A review of 105 subscapular-based flaps harvested using a new dorsal decubitus position: how far can we go?

Objective: Interest in flaps based on the subscapular vascular system has decreased because of the need for intraoperative patient repositioning and the inability to employ a simultaneous 2-team approach. The aims of this study are to review our experience using dorsal decubitus patient positioning for subscapular-based flap harvest and to demonstrate the effectiveness and safety of this approach.

Methods: A retrospective review of all subscapular-based flap cases performed by the senior author at 2 hospital centers from 1995 to 2010 was conducted.

A new dorsal decubitus position for raising subscapular-based flaps.

Flaps based on the subscapular vascular system are reliable and versatile tools that provide excellent coverage for a wide range of tissue deficits. Raising these flaps in the described dorsal decubitus position permits two surgical teams to work simultaneously while obviating the need for intra-operative position changes. In cases where a subscapular-based flap is deemed the most suitable option for reconstruction, the dorsal decubitus technique eliminates many of the limitations associated with the traditional lateral decubitus approach without compromising the range of tissue obtainable.

Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction.

The latissimus dorsi, whether taken as a muscle or with a skin paddle, is one of the most useful flaps in the reconstructive surgeon's arsenal. With its predictable type V vascular pedicle, this broad muscle can be elevated on its dominant thoracodorsal pedicle or used in a reverse manner on its secondary thoracic and lumbar perforators. Traditionally harvested in a lateral decubitus position, over the last 10 years we have chosen to elevate this muscle in a dorsal decubitus position, enabling 2 surgical teams to operate simultaneously.

Lessons from a case of oromandibular mucormycosis treated with surgery and a combination of amphotericin B lipid formulation plus caspofungin.

A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery.

Imatinib mesylate as a preoperative therapy in dermatofibrosarcoma: results of a multicenter phase II study on 25 patients.

Aims: The treatment of dermatofibrosarcoma protuberans (DFSP) involves wide local excision with frequent need for reconstructive surgery. A t(17;22) translocation resulting in COL1A1-PDGFB fusion is present in >95% of cases. Certain patient observations and a report on nine patients suggest that imatinib mesylate, targeting platelet-derived growth factor receptor beta, has clinical potential in DFSP.

Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma.

Background: In contrast to vulvar squamous cell carcinoma (SCC), the etiologic factors and precancerous lesions associated with penile carcinoma remain uncertain.

Objectives: To describe the morphologic features of lesions adjacent to invasive penile SCC and their relationship with the associated carcinoma and to compare these associations with vulvar carcinoma.

Methods: This was a retrospective histologic analysis of 68 cases of penile SCC.

Highly sensitive multivariable assay detection of melanocytic differentiation antigens and angiogenesis biomarkers in sentinel lymph nodes with melanoma micrometastases.

Objectives: To evaluate the prognostic value of melanocytic differentiation antigens and angiogenesis biomarkers in sentinel lymph nodes (SLNs) with melanoma micrometastases.

Design: Prognostic study of an inception cohort.

Setting: Academic research.

Slow dynamic lymphoscintigraphy is not a reliable predictor of sentinel-node negativity in cutaneous melanoma.

We reviewed data from 160 consecutive patients (89 M/71 F; 53.5 [range, 9-88] years) who had under-gone lymphoscintigraphy and sentinel lymph node biopsy (SNB) in our hospital for histologically proven cutaneous malignant melanoma (CMM) (located on the upper limb: 33; lower limb: 57; trunk: 44; and head and neck: 26 patients), with a Breslow index > 1 mm and without clinical or radiologic evidence of metastatic spread. Colloidal (99m)Tc-rhenium sulfide (36-76 MBq) was injected intradermally in the four quadrants around the tumorectomy scar, followed by dynamic acquisition and static imaging.

Location of communicating veins for medial plantar venous flap.

Background: The medial plantar venous flap is suitable for reconstruction of the palmar surface of the finger. However, it is sometimes difficult to detect and harvest the distal subcutaneous vein of the flap. In such a situation, the communicating vein can be used as a distal vein for the flap.

A simplification for harvesting medial plantar venous flap with communicating veins: usefulness of preoperative ultrasound imaging.

Background: The medial plantar venous flap is ideally suited for reconstruction of injuries to the palmar surface of the finger. However, when the distal veins of such flaps are narrow, harvesting is no longer simple and anastomosis to the digital artery presents a challenge.

Methods: Using ultrasound imaging, we investigated the presence or absence of communicating veins in the medial plantar region in 40 feet of 20 healthy individuals.

Reconstruction of large thoracoabdominal defects using two-stage free tissue transfers and prosthetic materials.

Very large full thickness defects of the thorax or abdomen after tumoral resections commonly need to be reconstructed with free tissue transfers. We retrospectively analysed the protocol of performing the free tissue transfer before the wide excision in 15 patients (mean age of 48) with large tumours of the thorax and abdomen. During the first stage, the flap was folded on itself in a strategic position close to the future resection site and microsurgical anastomoses performed.

Prognostic significance of a combined clinicopathologic score for response to primary systemic therapy in locally advanced breast cancer.

The response to chemotherapy is one of the best indicators of prognosis in locally advanced breast cancer (LABC). The pathologic response (pR) of 108 LABC patients was analysed and compared with their clinical response (cR). Our aim was to define a new combined clinicopathologic response score (cpR) and to explore its correlation with survival data.

A scanning electron microscopical study of the two sides of polypropylene mesh (Marlex) and PTFE (Gore Tex) mesh 2 years after complete abdominal wall reconstruction. A study of 15 cases.

The use of biomaterials for the repair of abdominal wall defect is becoming common and safe. It has been 20 years since the senior author developed a method to reconstruct the very large transfixing abdominal wall defect with a combination of two biomaterials (Gore Tex) PTFE as a neo peritoneum and polypropylene superficial to this in order to give rigidity to the abdominal wall) and a superficial flap. An observation at the electron microscopy level of the two sides of the implants' surfaces was performed.

Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery.

Objective: The request for cosmetic surgery is of a psychological nature. Very few studies have quantitatively assessed whether or not this psychological need was actually satisfied, and more precisely, which psychic components were satisfied.

Material And Methods: This is a multicentric, prospective cohort study.

Tendon transfers as applied to tetraplegia.

The techniques of the tendon transfers that are used primarily for the functional rehabilitation of upper limbs in tetraplegia are described in this article. The restoration of active elbow extension can be obtained either by biceps-to-triceps or by deltoid-to-triceps transfers. Grasp and key grip can be restored either by active or by passive tendon transfers.

Detection of hemodynamic turbulence in experimental stenosis: an in vivo study in the rat carotid artery.

In a previous study, we have demonstrated that turbulences in arteries less than 1.5 mm in diameter perfused ex vivo by an oscillated flow can be determined using nonlinear mathematical models. The hypothesis tested here was that nonlinear analyses enable the in vivo detection of turbulences in blood flow in vessels with dimensions affected by microsurgery.

Depression, anxiety and quality of life among scheduled cosmetic surgery patients: multicentre prospective study.

Objective: To measure cosmetic surgery patients' state of psychological vulnerability. Method: A multicentre prospective study was carried out in three hospital departments. One hundred and three patients scheduled for cosmetic surgery were examined using a structured interview and using three assessment scales: the MADRS (Montgomery and Asberg Depression Rating Scale), the SISST (Social Interaction Self Statement Test) and the EQ-5D (EuroQol) which measures quality of life.