Replantation of a degloved hand with added arteriovenous anastomoses: report of two cases.

Revascularization of the degloved skin is generally accepted as the best option for the management of totally degloved hands. Nevertheless, the selection of vessels for anastomoses is usually difficult in this situation, and insufficient perfusion of the degloved hand skin is common after arterial repair. We present 2 cases of patients who sustained totally degloved hand injuries.

Spontaneous rupture of adrenocortical carcinoma: a coincidence or a tendency?

We report a rare case of adrenocortical carcinoma spontaneously rupturing. To our knowledge, this is the sixth reported case in literature that is not related to any preceding traumatic incidents or predisposing disease. Upon reviewing previous cases, tumor size greater than 10 cm in adults is a predisposing factor for spontaneous rupture, while the degree of lymph node invasion or the extent of distant metastasis is not indicative.

Immediate emergency free anterolateral thigh flap transfer for the mutilated upper extremity.

Background: Immediate emergency free flaps are defined as flaps performed directly following emergency surgery due to the exposure of major reconstructed arteries, major nerves, bones, and tendons. The authors document their experience in using free anterolateral thigh flaps in the immediate reconstruction of complex upper extremity injuries.

Methods: From January of 2000 to October of 2006, 12 patients ranging from 10 to 59 years old with complicated upper extremity traumatic injuries were treated with immediate emergency free anterolateral thigh flap transfers.

Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema.

Background: Restoring the continuity of lymphatic drainage by lymphaticovenous or lymphaticolymphatic anastomosis was observed in the short term to be patent but eventually occluded because the elevated interstitial pressure will cause obliteration of these tiny, thin-walled, low-pressure lumens. The purpose of this study was to evaluate the outcome of vascularized groin lymph node transfer using the wrist as a recipient site in patients with postmastectomy upper extremity lymphedema.

Methods: Between January of 1997 and June of 2005, 13 consecutive patients with a mean age of 50.

Long-term outcomes of composite auricle as a neurosensorial facial subunit allotransplant.

A total of 22 composite auricle transplantations were performed in allogeneic experimental (group I, n = 10), allogeneic control (group IIa, n = 5), and isogeneic control (group IIb, n = 7) groups. Allotransplantations were carried out across major histocompatibility complex barrier from Lewis Brown Norway rats to Lewis rats. Isotransplantations were performed between Lewis rats.

Bimaxillary protrusion: an overview of the surgical-orthodontic treatment.

Bimaxillary protrusion is a commonly seen deformity in Asian populations. This condition is characterized by protrusive and proclined upper and lower incisors and an increased procumbency of the lips. It is usually combined with lip incompetence, gummy smile, mentalis strain, and anterior open bite.

Replantation of the great toe: review of 20 cases.

Background: Although great toe loss represents not only disruption of external body integrity but also a functional defect with possible psychological consequences, only a few publications concerning great toe replantation have been reported in the literature. The purpose of this study was to present the authors' experience with great toe replantation.

Methods: The authors retrospectively reviewed 20 cases in which replantation or revascularization of the great toe was attempted.

Sellar lymphoma mimicking sphenoid infection presenting with cavernous sinus syndrome.

Lymphomas can occur throughout the body, but are relatively rare in the sphenoid region. The clinical presentations are atypical, ranging from nasal symptoms, pituitary hormone dysfunction and neurological impairment. We report a 63-year-old female patient who suffered nasal discharge, retro-ocular pain and left lateral gaze palsy for 3 months.

The role of adipose protein derived hydrogels in adipogenesis.

Biomaterials that induce adipogenesis may ultimately serve as alternatives to traditional tissue reconstruction and regeneration techniques. In addition, these materials can provide environments for studying factors that regulate adipogenesis. The present study investigates the potential of adipose-derived matrices to induce adipogenesis in vitro and in vivo.

Anatomical and technical aspects of harvesting the auricle as a neurovascular facial subunit transplant in humans.

Background: Auricular transplants from cadaveric sources may be a viable alternative for difficult auricular reconstruction once immunologic problems are largely solved. The authors report on the neurovascular anatomy and technical details of harvesting the auricle as a single facial subunit.

