Neurological complications of foot and ankle surgery.

Postoperative neurological complications following foot and ankle surgery are common. This article reviews the structural architecture of peripheral nerves and innervation patterns around the foot and ankle; describes the pathophysiology of surgery-related nerve injury; and illustrates the postoperative neurological complications using specific case examples.

MRI for definitive in utero diagnosis of cleft palate: a useful adjunct to antenatal care?

OBJECTIVE: To assess the use of fetal magnetic resonance imaging (MRI) in obtaining a definitive prenatal diagnosis of cleft palate. DESIGN: All expectant mothers with a sonographically diagnosed fetal cleft lip or a previously affected child with cleft palate were offered antenatal MRI at around 34 weeks' gestation. Images were interpreted by a consultant radiologist who was blinded to the ultrasound diagnosis. Two MRI readings were performed: one at the time of examination and one at the end of the study to elicit the radiologist's learning curve. MRI findings were correlated with the birth diagnosis. SETTING: Tertiary referral center for facial clefts--the Spires Cleft Centre, Oxford Children's Hospital, Oxford, United Kingdom. PARTICIPANTS: Study participants included 49 pregnant women between 24 and 37 weeks' gestation, four with a family history of cleft posterior palate and 45 with a facial cleft on a 20-week ultrasound. RESULTS: The positive predictive value of fetal MRI for involvement of the palate was 96%, and the negative predictive value was 80%. The accuracy in predicting palatal clefting of four different MRI signs is discussed. The radiologist's interpretation skills significantly improved between the two MRI readings. CONCLUSIONS: Fetal MRI enables us to predict accurately the extent of a cleft palate after an ultrasound diagnosis of cleft lip. With more accurate diagnosis of the severity of the cleft, we can counsel patients more precisely and plan postnatal management correctly.

A formula determining resection weights for reduction mammaplasty.

BACKGROUND: Reduction mammaplasty is a frequently performed plastic surgical procedure, yet preoperative assessment usually excludes an estimated resection weight. In this retrospective study, a formula was derived using regression analysis of routinely measured preoperative anthropomorphic measurements and intraoperative resection weights. METHODS: Data were collected from 214 consecutive breast reduction patients operated on at a tertiary referral center between January of 1993 and January of 2006. The operations were performed by 15 plastic surgeons using a variety of reduction pattern techniques. Four variables were recorded for each patient: notch to nipple distance, nipple to inframammary crease distance, body mass index, and age. Regression analysis was performed on the data to establish which preoperative measurements correlated most accurately with the resection weight. RESULTS: The following formula was established relating nipple to inframammary crease distance and notch to nipple distance measurement to the weight removed: Breast weight = (35.4 x notch to nipple distance + 60.66 x nipple to inframammary crease distance) - 1239.64. CONCLUSION: Use of this formula aids the surgeon with patient counseling, insurance company quotes, and intraoperatively in patients with asymmetry or those undergoing reconstruction, as a guide to resection weights.