Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts.

Creativity in plastic surgery as a major contribution to medicine, surgery, and patient care.

All human beings are provided by nature with the ability not only to survive but also to improve the quality of life. A sort of brain plasticity allows us to adapt to new information and circumstances. This also accounts for what is called creativity.

Primary simultaneous lip and nose repair in the unilateral cleft lip and palate.

Background: "Do not touch the nose in primary repair of the unilateral cleft lip and palate!" In the past, this dogmatic attitude caused functional and aesthetic (psychological) problems for the child until secondary corrections during adolescence were performed. In the 1950s, surgeons started to correct at least a few features of the nasal deformity and to develop radically corrective measures. Since 1970, a new and very comprehensive concept of correction has been used at the authors' department of plastic and reconstructive surgery.

Transpositional replantation of digits. Case reports.

Heterotopic or transpositional replantation of digits is technically feasible with results similar to those of conventional replantation procedures. Occasionally in multiple digital amputations not all the digits may be replanted in their correct place as a result of complex injuries proximal to the amputation zone or severe damage to important fingers. In these circumstances the amputated digits that are in the best condition as regards undamaged tissue are used for replantation.

[Complex hand injuries. Importance of primary repair with free flaps].

Background: The treatment of large and complex hand injuries is particularly challenching concerning the functional and cosmetic outcome. In this kind of injuries the primary defect cover is of paramount importance and so the initial situation for secondary reconstructive options may be evidently improved.

Material & Methods: Between October 1986 and Mai 1996 43 patients with large complex and combined hand injuries were primarily treated with 49 free flaps.

One-stage reconstruction of defects in the hypopharyngeal region with free flaps.

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed.

Reconstruction of large soft tissue defects in the inguinal and suprapubic region using a variety of flaps.

Objectives: To review a variety of optional reconstructive procedures for the surgical management of extensive soft tissue defects after radically curative or palliative resection of tumors, scars or damaged tissue in the inguinal and suprapubic region.

Methods: Clinical experience with 24 pedicled or free flaps applied in 20 patients to cover extensive defects with exposed underlying structures are presented. The proper selection of flap was based on the individual requirements of each patient taking into consideration age, cause, size, shape and deepness of the defect, donor site morbidity, the patient's general condition and the situation of vascular supply of the adjacent regions.

A new classification for the standardization of nomenclature in free flap wound closure.

A profusion of terms are currently used to describe free flap wound closure. It is important to broadly standardize nomenclature when embarking on a comparison of functional outcomes between institutions. Therefore, a series of 68 "emergency" (within 24 hours) free flaps performed by a single surgeon were reviewed with respect to a total experience of 188 free tissue transfers to formulate a consistent nomenclature applicable to free flap wound closure in general.

An unusual case of deep penetrating dermatofibroma of the lower leg. Case report.

Histological examination of a punch biopsy specimen of a slowly growing, irregular dermal tumour from the right lower leg of a 32-year-old woman, which had been diagnosed clinically as a dermatofibrosarcoma protuberans, showed it to be a deep penetrating dermatofibroma. The diagnosis was established by characteristic histological and immunohistochemical criteria. This allowed sequential excision in two sessions with primary closure and an optimal cosmetic result.

Clinical experience and indications of the free serratus fascia flap: a report of 21 cases.

The free "serratus fascia" flap as a free flap was first described by Wintsch and named a free fascia flap of gliding tissue; however, it has not yet been given a distinct name. The particular advantages of this flap consist of an easy access and a low donor-site morbidity without functional deficit. Additionally, it may be designed very variably and molded even three-dimensionally as a tendon wraparound flap or folded to fill up cavities.

Closure of complex defects in the chest wall with muscle flaps.

Aggressive treatment of thoracic malignancy may be complicated by complex defects in the chest wall. These may be associated with serious complications such as chronic infection, respiratory or cardiac failure, or major haemorrhage. Closure of the defect and restoration of the integrity of the chest wall is important for both functional and cosmetic reasons.

