Quantification of level I neck lymph nodes for lymph node transfer in lymphedema treatment: an anatomical study and review of literature.

Background: Vascularized lymph node transfer (VLNT) is an effective microsurgical method for the treatment of lymphedema. Knowledge of lymph node quantity and regional anatomy of donor sites are essential for surgery optimization. The aim of the study was to quantify the level I lymph nodes of the neck (submental and submandibular lymph nodes), describe the regional anatomy and review the current literature.

Median Nerve Trifurcation.

Median nerve trifurcation in the carpal tunnel has only rarely been described and never reported to be found at surgery. We present the first such case, highlighting a median nerve trifurcation found at carpal tunnel release. Consideration of amendment of the Lanz classification should be made to account for such cases, and surgeons should be aware of possible anatomical variations to avoid iatrogenic injury.

A Prognostic Dilemma of Basal Cell Carcinoma with Intravascular Invasion.

Basal cell carcinoma is the most common malignancy; however, it very rarely metastasizes. Despite the low mortality caused by this cancer, once it spreads, it has dim prognosis. We report a case of basal cell carcinoma with rare intravascular invasion and review the literature for risk factors and management of metastasis.

Clinical applications of dynamic infrared thermography in plastic surgery: a systematic review.

Background: Infrared thermography (IRT) has become an increasingly utilized adjunct to more expensive and/or invasive investigations in a range of surgical fields, no more so than in plastic surgery. The combination of functional assessment, flow characteristics and anatomical localization has led to increasing applications of this technology. This article aims to perform a systematic review of the clinical applications of IRT in plastic surgery.

Direct comparison of postoperative monitoring of free flaps with microdialysis, implantable cook-swartz Doppler probe, and clinical monitoring in 20 consecutive patients.

Background: There is an increasing demand for successful free tissue transfer, with postoperative monitoring of flaps a key to early salvage. Monitoring methods have ranged from clinical techniques to invasive options, of which two are particularly applicable to buried flaps (Cook-Swartz Doppler probe and microdialysis). The evidence for these options has been represented largely in separate cohort studies, with no single study comparing these three techniques.

Reducing radiation dose without compromising image quality in preoperative perforator flap imaging with CTA using ASIR technology.

Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results.

Trigger finger release with stepwise preservation of the A1 pulley: a functional pulley-preserving technique.

The first annular (A1) pulley is an important structure of the hand, providing a biomechanical support to the metacarpophalangeal joint and maintaining joint stability and flexor tendon alignment. Albeit uncommon, disruption of this pulley can result in dislocation or ulnar drift of the digit, particularly pronounced in patients with rheumatoid arthritis. Despite this, the A1 pulley is commonly divided without reconstruction in trigger finger.

Developments in image-guided deep circumflex iliac artery flap harvest: a step-by-step guide and literature review.

Purpose: The deep circumflex iliac artery (DCIA) flap has evolved significantly over time in the intricacies of flap design and breadth of surgical application. This has been facilitated by advances in preoperative imaging and planning, in particular, computed tomographic angiography. Studies have highlighted that advanced imaging modalities and other technologies such as image-guided stereolithographic biomodeling can substantially improve flap planning, flap harvest, and operative outcomes.

Digital neural loops: classification and implications of variation in hand surgery.

Background: The "neural loop" describes a digital artery passing through a digital nerve, after which both the structures progress distally to supply the digit. While rare, past descriptions refer to neural loops located around the common palmar digital arteries, with no reports of more distal loops.

Methods: We describe a case in which a distal neural loop was identified, with the ulnar proper palmar digital nerve (PPDN) to the long finger split, and reconstituted around the radial proper palmar digital artery (PPDA) to the ring finger.

Free distal volar forearm perforator flap: clinical application in digital reconstruction.

Introduction: Soft tissue defects of the digits can be a challenging problem for the hand surgeon. For non-graftable defects, numerous local, regional and free flaps have been described for resurfacing, each with their own limitations - bulk, colour, texture mismatch, donor morbidity. Perforator flaps increasingly provide the optimal option for reconstruction of digital defects as they are thin, pliable and with low donor site morbidity.

The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation.

Purpose: The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft.

The vascular basis of the hemi-hamate osteochondral free flap. Part 2: surgical anatomy and clinical application.

Purpose: The free vascularised hemi-hamate flap combines the utility of providing a small osteochondral portion of hamate for reconstruction, while providing a means of vascularisation to preserve articular cartilage after transfer. In Part 1 of this series, we highlighted the vascular approaches to such a technique. The current study investigates the bony architecture of the hamate, with particular emphasis on its utility for a range of osteochondral defects in the hand.

Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.

Background: Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies.

Methods: Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database.