Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele.

Purpose: We have previously reported a small series on the closure of large myelomeningocele (MMC) defects with a keystone design perforator island flap (KDPIF) in a paediatric neurosurgical centre in Australia. We are now presenting an updated longer term follow-up of an expanded series demonstrating longer term durability of this vascularized flap for large myelomeningocele defects.

Methods: The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2016.

Acute Hemorrhagic Flexor Tenosynovitis due to Vincula Injury.

A 20-year-old previously well woman presented to the emergency department with classical signs of acute flexor tenosynovitis, 4 hours after a minor puncture wound over the volar aspect of her right middle finger distal interphalangeal joint. Exploration of the flexor sheath in theatre revealed frank blood within the sheath and extension of the puncture wound through the profundus tendon into the short vincula beneath. The blood was irrigated from the sheath, and the patient made a complete recovery by 2 weeks postoperatively.

Closed digital artery injury.

Closed digital artery injury with secondary acute ischemia is a rare phenomenon. The most common injury pattern involves a crush mechanism with a resultant transverse fracture in proximity to the interphalangeal joints. Secondary acute ischemia requires urgent surgical exploration with digital arterial repair to avoid necrosis and associated decreased hand function.

Mandibular ameloblastoma: clinical experience and literature review.

Background: Ameloblastoma is a locally aggressive odontogenic tumour of the mandible and maxilla that, if neglected, can cause severe facial disfigurement and functional impairment. A thorough understanding of its clinicopathological behaviour is essential to avoid recurrence associated with inadequately treated disease. Currently, wide resection and immediate reconstruction is the treatment of choice in most cases of mandibular ameloblastoma.