Low-flow vascular malformations of the hand and forearm: a multidisciplinary experience in a tertiary paediatric centre.

Background: Vascular malformations (VMs) involving the hand and forearm in children provide management challenges due to complex anatomy, indispensable functionality and developmental implications.

Methods: The institution's Vascular Registry was searched for patients with hand and arm VMs, supplemented by chart review of included patients.

Results: Twenty-one patients were identified, 52% male, with mean presenting age 5.

Re Facial aesthetic injections in clinical practice: Pretreatment and post-treatment consensus recommendations to minimise adverse outcome Region-specific changes in line with the Covid-19 pandemic.

Despite the recent publication in March 2020 of guidelines for facial injectable treatments, the speed of the COVID-19 pandemic and its safety implications necessitate changes to these guidelines The authors described what would constitute safest practice in the provision of facial injectable treatments and summarised these in table form. Adherence to a high standard of asepsis and infectious disease precautions remain a key patient safety requirement when performing facial aesthetic injections. A revision and update of these guideline summary tables follows.

A new approach to preexisting vertical midline abdominal scars with crossover DIEP flap breast reconstruction.

Breast reconstruction using a free transverse rectus abdominis myocutaneous flap or a deep inferior epigastric perforator (DIEP) flap is a challenge in patients with a vertical midline abdominal scar due to the poor perfusion of the lower abdominal skin ellipse across the midline. In such patients, only one half of the abdominal skin ellipse can be used with certainty, and this limits the amount of tissue available for reconstructing the breast. Two cases of breast reconstruction in patients with a lower midline abdominal scar are presented using the DIEP flap, in which the poor perfusion across the midline scar was overcome by a technique of crossover anastomoses between the two deep inferior epigastric pedicles.

The dorsalis pedis fascial flap.

The dorsalis pedis fasciocutaneous flap has been used successfully in soft tissue reconstruction both as a pedicled and a free flap. The long-term donor site problems associated with this dorsalis pedis flap prompted us to look at the use of the dorsalis pedis fascial flap in soft tissue reconstruction. We describe the results of our anatomic study and clinical series of the use of the dorsalis pedis fascial flap both as a free flap and a pedicled flap.

Purse-string nipple areolar reconstruction.

We present a surgical technique of nipple areolar reconstruction that uses a purse-string to increase areolar projection while reducing loss of nipple projection. A permanent purse-string is used around a modified CV flap to advance tissue centrally to the base of the nipple reconstruction. Two opposing hemiareolar island flaps are advanced toward the base of the nipple to add tissue volume.

Optimizing blepharoplasty outcomes in patients with previous laser vision correction.

Background: Dry eye syndrome, often referred to as dysfunctional tear syndrome, can occur following laser vision correction surgery and routine blepharoplasty. Identifying patients prone to developing or worsening of dysfunctional tear syndrome following blepharoplasty can help optimize surgical outcomes.

Methods: The authors highlight the salient features of the dysfunctional tear syndrome including key steps in identifying at-risk patients.

Keystone island flap: an alternative reconstructive option to free flaps in irradiated tissue.

Background: The Keystone Flap is an island flap that is very useful for repairing skin defects of the integument. Described as a keystone, this arc-shaped flap in fact consists of a schematically designed, perforator-based reconstructive unit which serendipitously resembles two conjoined VY flaps. This facilitates closure because of the multiple VY points at the extremes, where the surrounding tissue is advanced to close the defect while the flap size remains basically static.

A technique for sequential segmental neuromuscular stimulation with closed loop feedback control.

In dynamic myoplasty, dysfunctional muscle is assisted or replaced with skeletal muscle from a donor site. Electrical stimulation is commonly used to train and animate the skeletal muscle to perform its new task. Due to simultaneous tetanic contractions of the entire myoplasty, muscles are deprived of perfusion and fatigue rapidly, causing long-term problems such as excessive scarring and muscle ischemia.