Dermal Matrices: Do We Always Know What Is Going On?

The use of dermal matrices in abdominal wall reconstruction has gained increased attention over time, particularly in contaminated fields. One of their advantages is the greater capacity to resist infection. We report a case of a 36-year-old man, with congenital bladder exstrophy and neobladder reconstruction during childhood. He presented to us with an abdominal hernia associated with a vesicocutaneous fistula. We used a bovine-derived dermal matrix (SurgiMend®, TEI Biosciences, MA, USA) for reinforcement of the abdominal repair considering its laboratory-proven mechanical superiority regarding strength. The early postoperative period was complicated by an infection that led to mesh disintegration and the need for surgical revision. We believe that matrix digestion by bacterial enzymes culminated in rapid breakdown of the product. Further investigations are warranted to determine optimal selection criteria and indications of bioprosthesis in contaminated wounds. Surgeons should be cautious when selecting a biologic mesh in these cases, favoring meshes with a better integration profile.

Super Digit: More Than a Complicated Syndactyly.

Super digits are a rare hand malformation, first described by Virchel Wood. Surgical intervention to try to make two fingers out of a super digit has been discouraged. Here, we present a variant of a super digit type IC2 and propose a revision of the characteristics in each super digit subtype. In our view, this adjustment in Wood's original description could facilitate the identification of super digits, which are a contraindication to syndactyly release.

Analysis of Extended Deep Fat Pad Excision in Abdominoplasty.

BACKGROUND: Because abdominoplasty flap's major vascularization is suprafascial, some surgeons perform excision of the deep fat pad below Scarpa's fascia to achieve a better abdominal contour and balance the lower abdominal projection above and below the scar. The dimensions of this excised adipose flap and its correlations to both the classic abdominoplasty flap and patient biometrics have not been studied yet and are the aim of this article. Short-term complication outcomes are also reported. METHODS: We performed a prospective case series study, operating 74 consecutive women using an otherwise standard abdominoplasty technique, and recorded patient variables, flap dimensions, and complications. RESULTS: Average values are as follows: BMI, 27.35 kg/m; total flap weight, 1868 g; adipose flap weight, 157 g (corresponding to 9% extra flap weight); adipose flap height, 7.2 cm; and preserved infraumbilical deep fat pad thickness, 7.7 mm. Statistical analysis of correlations between variables was performed. CONCLUSIONS: Increased patient weight, umbilical perimeter, BMI, and width of the operative specimen can be used to predict a heavier extra adipose flap. The extra fat excision is safe, preventing inadvertent invasion of the abdominoplasty flap's suprafascial plane that can happen with liposuction. No flap necroses were observed. The use of this technique may prove useful to achieve a slimmer abdominal contour and harmonize it with the pubic region.

Isolated Robin sequence in siblings: review of current concepts.

Robin sequence is a condition that includes the triad of micrognathia, glossoptosis and upper airway obstruction, although many authors now consider that cleft palate is also an important part of the sequence. It can be classified as isolated, syndromic or associated with other anomalies without an identifiable syndrome. A possible genetic cause for isolated Robin sequence is yet under preliminary investigation, and the finding of siblings with the same condition, as are the two children we present in this work, is extremely rare, with only nine similar cases previously described. Our article includes the description of the treatment plan and outcome for both children. We review the current concepts and trends of epidemiology, genetics, diagnosis and different treatment options available. We conclude that in cases of failure of more conservative measures in the first weeks, mandibular distraction osteogenesis may be a good and rational option for the management of isolated Robin sequence, as is currently supported in recent literature, providing a reliable way of avoiding tracheostomy.