Methods: Nine auricles were studied in latex-injected (n = 5) and fresh cadaveric heads (n = 4).

Functional assessment of the reconstructed fingertips after free toe pulp transfer.

Background: Posttraumatic fingertip reconstruction with free toe pulp transfer was first described in 1979. Several studies have tested the sensibility of the reconstructed digits using the two-point discrimination test. The goal of this study was to comprehensively assess the functional outcome of the reconstructed fingertips after free toe pulp transfer.

Surgical approach to the patient with bimaxillary protrusion.

The patient who has bimaxillary protrusion often is treated using a combination of orthodontics and orthognathic surgery, and the general approach is dental extraction with retraction of the incisors. In certain cases, maxillary excess may be corrected solely with LeFort I osteotomy and setback and without dental extraction or anterior segmental osteotomies. This article discusses (1) treatment evaluation and planning and (2) the specific surgical techniques, primarily anterior segmental osteotomies and the technical details for setback of the LeFort I osteotomized segment (more than 5 mm), as they relate to the surgical approach of the patient who has bimaxillary protrusion.

Modulation of human monocyte-derived dendritic cells maturation by a soluble guanylate cyclase activator, YC-1, in a cyclic nucleotide independent manner.

This study evaluated how YC-1, a guanylate cyclase activator, affects the maturation of human monocyte-derived dendritic cells. Maturation markers and intracellular signaling pathways were evaluated. YC-1 inhibited the lipopolysaccharide up-regulation of mature markers, including CD40, CD80 or CD86 in a concentration-dependent manner with IC(50) values of 4.

Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.

Background: Microsurgical free tissue transfer has become a reliable technique. Nevertheless, 5 to 25 percent of transferred flaps require re-exploration due to circulatory compromise. This study was conducted to evaluate the timing of occurrence of flap compromise following free tissue transfer, and its correlation with salvage outcome.

Prefabrication of the free fibula osteocutaneous flap to create a functional human penis using a controlled fistula method.

Neophalloplasty remains one of the most challenging efforts in plastic and reconstructive surgery. The complex functional and aesthetic requirements are difficult to attain with consistency and safety. The current gold standard technique involves the use of a radial forearm tube-in-tube free flap, which also requires the placement of a stiffening prosthetic device for dual function.

Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: A retrospective analysis of 118 cases.

In this article, the long-term outcomes of hand defects after 1-stage reconstruction with lateral arm flap were retrospectively analyzed in a large series. Between the years 1990 and 2004, 118 traumatic hand defects were reconstructed using lateral arm fasciocutaneous flap (n = 104), lateral arm fascial flap (n = 6), and composite lateral arm flap (n = 8) in Chang Gung Memorial Hospital. There were 22 females and 96 males with an average age of 32.

Simultaneous endoscope-assisted contralateral breast augmentation with implants in patients undergoing postmastectomy breast reconstruction with abdominal flaps.

Background: Unilateral breast reconstruction after mastectomy provides the challenge of achieving symmetry with the opposite side. Reduction mastopexy is a common balancing procedure for the contralateral breast used to achieve pleasing and symmetrical breasts. Although symmetry is the ultimate goal, some women have a hypoplastic and/or ptotic contralateral breast, and the recreation of this shape would therefore not be desirable.

Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation.

Hepatic artery thrombosis is the most common technical complication in liver transplantation. The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique. At a period of 31-months, we participated in a total of 42 right lobes, 7 left lobes, and 1 whole-liver liver transplantations from cadaveric (n = 20) or living (n = 30) donors.

The effect of A2A adenosine receptor agonist on composite tissue allotransplant survival: an in vivo preliminary study.

Background: In vitro experimental studies showed that A2a receptor agonists reduce allostimulatory functions of the dendritic cells through modulation of surface expression of the costimulatory molecules and down-regulation of cytokines. Similar suppressive effects on dendritic cells have also been observed with Cyclosporine A (CsA). In this study we sought to explore if combined use of these two drugs in vivo could prolong the survival of composite tissue allografts across MHC barriers.