Freestyle propeller flaps from the lower abdomen: a valuable reconstructive option for proximal thigh defects.

The concepts of freestyle flap design allows for flap creation from virtually every place in the body. Descriptions of named flaps based on their arterial origin are commonly described in the literature, allowing for predictable flap design. However, in certain cases, isolating a flap based on a Doppler signal and retrograde perforator dissection will allow for appropriate flap creation and wound coverage. We describe a 52-year-old female with a chronic open wound that failed wound care and local soft tissue rearrangement. This led to detection of a strong perforator signal in the lower lateral abdomen prompting the use of a freestyle propeller flap. The patient recovered without complication. Twelve-month follow-up demonstrated trunk and lower extremity mobility without impairment. We describe a successful and novel use of a rare, unnamed perforator from the lower, lateral abdomen by employing the freestyle propeller flap for coverage of a proximal thigh wound.

Better sex from the knife? An intimate look at the effects of cosmetic surgery on sexual practices.

BACKGROUND: The positive effects of aesthetic plastic surgery with respect to body image and self-esteem have been reported in the literature. However, the possible effects of aesthetic surgery on the sexual practices and characteristics of patients have been largely unexplored. OBJECTIVE: This paper seeks to examine the degree to which a major aesthetic procedure affects the patient's postoperative psychosexual life. METHODS: An anonymous questionnaire regarding preoperative versus postoperative psychosexual health and sexual behaviors was mailed to 330 male and female patients who had undergone a major aesthetic procedure by the senior author (G.M.S). Major procedures were defined as breast augmentation and/or mastopexy; facial aesthetic surgery, including face lift, brow lift, and rhinoplasty; and body contouring procedures, including abdominoplasty with or without lipoplasty, or lipoplasty alone. RESULTS: Of the 330 surveys mailed out, 54 were returned as undeliverable. Seventy completed surveys were returned. All the respondents were women, with a mean age of 38 years. More than 95% of respondents reported improvements in body image. Eighty percent of breast augmentation respondents and 50% of body surgery respondents declared improvements in sexual satisfaction. Fifty percent of breast and 60% of body respondents had changed to more provocative attire. Approximately 70% of the breast and body group testified that their partner's sex life had been enhanced. More than 30% of breast patients and 50% of body patients reported an enhanced ability to achieve orgasm. When body and breast respondents were compared with face surgery respondents, statistical significance (P < .01) was found among most psychosexual variables investigated. CONCLUSIONS: The results of this study affirm that cosmetic surgery patients overwhelmingly tend to feel better about their body after surgery. The sex lives of both patients and their sexual partners can be strikingly enhanced after elective cosmetic surgery, particularly if the surgery is focused on the breasts, abdomen, and thighs.

A novel technique for peripheral nerve repair.

OBJECTIVE: To evaluate a novel technique for the repair of neural deficits using a single fascicle to bridge an injury in the rat sciatic nerve. STUDY DESIGN: Twenty-four male Lewis rats were divided into four groups as follows: group 1 (control group), 1.5-cm deficit without repair; group 2, conventional epineural repair with autografts (100% diameter); group 3, nerve repair with large single autograft fascicle (50% diameter); and group 4, nerve repair with small single autograft fascicle (25% diameter). METHODS: Nerve regeneration was evaluated at 3, 6, and 12 weeks by somatosensory evoked potential (SSEP) evaluation and standardized pin-prick and toe-spread tests. Nerve samples were harvested at 12 weeks and stained with toluidine blue to assess the total number of myelinated axons, axon area, and myelin sheath thickness. RESULTS: In group I, the pin-prick and toe-spread tests showed no response at 3, 6, and 12 weeks. Rats in groups 3 and 4 demonstrated significantly better pin-prick test results and a trend toward better toe-spread test responses compared with conventional-repair animals. The SSEP evaluations displayed nondiagnostic waves in rats in group 1 rats. There was no evidence that the other surgery groups differed significantly in median SSEP latencies. Histological evaluation revealed fibrosis in rats in group 1 rats and a significantly higher median number of axons and myelin thickness in the small single fascicle (1296 axons and 4.22 microm, respectively) and large fascicle (2682 axons and 4.62 microm, respectively) groups compared with the conventional autograft group (630 axons and 2.93 microm, respectively). The small fascicle group had a significantly greater mean axon area (58.59 micro m2) than the large fascicle (29.66 micro m2) and conventional autograft (25.35 micro m2) groups. CONCLUSIONS: Peripheral nerve repair using a single fascicle graft resulted in better functional recovery and morphometric outcome without a significant difference in electrophysiological status compared with conventional nerve repair. This technique may provide expanded sources of nerve autografts and alleviate the morbidity of harvesting peripheral nerves from multiple sites for individuals with extensive peripheral nerve injuries.