Congenital Symmastia: A Four-Step, Minimally Invasive Approach.

Symmastia is a rare condition in which breasts are unified medially due to aberrant development of mammary tissue in the intermammary region, resulting in the appearance of an intermammary web. There are limited reports on this rare anomaly and hence, no standard protocols on its management. Additionally, creating a normal cleavage in these young patients without scars over or around the breast is a challenge from an esthetic standpoint. In this article, we present a case of congenital symmastia corrected by four steps: liposuction of the intermammary region, use of suction drains along medial breast border, transdermal bolster sutures, and customized compression garment. Esthetic creation of the medial breast footprint and good preservation of breast contours was achieved with considerably less scars. Thus, we propose our four-step approach as an effective, minimally invasive method for treating congenital symmastia.

Medial femoral condyle vascularised corticoperiosteal graft: A suitable choice for scaphoid non-union.

INTRODUCTION: Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union. MATERIALS AND METHODS: This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels. RESULTS: There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements. DISCUSSION: MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions. CONCLUSION: Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.

Thoracodorsal artery perforator flap: Indeed a versatile flap.

INTRODUCTION: The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency. MATERIALS AND METHODS: We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities. RESULTS: We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily. CONCLUSION: The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.

A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography.

INTRODUCTION: Replication of the exact three-dimensional (3D) structure of the maxilla and mandible is now a priority whilst attempting reconstruction of these bones to attain a complete functional and aesthetic rehabilitation. We hereby present the process of rapid prototyping using stereolithography to produce templates for modelling bone grafts and implants for maxilla/mandible reconstructions, its applications in tumour/trauma, and outcomes for primary and secondary reconstruction. MATERIALS AND METHODS: Stereolithographic template-assisted reconstruction was used on 11 patients for the reconstruction of the mandible/maxilla primarily following tumour excision and secondarily for the realignment of post-traumatic malunited fractures or deformity corrections. Data obtained from the computed tomography (CT) scans with 1-mm resolution were converted into a computer-aided design (CAD) using the CT Digital Imaging and Communications in Medicine (DICOM) data. Once a CAD model was constructed, it was converted into a stereolithographic format and then processed by the rapid prototyping technology to produce the physical anatomical model using a resin. This resin model replicates the native mandible, which can be thus used off table as a guide for modelling the bone grafts. DISCUSSION: This conversion of two-dimensional (2D) data from CT scan into 3D models is a very precise guide to shaping the bone grafts. Further, this CAD can reconstruct the defective half of the mandible using the mirror image principle, and the normal anatomical model can be created to aid secondary reconstructions. CONCLUSION: This novel approach allows a precise translation of the treatment plan directly to the surgical field. It is also an important teaching tool for implant moulding and fixation, and helps in patient counselling.