Quantitative assessment of microhemodynamics in ischemic skin flap tissue by intravital microscopy.

Skin flaps are susceptible to ischemia, which may result in tissue necrosis particularly in areas deprived of their original anatomic blood supply. The pathophysiology of skin flap failure has been debated for many years, but due to methodological insufficiencies, every proposed theory has remained hypothetical. The aim of this study was to gain more evidence for the mechanisms involved in flap ischemia by assessing quantitatively hemodynamic parameters such as diameter, flow velocity, and volume flow in the microcirculation of a flap.

[Face lift--indications, contraindications and operation].

The face lift procedure is often performed in aesthetic plastic surgery. It corrects the stigmata of age, i.e.

Breast reduction improves symptoms of macromastia and has a long-lasting effect.

A retrospective study was undertaken to evaluate the long-term results of reduction mammaplasties. Of special interest was the extent to which the amount of breast tissue removed correlated with pain relief after reduction mammaplasty. One hundred fourteen patients underwent an average reduction of 1,266 g.

Autologous fat injection for soft tissue augmentation in the face: a safe procedure?

Autologous fat injection for soft tissue augmentation in the face is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction following fat injections into the face. Acute visual loss after injection of various substances into the face is a well-known complication of such interventions.

[Functional long-term result after mandibular reconstruction with vascularized iliac bone graft. A case report].

In an eleven-year-old boy with a large sarcoma of the left mandible, a hemimandibulectomy with en bloc soft tissue resection was performed. Preoperatively a chemo-and radiotherapy was administered and after resection of the sarcoma stabilization of the remaining mandible was achieved by temporary reconstruction plate articulating in the temporomandibular fossa. Postoperative cytostatic therapy was then given and further development of the remaining mandible awaited.

Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study.

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have experienced several complications after free TRAM flaps in our practice, including fat necrosis, partial and complete flap necrosis, abdominal-wall weakness, and hernias. In order to evaluate the incidence and types of complications, as well as the influence of preoperative risk factors (chemotherapy, radiotherapy, overweight, smoking habits, and abdominal scars), on complications, a multicentric prospective study including Bern (Switzerland), Leuven (Belgium), Stuttgart (Germany), and Verona (Italy) was designed.

[The anterior chamber lens: 10 years later. A follow-up study].

Methods: A follow-up study concerns about 120 eyes with an AC lens implanted between 5 and 11 years ago (mean: 6.75 years). Corneal edema is present in 6.

[Reconstruction of the lower extremity using partially destroyed or amputated parts].

We are often confronted with heavy destructions of the lower extremities, where there is no possibility to conserve the limb, because of the general or/and local conditions. In this situation it's wise to preserve vital rest structures that can be used for primary or secondary reconstructions of the injured limb. There are different possibilities, some of them are presented in the cases described in this article.

[Development of thoracic wall recurrence after mastectomy. Surgical consequences].

It has been demonstrated, that in a regular mastectomy a certain amount of glandular tissue is left back in the overlying skin flaps. If direct skin closure is achieved postoperatively, the glandular tissue remnants are laid with the skin flaps on top of the denuded pectoral muscle. Since these glandular tissue remnants may contain or develop breast cancer, a latter recurrence on the thoracic wall may take place.

[Gracilis muscle repair in perineal and genital soft tissue problems].

The transposition of the gracilis muscle is shown as a reliable modality of treatment in chronic soft tissue problems and fistulas of the anogenital region. A short summary of the specific anatomy is given. The clinical application is illustrated with 2 case reports.

[Myocutaneous latissimus dorsi sliding flap in reconstruction of the lower thoracic wall in chronic fistula caused by cystic echinococcosis of the liver].

We report the successful treatment of a 47-year-old man who had a 22-year history of chronic discharge from a hepatic echinococcal cyst. Before treatment in our unit there had been 8 previous attempts to control the fistula. By means of a right thoracoabdominal incision (with resection of the 7th and 8th ribs) it was possible to perform a cystectomy with subsequent marsupialisation of the residual cyst wall to the skin.

[Missed and iatrogenic nerve lesions in surgery].

Missed and iatrogenic nerve lesions are not encountered very often. Nevertheless, they represent an increasingly important subject because of their implications for the patient and the physician and their legal aspects. We present an overview of the patients with missed or iatrogenic nerve lesion treated at the Division for Plastic and Reconstructive Surgery of the Inselspital in Berne from 1980 to 1989.

Evaluation of long-term results in breast reconstruction using the latissimus dorsi flap.

To evaluate the early and long-term results of the latissimus dorsi musculocutaneous flap for breast reconstruction, a series of 92 women who underwent surgery at my department from 1979 to 1989 was critically reviewed. Special attention was directed to the late foreign body reactions leading to deformation, asymmetry, and induration of the reconstructed breast. Guidelines regarding prevention of capsular contraction are discussed and some essential surgical refinements outlined.

[Local late sequelae following breast saving therapy of breast cancer: problem cases and possibilities for their correction].

The variety of deformities seen after local tumorectomy and postoperative radiotherapy in small breast cancers is shown. Most of the unfavorable results are due to surgical errors or improper radiotherapy, and could therefore be avoided. Late asymmetry due to soft tissue defect of fibrosis of the irradiated breast can be corrected by uni- or bilateral asymmetric reduction mammoplasty.

"The open sky rhinoplasty" for correction of secondary cleft lip nose deformity, Technique and recent results.

The typical nose deformity after cleft-lip repair still represents great challenge for the plastic surgeon in this field. Many methods have been designed in attempts to correct the deformity, either during primary closure of the lip or as a secondary procedure when growth of the nose is complete. In this paper the author's own technique of secondary rhinoseptoplasty in cleft-lip patients is presented.