[Interplast in India. Review of 14 years]. / Interplast en Inde. Revue de 14 ans.

Interplast teams conducted two-week (or less) camps in India over a 14 year period. The majority of the teams were mixed and consisted of German and Dutch plastic surgeons and nurses. In five different villages and cities, 1015 patients were operated: 41% concerned cleft lip and palate and 32% post-burn contractures. The work is rewarding and is considered by some the best holiday imaginable. The teams intend to continue their project in the future.

"Impossible" reversed radial forearm free flap in microsurgical reconstruction.

The reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed.

Revascularised omentum in microvascular surgery.

The clinical use of microvascular surgery has developed considerably. Transplantation of skin, muscle, musculocutaneous island flaps, bone or osteocutaneous island flaps are possible for different reconstructive problems. These make the indication for revascularised omentum limited. A short review of the possible indications of revascularised omentum transplants and its complications is given.

Reconstruction of bone and soft tissue defects with free fibula transfer.

More and more it is recognized that for the reconstruction of extensive long-bone defects, especially in combination with soft tissue loss, revascularized bone transfers are preferable. For the reconstruction of larger bony defects, revascularized crista iliaca bone or fibula bone are the first choice. The fibula has certain advantages over the crista: It is a straight cortical bone, the length is almost always sufficient to reconstruct large defects, and soft tissue reconstruction is possible by including a skin island. A short description of the operation technique, pitfalls, and indications are given.

Pressure resistance of breast implants as a function of implantation time.

Using a relatively simple test, breaking pressures of 50 gel-filled breast implants that had to be removed have been evaluated. These pressures values were compared with forces generated in executing closed capsulotomy (nutcracker method). It is shown that there is a negative correlation between pressure resistance of breast implants and duration of implantation. After an implantation time of more than five years, our advice is to perform closed capsulotomy if done in a very gentle way, and implant rupture then certainly has to be taken into account.

Results of primary repair of ulnar and median nerve injuries at the wrist: an evaluation of sensibility and motor recovery.

Sensibility and motor recovery after primary repair of ulnar and median nerve injuries at the wrist were evaluated in 21 patients (22 injuries). The outcome was graded according to the MRC system and correlated with the clinical results. Follow-up after an average of two years showed good clinical results in 10 cases, fair results in 9 and bad results in 3 cases. Primary neurorrhaphy can be considered as the treatment of choice for serious ulnar and median nerve injuries of the wrist in accordance with previous studies.

Is additional epidural sympathetic block in microvascular surgery contraindicated? A preliminary report.

The use of additional epidural sympathetic block during and after microvascular surgery in the lower extremities to prevent vasospasm is generally agreed on. However, a significant fall in the perfusion rate of the transplants was seen after application of bupivacaine (Marcain) via the epidural catheter. This effect has, to our knowledge, not been described before and is probably caused by the sympathectomy effect of this type of analgesia.

[Surgical treatment of decubitus ulcers in the area of the ischium, sacrum and trochanter major]. / Die operative Behandlung von Dekubitalgeschwüren im Sitzbein-, Kreuzbein- und Trochanter major-Gebiet.

The operative management of pressure sores in the ischial, sacral and trochanteric region is based on the gluteus maximus muscle and its vascularization. Pressure sores in the sacral region were closed with eleven V-Y musculocutaneous flaps, for the ischial region with fifteen pendulum flaps, and for the trochanteric region with eight medial thigh flaps. In the four years follow-up of 24 patients three recurrences occurred and the post-operative morbidity was acceptable. The operative technique and the complications are further discussed.

Massive deformation of the scrotal wall by idiopathic calcinosis of the scrotum.

Idiopathic calcinosis of the scrotum is a rare disease that may cause massive deformation of the scrotal wall. The first patient we present was also known to have neurofibromatosis. In the second patient we describe, nodules of idiopathic calcinosis of the scrotum were seen with walls that evidenced no epithelial lining, as well as calcification in epithelial cysts. At present, the only possible treatment is excision, and we excised the afflicted skin without problems in primary wound closure.

A congenital diverticulum of the small intestine; Meckel's diverticulum or duplication?

A diverticulum of the small intestine is a condition with only a low morbidity. This is generally a Meckel's diverticulum (MD). There is, however, the possibility of another congenital malformation, which can closely resemble a MD but has another etiology, the tubular duplication of the small intestine. In a period of three months six patients were treated with a MD with different clinical presentations and histologic findings and an invaginated duplication of the small intestine in a male adult patient. The diagnosis of a tubular duplication of the small intestine is not often considered when finding a diverticulum of the small intestine and such a malformation is too easily called a Meckel's diverticulum.