The effect of desferrioxamine on lipid peroxidation and survival of ischaemic island skin flaps in rats.

To produce total necrosis, it was found necessary to subject pedicled groin flaps in rats to 16 hours of warm ischaemia (WI) (whether clamped in situ or removed and maintained at 37 degrees C ex vivo before replantation). Biochemical markers of lipid peroxidation (Schiff bases and thiobarbituric acid (TBA)-reactive material) in homogenates of full thickness skin or of subcutaneous fat rose significantly (p less than 0.001) after 14 hours of WI and reperfusion in vivo. Desferrioxamine (15 mg/kg i.v.) administered systemically either before 14 h WI only, before reperfusion only after 14 h WI or in both circumstances inhibited these rises to near-control (fresh tissue) levels. In survival experiments, this treatment also protected these flaps from necrosis (p less than 0.01).

The uses of the SEPA flap in the repair of defects in the hands and fingers.

A series of 30 cases is presented in which the SEPA flap was used to provide skin cover for injuries and defects in the hand and fingers. Our experience with both unilateral and bilateral SEPA flaps confirms their reliability, convenience and versatility. The SEPA flap design can be used in conjunction with other flaps and in itself contributes to a more rational use of the skin of the lower abdomen in reconstructive surgery.

The combined use of the superficial external pudendal artery flap with a flap of the anterior rectus sheath for the simultaneous cover of dorsal and volar defects on the hand.

It is not easy to provide skin cover simultaneously to both the dorsal and the volar surface of an injured hand. A case is reported in which the dorsum of the hand was covered by a superficial external pudendal artery (SEPA) axial pattern flap (Dias, 1984) and the volar surface by a flap fashioned from the anterior rectus sheath, which in turn was covered with a split-skin graft. A good result was obtained.

An objective study of the dimensions of the ischial pressure point and its correlation to the occurrence of a pressure sore.

A simple non-invasive technique has been used to study the dimensions of the ischial pressure point in normal and paraplegic individuals. The same technique charts the surface area of the gluteal impression. The data obtained in these two groups of patients (normal and paraplegic) have been analysed to see if it is possible to predict the greater susceptibility of certain individuals to suffer from pressure sores over the ischial tuberosity.

De-epithelialised turn-over flaps for "salvage" operations.

Full-thickness loss of a part of a skin flap may produce a serious residual defect that needs additional flap cover. A de-epithelialised "turn-over" skin flap (Thatte, 1981; Mahler and Yanai, 1981; Thatte, 1982) fashioned from the surviving adjacent flap skin, can provide a simple solution to these residual defects. The same technique can also be effectively employed where a skin flap of inadequate dimensions has been transferred to an area resulting in a defect or a deformity due to skin shortage. Two representative cases are presented and the merits of the technique are discussed.