Extended step-advancement flap for avulsed amputated fingertip--a new technique to preserve finger length: case series.

Purpose: The conventional step-advancement flap does not restore fingertip length after avulsion amputation with projecting bone owing to the limited size of the distal triangular flap. To overcome this problem, the extended step advancement flap using the stepladder principle, described in this article, provides an extended distal triangular flap that can be wrapped around the projecting tip of the distal phalanx while avoiding longitudinal volar scarring. The purposes of this study were to present a modification of the original step-advancement technique and to report on results in 6 patients.

Mons pubis ptosis: classification and strategy for treatment.

Background: Obesity and massive weight loss cause bulging and ptosis of the mons pubis. The pubic area can cause an embarrassment to patients. In some cases, the deformity can be seen even under clothing.

Unusual distribution of the lower body fatty tissue: classification, treatment, and differential diagnosis.

Unusual fat distribution of the lower part of the body is clinically characterized by massive symmetric and diffuse fat deposition in the trochanters, groins, buttocks, hips, and lower extremities, which contrasts sharply with the normal upper part of the body. The massive lipomatoses of the lower part of the body can be classified into 3 types: type 1, the familial symmetrical lipomatosis that affects the groins, trochanters, hips, buttocks, and thighs; type 2, the bilateral peritrochanteric familial lipomatoses; and type 3, the unilateral peritrochanteric lipomatosis. This unusual adiposity runs in families and predominantly exists in the Mediterranean region, and seems, however, to be common in North Africa.

A perforator-based bilobed fasciocutaneous flap: an additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease.

A great variety of procedures have been proposed for the cure of sacrococcygeal pilonidal disease. A bilobed fasciocutaneous flap, based on the parasacral perforators, is described. This retrospective study was conducted to evaluate our experience with bilobed fasciocutanous flaps and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus.

The split peroneus muscle flap: a new flap for lower leg defects.

The peroneus brevis tendon mechanism is more effective than the peroneus longus mechanism in rotating the navicular externally and the calcaneus into valgus. A longitudinal vertical split of the peroneus brevis muscle is a new technique that allows coverage of the fibular and pretibial region defects without impairing the muscle function. The essential features of the flap are: transposition of the muscle without disinsertion, splitting the muscle longitudinally along a distinct anatomical plane, and preservation of the anatomical continuity of the muscle.

A single stage liposuction and dermopexy for grade 3b and grade 4 pseudogynecomastia after massive weight loss: an observational study.

Nineteen middle-aged males with grade 3b and grade 4 pseudogynecomastia following severe weight loss were treated by liposuction and simultaneous skin reduction. From 1997 through 2005 nine males with grade 3 and ten with grade 4 pseudogynecomastia were included in this study. Ages ranged from 23 to 48 years.

Classification of brachial ptosis: strategy for treatment.

Background: The author presents a clinical classification of brachial ptosis based on the amount of adipose tissue deposit and the degree of ptosis. This system offers guidelines for graduated treatment of fat deposit and brachial ptosis. Minor modifications to previous techniques are reported to keep the scar short, as low as possible, and not wide, and to avoid postoperative contour deformities.

Reverse osseofasciocutaneous radial forearm flap for thumb reconstruction: a flap design and case series.

Purpose: To report the outcome of the modified design of the osseofasciocutaneous radial forearm flap. The flap was modified because of problems associated with the use in thumb reconstruction.

Methods: We performed retrospective review of all patients who sustained nonreplantable thumb amputations who had this procedure between August 2000 and March 2005.

Subtotal reconstruction of the burned auricle.

The goal for external ear reconstruction is to restore the function of the helical rim in order to provide support for eyeglasses and to provide a cosmetically acceptable auricle. Reconstruction necessitates both flap coverage and flexible framework formation. This article reviews 22 patients who underwent subtotal reconstruction of the auricles after burns.

Abdominal dermolipectomy in an abdomen with pre-existing scars: a different concept.

Although abdominal dermolipectomy is a frequently performed procedure, few publications have reported on the safety of the procedure in the scarred abdomen. The aim of this study was to stress the possibility of performing a natural-looking abdominoplasty with no complication such as skin necrosis or liponecrosis in the presence of abdominal scars and to clarify that the scarred abdomen is not a great limitation for full abdominoplasty as reported in the literature. Seventy-six abdominoplasties were performed on scarred patients from July of 1997 to June of 2003.

Bilobed fasciocutaneous flap for reconstruction of the posterior neck after necrotizing fasciitis.

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of overlying skin. Eleven cases of necrotizing fasciitis of the posterior neck are reviewed to demonstrate the advantage of using a bilobed fasciocutaneous flap for repair following surgical debridement. Nine men and two women aged 40 to 65 years (mean age, 54.

Intraabdominal pressure after full abdominoplasty in obese multiparous patients.

This study measured intraabdominal pressure in morbidly obese and multiparous patients who underwent abdominoplasty with musculoaponeurotic plication. The purpose of this study was to evaluate any potential adverse effect on pulmonary function by virtue of pulmonary function tests and measurement of peak airway pressure. The study included 43 multiparous, morbidly obese women (mean body mass index, 35.

Large thoracolumbar meningomyelocele defects: incidence and clinical experiences with different modalities of latissimus dorsi musculocutaneus flap.

In this study, we report a series of large thoracolumbar meningomyelocele (MMS) defects. The total incidence per 1000 live birth is 0.6, the male incidence per 1000 live birth is 0.

Tendofascial island flap based on distal perforators of the radial artery: anatomical and clinical approach.

The possibility of transferring vascularized tissue to restore function and to resurface large defects, together with the use of composite flaps, has led to recent advances in "one-stage" reconstructive surgical procedures. On the basis of a previous study of the blood supply of the adipofascial flap and a new study of the blood supply of the flexor carpi radialis tendon from the transfascial and direct branches of the radial artery, a fascial island flap complete with tendon was devised and used to treat four male patients who had sustained traumatic soft-tissue losses on the dorsum of the hand and segmental losses of the extensor digitorum communis. The use of a completely vascularized, single-stage, composite flap did not involve sacrifice of the radial artery, the functional and aesthetic results were good, and there was minimal donor-site morbidity.

V-Y fasciocutaneous pudendal thigh flap for repair of perineum and genital region after necrotizing fasciitis: modification and new indication.

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of the overlying skin, and it is a toxin-mediated disease. The aim of this study was to review 13 cases of necrotizing fasciitis of the perineum and the external genitalia region with regard to the diagnosis, treatment, and methods of reconstruction of secondary defects. The study was performed from June 1997 to May 2001 and involved 11 men and 2 women who ranged in age from 35 to 67 years (mean age, 53 years).

The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up.

Solitary lipomas and familial multiple lipomatosis are the most common benign tumors and are very well encapsulated. They are very slow growing and have the potential for recurrence if incompletely excised and a very remote chance for malignant changes. These can be freed from surrounding tissue without difficulty, but because of the fibrous nature of the capsule, its violation is more likely with suction technique and may result in an inadequate resection, possibly leading to recurrence.

Use of an adipofascial flap based on the proximal perforators of the ulnar artery to correct contracture of elbow burn scars: an anatomic and clinical approach.

Different techniques can be used to repair contracture of burn scars on the elbow, including local or distant pedicle flaps, muscle or myocutaneous flaps, free flaps, and tissue expanders. Among these, a pedicled adipofascial flap based on the most proximal two to four perforators of the ulnar artery (located 1 to 5 cm from the origin of the artery) can be anastomosed to form a sort of axially patterned blood supply within the fascia and subcutaneous fat. Therefore, no major vessel in the forearm need ever be severed.