An ideal retractor system for reconstructive surgery of the abdominal wall: taking the weight off your assistant.

Following bariatric surgery, body-contouring surgery is often combined with reconstruction of the musculofascial layers of the abdominal wall. Large amounts of tissue have to be retracted from the start to assist in lymph and venous drainage, and to facilitate a lower abdominal incision. During the procedure a good retractor is indispensable. The Rultract retractor system was originally developed for thoracic surgery. We have found this system, which is readily available in most centres, to be a suitable retractor in difficult post-bariatric surgery, where the patient requires abdominal wall reconstruction in combination with a dermolipectomy. It can be easily adjusted to a wide variety of desired positions without obstructing the surgeon's range of action and replaces the need for one or more assistants in the operating team.

The groin flap revisited--what the textbooks do not tell.

The groin flap remains an excellent choice as a distant pedicled, or free microvascular flap for soft-tissue coverage of the hand because of its reliable arterial-venous pedicle and minimal donor site morbidity. Although interest has waxed and waned over the years, a number of valuable aids have been developed that have added to the success of the flap. Some of these aids, which do not yet appear in the textbooks, are briefly reviewed.

A variant of Tietze's syndrome occurring after reconstructive breast surgery.

Costosternal chondrodynia (Tietze's syndrome variant) should be considered in those rare patients who present with severe breast pain several months after reconstructive breast surgery. The authors treated 25 cases, 3 of which are discussed in detail, where the origin of the pain was traced to the costosternal cartilages. The differential diagnosis and management of this hitherto undescribed problem after breast surgery are discussed.

Nummular nipple hypertrophy and repair as part of an aesthetic nipple-areola unit.

The author suggests that an aesthetically pleasing ratio between nipple and areola diameter exists which should always be taken in consideration during nipple and areola reconstruction. In a study of 40 nipple-areola complexes of 20 healthy, nulliparous, Caucasian female volunteers with a mean age of 25.5 years, the average nipple diameter measured 28% of the areola diameter, that is, a ratio of 1:3.6. A hitherto undescribed form of macrothelia is presented in which the nipple width rather than the projection (length) is increased. A successful technique for reconstruction is described, based on the new method of assessing the aesthetic relations within the nipple-areola complex and known anatomy.

Ultrasound mammography in prosthesis-related breast augmentation complications.

Ultrasound mammography is presented as a safe, simple, and reliable method of assessing prosthesis and prosthesis-related complications in the augmented breast. The ability to distinguish between silicone gel, muscle, hematoma, and fluid collections has made ultrasound mammography especially valuable in diagnosing capsular rupture, implant rupture, or periprosthetic hematoma in subpectoral breast augmentations. Examples are given and discussed.

Malignant fibrous histiocytoma of the parotid gland associated with polycythemia.

Although malignant fibrous histiocytoma (MFH) is thought to be the most common soft tissue tumor of late adult life, it is extremely uncommon in the parotid gland. A case of MFH in the parotid is reported, associated with polycythemia, which remitted following surgical extirpation of the tumor.

Low-density lipoprotein receptor deficiency resulting in familial hypercholesterolaemia in a black man. A follow-up study.

The binding and catabolism of low-density lipoprotein (LDL) was measured in cultured skin fibroblasts and Epstein-Barr virus-transformed lymphoblastoid cells from a South African black man. On the basis of LDL receptor activity, the patient was classified as a familial hypercholesterolaemic homozygote of the LDL receptor-defective type.

The presence of a caput epididymidis in congenital absence of the vas deferens.

Experience with 2 patients stimulated a review of the literature on congenital absence of the vas deferens in 133 cases. Bilateral absence was more common and occurred in 80 per cent of the cases, and a caput epididymidis was said to be present in at least 88 per cent. Information concerning the epididymis was lacking in 8.9 per cent of the cases. Two probable explanations for this common clinical finding are offered. Embryologic studies have shown that the caput, unlike the rest of the epididymis, can develop from genital ridge derivatives mainly. This clinical-embryological consideration refutes the common belief that the vas deferens and epididymis as a whole are of mesonephric duct origin. A second, independent factor is the selective blood supply of the caput in some cases. In these cases the caput is preserved by a branch of the testicular artery, perforating the tunica albuginea from within outwards, instead of a branch of the spermatic artery originating from the extratesticular portion of the testicular artery.

Primary familial hypercholesterolaemia in a South African black. A case report.

A case of familial hypercholesterolaemia is presented. This is to the best of our knowledge the first report of such a case in a South African black. The modes of presentation and inheritance are discussed and the relevant literature is reviewed.