Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.

PURPOSE: We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children. INTRODUCTION: Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved. METHODS: We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure. RESULTS: We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively. CONCLUSIONS: We believe that island-nail transfer in children obtains excellent results.

The Ti-Epiplating system as an alternative for ear prostheses in burned patients.

Burned ear reconstruction remains one of the most difficult areas of plastic surgery, and the aesthetic results are not always acceptable. In this study, the authors describe the results of the prosthetic rehabilitation of patients needing burned ear total reconstruction with a plate-like system (Titanium Epiplating System, Medicon, Tuttlingen, Germany) treated in their hospital between 2006 and 2009. The goals of this study were to report on the use of bone anchor implants with a plate-like system for total ear reconstruction in burned patients, to analyze treatment outcomes, and to discuss important clinical variables encountered during treatment, as well as to determine criteria for success in the implants and prostheses. Two case reports are presented, and treatment outcomes have been analyzed. In both patients, implants became anchored, and neither demonstrated failure during the study period. The cosmetic results and patient acceptance were very satisfactory, with no postoperative complications. The plate-like system for the treatment of auricle burns is an acceptable technique that complements traditional reconstructive procedures.

Computed tomographic angiography with VirSSPA three-dimensional software for perforator navigation improves perioperative outcomes in DIEP flap breast reconstruction.

BACKGROUND: Vascular anatomy of the abdominal wall varies greatly, especially in the case of the perforator branches of the deep inferior epigastric artery. Preoperative three-dimensional reconstructions with VirSSPA software have been used in the authors' center since the year 2007 for the planning of perforator flaps in breast reconstruction. The main objectives were to reduce surgery time and the number of complications. METHODS: A comparative study was conducted in 70 patients subjected to delayed breast reconstruction based on unilateral deep inferior epigastric perforator (DIEP) flaps. Half of the patient group underwent preoperative imaging with computed tomographic angiography-guided VirSSPA reconstruction, whereas the other half was subjected to preoperative Doppler ultrasound for perforator mapping. Operation time ranges, lengths of stay, and operative complications were assessed. RESULTS: The use of VirSSPA preoperative planning correlated with operative times reduced by a mean of 2 hours 8 minutes. In addition, a statistically significant reduction (>45 percent) in the incidence of any flap-related complications was observed in patients undergoing preoperative computed tomographic angiography-guided VirSSPA reconstruction and a decrease above 50 percent in overall donor-site morbidity. The use of computed tomographic angiography-guided VirSSPA three-dimensional reconstruction was found to be a protective factor against developing any kind of complication after DIEP flap surgery (odds ratio, 0.03; 95 percent confidence interval, 0.006 to 0.15). CONCLUSIONS: Computed tomographic angiography-guided VirSSPA three-dimensional reconstruction in the assessment of perforator flaps was proved to be safe and reliable. The main benefits of this technique were the reduction of surgical time and reduction of the number of complications.

Use of a three-dimensional virtual reality model for preoperative imaging in DIEP flap breast reconstruction.

BACKGROUND: The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a deep inferior epigastric artery perforator (DIEP) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Computerized models and virtual reality applications are being used to facilitate teaching and preoperative evaluation in a number of other complex anatomical regions. The variability in perforator anatomy makes DIEP flap surgery a suitable candidate for application of such technology. In this context, a study was undertaken to determine the feasibility of computed tomography angiography (CTA)-guided VirSSPA three-dimensional (3D) software for virtual reality navigation in DIEP flap surgery and to compare findings with operative measurements. MATERIALS AND METHODS: We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared with operative findings. RESULTS: In all cases, the major perforators were accurately localized using both methods. 3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared with operative findings, showing an average error rate of 0.23cm (95% CI, 0.17-0.30). CONCLUSION: In short, the main advantage of VirSSPA, when used in conjunction with an image assessment such as CTA, is to provide additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle.