Sensitive areolar reconstruction in using a neurocutaneous island flap based on the medial antebrachial cutaneous nerve.

Sensory reconstruction has recently been stressed in breast reconstruction. However, there are no reports concerning the reconstruction of a sensitive areola. The bilateral reconstruction of a sensitive areola using a neurocutaneous flap based on the medial antebrachial cutaneous nerve is reported. The flap was harvested from the distal third of the forearm as an island flap and tunneled to reach the apex of the new breast, which was previously reconstructed using a 135-cc, gel-filled, silicone prosthesis covered by a latissimus dorsi myocutaneous flap. Six months later, fine sensibility in the reconstructed areola was demonstrated. The patient could perceive light touch, pain, and 14 mm two-point discrimination. At 2 months after surgery, 50 percent of cutaneous faulty stimulus location was observed. However, at 4 and 6 months after surgery, faulty location disappeared. Six months after harvesting the medial antebrachial cutaneous nerve, the sensory deficit was minimal; it included a hypoesthesic zone of 4 to 7 cm and an anesthesic zone of 2.5 to 5 cm on the middle third of the forearm. Fifteen months after the procedure, no hypoesthesic zone was observed; only a 2 to 3 cm anesthesic zone on the proximal medial side of the forearm existed. This sensory deficit passed unnoticed by the patient. The technique developed here is a refinement in breast reconstruction, and we think it should be used in selected patients.

Tenorrhaphy and tendinous venous envelope (TVE). A morphofunctional study in 24 beagles dogs.

A morphofunctional study was undertaken in 24 Beagle dogs subjected to a a tenorrhaphy, in order to evaluate the results obtained with 3 different surgical procedures (16 hands each)--"traditional" (TRAD); the "tendinous venous envelope" (TVE), and the "simulated procedure" (SHAM). The surgical tissue (n = 48) was the extensor digitorum communis muscle of the hand (forepaw) bilaterally. For TRAD procedure, the Bunnell suture technique was applied. For the TVE procedure, the tenorrhaphy site was wrapped in a segment of autologous femoral vein and for the SHAM procedure, the tendon was exposed over 3 cm without sectioning it and the wound was closed. In each case, the limb was immobilised for 21 days in a cast. Functional data (288 X-rays) was obtained on angle variations of the radio-carpal joint in 2 different positions--passive (physiological), and forced (with an additional weight of 150 g). For each position, the angle variation obtained for each one of the surgical procedures were compared at 3 different times: day zero (surgical intervention), day 21 (cast removal), and day 35 (surgical tissue removal). Morphological data (144 sections) was obtained by analyzing the surgical tissue (tendinous fibrosis; fusion of the tendon clusters with the epimysium and the neighboring tissues; synovitis and the virtual space between the tendon and the neosheath). Tests of variance analysis by posts (critical H = 5.99), showed that the TVE procedure produced better results as compared to TRAD (SHAM approximately equal to TVE > TRAD) on day 21 (H = 22.58) as well as on day 35 (H = 8.08).