Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies.

Background: Increasingly radical surgery combined with neo-adjuvant radiotherapy present a challenge for the reconstructive surgeon. The study objective was to review outcomes of Vertical Rectus Abdominis Myocutaneous (VRAM) flap-based perineal reconstruction following resectional surgery for pelvic malignancies.

Methods: Single-centre retrospective analysis of patients undergoing immediate VRAM flap reconstruction of a perineal/pelvic defect for pelvic malignancy between July 2009 and November 2017.

Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant.

Background: Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant.

Giant anterior chest wall basal cell carcinoma: a reconstructive challenge and review of the literature.

Giant basal cell carcinomas (GBCC) are rare, accounting for <1% of BCCs. Those occurring on the anterior chest wall are a very rare subset that brings particular reconstructive challenges. We describe a 75-year-old man whose 13.

Herniation of the liver via an incisional abdominal wall defect.

Herniation of the liver through an anterior abdominal wall incisional defect has rarely been described. An 81-year-old man presented to our surgical team with acute right upper quadrant abdominal pain. He had undergone coronary artery bypass grafting via a median sternotomy 7 years previously.

Extensor pollicis longus dysfunction associated with non-united fracture of the trapezium.

A 26 year old man was referred to us with extensor pollicis longus dysfunction (EPL), and investigation revealed a fracture of the trapezium (left) and carpo-metacarpal joint dislocation of the thumb. Operative exploration revealed mechanical displacement of the tendon secondary to fracture dislocation of the trapezium as the cause for EPL dysfunction. The lesion was managed with an open reduction and screw fixation resulting in good functional outcome.

Evolving resistance to obesity in an insect.

Failure to adapt to a changing nutritional environment comes at a cost, as evidenced by the modern human obesity crisis. Consumption of energy-rich diets can lead to obesity and is associated with deleterious consequences not only in humans but also in many other animals, including insects. The question thus arises whether animals restricted over multiple generations to high-energy diets can evolve mechanisms to limit the deposition of adverse levels of body fat.