[Surgical technique and clinical results of modified endo-dermo-"brassière" breast reduction-plasty]. / Operative Technik und klinische Ergebnisse der modifizierten Endo-Dermo-"Brassière"-Mamma-Reduktionsplastik.

The variety of techniques feasible for reduction mammaplasty depends on the patient's anatomy. The inferior pedicle technique and its manifold variations have been described by several authors, probably being the most popular breast reduction technique. The advantages include the ease of performance, good preservation of the neuro-vascular supply of the nipple, new configuration of the breast and fixation like an endo-brassière. Here we present the method of breast reduction, as we currently use it, as well as the principles and the technical considerations necessary to achieve an optimal outcome. Additionally, a retrospective study of selected patients is performed. Results have been very gratifying, not only concerning the esthetical appearance of the breast, but also the long-term preservation of it's new shape. Complications like necrosis of the NAC complex were not observed till yet.

[Pyoderma gangraenosum--a rare complication after breast reduction]. / Pyoderma gangraenosum--Eine seltene Komplikation nach Mammareduktionsplastik.

Applying standardized and sound operative techniques, impaired wound healing following reduction mammoplasty is rare. A postoperative case of pyoderma gangraenosum is reported. This necrotizing skin disorder seemed at first to be a postoperative bacterial infection, but correct diagnosis was finally made histopathologically. The clinical course, etiology, diagnostic findings, and therapy are discussed and a review of the literature is presented.

[Electromyographic studies of myocutaneous sliding flaps for the covering of sacral decubitus ulcer]. / Elektromyographische Untersuchungen an myokutanen Verschiebelappen zur Deckung des sakralen Dekubitus.

Gluteus maximus myocutaneous sliding flaps from one or both sides are useful in covering deep, usually infected sacral pressure sores. Although skin is known to tolerate higher pressure in the covered area, muscle offers far better conditions for flap healing of infected defects. In spite of excellent early results, the long-term fate of the transposed muscle remains uncertain. An electromyography study was performed on eleven patients out of 29 with sliding gluteus maximus myocutaneous flaps in periods up to seven months after surgery. Our results show that signs of denervation parallel reinnervation and functional integrity of the transposed muscle.

Repair of the upper eyelid by means of the prepuce after severe burns.

Burns to the eyelid often constitute difficult problems for reconstruction or repair. Functional and aesthetic aspects have to be considered, and suitable donor sites are not readily available in severely burned patients. In male patients, the prepuce yields an almost ideal skin for eyelid repair because of its high elasticity and adequate texture. Two patients with repair of both upper eyelids using the prepuce are demonstrated. The color match of this skin graft is satisfying. If both layers of the prepuce are transplanted, they yield enough tissue to cover both upper eyelids. This method seems to be an adequate method of reconstruction of burned eyelids in severely burned male patients when the usual donor sites for skin grafts are not available.

More arguments in favor of myocutaneous flaps for the treatment of pelvic pressure sores.

The use of myocutaneous flaps for the treatment of pelvic pressure sores is well accepted, yet there are still unanswered questions about why myocutaneous flaps are clinically superior to skin flaps. An experiment involving 16 pigs revealed new data on the diffusion of infection through myocutaneous and cutaneous flaps, showing that the muscles can act as a barrier against such infection. In 51 patients seen consecutively in 1988, osseous specimens of the infected bottom of the decubital ulcers were taken. There was florid osteomyelitis in 65.9% of all specimens, further emphasizing the importance of muscle flaps in the treatment of pelvic pressure sores when infection is still present. The fate of 16 transposed gluteus maximus muscles was monitored by electromyography postoperatively; 15 still showed voluntomotoricity up to 7 months after transposition.

Mitral valve prolapse in children with secundum--type atrial septal defect (ASD II).

A left ventricular angiocardiogram for evaluation of the mitral valve in patients with uncomplicated secundum type atrial septal defect has been proposed in a recent paper by Victoria et al. (1974). These authors observed 8 children with a ballooning mitral valve and ASD II. They stressed the necessity of performing a left ventricular angiocardiogram in every patient with ASD II. To challange their proposal, the angiocardiograms of 78 children with secundum type ASD were reviewed. Of these 89 angios 34 were performed using the left ventricle (LV) as injection site while 55 times the injection was made in other parts of the heart, e.g. left atrium, pulm. art., right ventricle, right atrium. All 34 LV angios, but only 12 of the others allowed an evaluation of function and morphology of the mitral valve. Of the 46 angiocardiograms 27 (58.7%) revealed an intact, normally closing and opening mitral valve. In the remaining 19 (41.3%) various grades of ballooning or mild prolapsing of one or two leaflets of the mitral valve could be detected. The "scallops" were minimal in 12, moderate in 4 and pronounced in 3 cases. A mild regurgitation was seen in 1 patient only. No patient had the pronounced ballooning observed by Victoria et al. On auscultation only 1 case had the apical murmur of mitral regurgitation. The ECG of our 19 "positive" cases did not show signs of left atrial or left ventricular hypertrophy. A left axis deviation was found in 1 patient. During surgery no structural abnormality of the mitral valve was noted. Postoperative reevaluation of the mitral valve (including left ventricular contrast injection) in 10 cases revealed no change of mitral valve appearance in 8, a decrease of the ballooning in one, and an increase in another patient. It is concluded that prolapses of the mitral valve are seldom of such a degree as to cause dysfunction in children with secundum type ASD. The indications for performing a left ventricular injection of contrast material are the clinical signs of mitral valve regurgitation and/or left axis deviation in the ECG.