Suicidal nonfatal impalement injury of the thorax.

We treated an impalement injury of the thorax resulting from a suicide attempt in the form of a road traffic accident. The patient survived and was discharged 5 weeks after his injury. The surgical management of thoracic impalement injuries and the rationale behind a multidisciplinary approach are discussed.

Repair of a giant inguinoscrotal hernia.

We present a case of a long-standing, giant inguinoscrotal hernia extending to the patient's knees, complicated by intestinal obstruction. Initial management involved conservative treatment of the intestinal obstruction and optimising the patient's general condition. Surgical treatment included debulking the contents of the hernia sac by performing a right hemicolectomy and a small bowel resection, and reconstruction of the abdominal wall using Marlex mesh and a tensor fasciae latae flap. Although abdominal wall reconstruction for massive ventral or incisional herniae is well reported, inguinoscrotal herniae of this magnitude are much rarer and pose additional problems, which are discussed in this paper.

Umbilicosculpture: a concept revisited.

After birth the umbilicus is the only naturally formed visible scar on the body. To reconstruct a neo-umbilicus following abdominoplasty various local interposition flaps have been described to circumvent a circular scar contracture and to recreate a superior hood. The additional scarring with these techniques can give an operated look to the neo-umbilicus. The importance of gravity in the formation of a superior hood is highlighted and the issue of circular scar contractures is addressed. Emphasis is placed on sculpturing the peri-umbilical fat to enhance contour and on placing the circular scar deep in the neo-umbilicus.

Martin-Gruber connections in South Africa. An anatomical study.

One hundred and twelve forearms in 56 preserved cadavers were dissected to assess the incidence of Martin-Gruber connections in a population in South Africa. The connections were found in 13 cadavers (23%) and one was bilateral. There were no significant racial or sexual differences in the incidence. The course of Martin-Gruber connections and their anatomical relationship with the ulnar artery are illustrated.

Maintaining the safe position in a palmar splint. The "double-T" plaster splint.

The injured and operated hand is routinely immobilized for a variable period of time in a palmar plaster splint. To minimize subsequent joint stiffness, the preferred position of immobilization of the hand is the "safe position". The true position of the hand in a splint was assessed on a lateral X-ray directly after application and just before removal 3 weeks later. It appears that in time the hand in a conventional palmar plaster splint loses its initial position because the bandage stretches. The "double-T" plaster splint maintains the safe position of the hand significantly better than the conventional palmar splint.

Penetrating cardiac injury--to close the pericardium or not? A case report.

Many trauma surgeons who treat penetrating cardiac injuries do not routinely suture the pericardium closed after repairing the heart. The patient reported here died from exsanguination during attempts to mobilise the heart which had adhered to the sternum. With the increasing demand for coronary artery surgery and the high incidence of carcinoma of the oesophagus in South Africa, both of which require access to the mediastinum, we recommend that in the trauma setting, the pericardium be closed to facilitate future surgery if required.