Reconstruction of large palmar defects of the hand using free flaps.

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable.

Facial reconstruction using a retroauricular-temporal free flap.

Large and deep soft-tissue defects of the face usually require resurfacing by free-tissue transfer. An appropriate free flap for facial reconstruction may be harvested from the retroauricular and temporal region utilizing two arterial pedicles (superficial temporal artery and posterior auricular artery). This flap provides normal color, texture, and thickness and thus is an optimal anatomic and aesthetic reconstruction with minimal donor-site morbidity.

Lipofibromatous hamartoma (neural fibrolipoma) of a flexor nerve of the index finger.

A 24 year old woman presented with a painless fusiform mass in her right index finger. Exploration showed an enlargement of the nerve by fibrofatty tissue and microsurgical intraneural dissection was done. Histological examination identified the lesion as a lipofibromatous hamartoma of the nerve, which is both rare and benign.

Internal mammary vessels as a recipient site.

In breast reconstruction with a free flap, the selection of suitable recipient vessels remains one of the most critical decisions for the surgeon. Most surgeons use one of the branches of the axillary vascular system, the thoracodorsal vessels. Because of a number of difficulties using this recipient site, the authors investigated the anatomy and availability of the internal mammary vessels for free flap breast reconstruction.

Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle.

Background: On the basis of studies with animals and experience with functioning muscle transfer in plastic surgery, we have developed a surgical technique to restore detrusor function for patients with bladder acontractility in whom there is no treatment alternative.

Methods: Three patients (aged 26 years, 28 years, and 68 years) with bladder acontractility as a result of spinal-cord injury (two patients) and chronic overdistension (one patient), who required catheterisation for bladder emptying for 5 years, 2 years, and 2 years, respectively, took part in our study. The patients were treated with microneurovascular free transfer of autologous latissimus dorsi muscle to the bladder to restore detrusor function.

[Use of the internal mammary artery in reconstructive microsurgery in the thoracic region: anatomical-radiologic study].

In this study, the topographic anatomy and the diameter of the internal mammary (thoracic) vessels was investigated in regard to their potential as a recipient vessel in reconstructive microsurgery in the ventral thoracic region. Particularly for reconstruction of large thoracic wall defects as well as for female breast reconstruction with free tissue transplantation, these vessels seem to be suitable due to their location. We performed an anatomical study on 86 cadavers and a radiological investigation on 50 female patients and volunteers.

Reconstruction of the helical rim with the rubber band-conditioned postauricular tubed flap: a case report.

Objective: A case with posttraumatic tissue loss of the auricle is presented, where successful reconstruction with the aid of a tubed flap is achieved by gradual lysis within three stages.

Background: Helical rim losses may be reconstructed with a tubed flap created from postauricular tissue.

Method: The vascularity of the tubed flap was increased with the intermittent application of a rubber band tourniquet.

Flap salvage in a "flow-through" flap by manual thrombectomy plus thrombolytic therapy.

A delay in identifying incipient flap failure may inevitably lead to complete pedicle thrombosis and the no-reflow phenomenon. The authors report a clinical case of a lateral arm free flap that suffered complete pedicle thrombosis. They successfully salvaged this flap, a type C fasciocutaneous "flow-through" flap, by manually moving the thrombus from proximal to distal in the main flap artery.

The lateral arm flap: review of 72 cases and technical refinements.

Between 1985 and 1995, 72 free lateral arm flaps (LAFs) were transferred in 68 patients. The main purpose of the reported study was to demonstrate a comprehensive follow-up and essential technical refinements: extension of the flap, shaping of a custom-designed flap, the "emergency" free flap, and sensible nerve coaptation. The effect of nerve coaptation vs.

[Infection prophylaxis in complex limb trauma through immediate definitive reconstruction via a free tissue transfer].

The concept of emergency free tissue transfer for severe extremity injuries represents a cutting-edge technology. We discuss our very positive results with this technique. The conceptual reasons for these favorable results, compared with conventional approaches, are also discussed.