION: Transposition of the tibial posterior tendon is a worthwhile alternative for those patients with a drop foot (and without important comorbidity) who cannot walk satisfactorily with an ankle-foot orthosis.

Histoplasmosis of the wrist.

We present a case of synovitis of the wrist due to histoplasmosis, diagnosed only after extensive surgery and culturing. Treatment with amphotericin B in combination with radical surgery was effective in curing the disease. This manifestation was probably an exacerbation of a latent chronic infection with Histoplasma capsulatum, although it was unclear why the exacerbation occurred. Synovitis resistant to treatment should be assessed with great care, especially in view of the growing number of immunocompromised patients. Close collaboration between surgeon, rheumatologist, pathologist and microbiologist is paramount in such cases.

Surgical treatment of noma.

In the acute stage of noma the role of surgery is a minor one: wound care and, very occasionally, treatment of haemorrhage. However in patients who survive noma, and develop a mutilated and disabled face (trismus, leakage of saliva, impaired speech), reconstructive surgery may improve their fate significantly. Because of economic and educational reasons reconstructive surgery in noma patients should be performed preferably in their own country. Treatment consists of excision of all scar tissue, correction of the trismus and closure of the tissue defects with local, pedicled or free flaps. Because of the large variety of tissue defects and the many surgical options, systematization and subsequently standardization of the reconstructive surgical approach to patients with the sequelae of noma is needed.