Alexander Gardetto

Ultrasonographic Appearance of Supinator Syndrome

Objective. To describe ultrasonographic findings in 4 patients with supinator syndrome (i.e., deep branch of the radial nerve). Methods. Four patients with weakness and pain in their forearm underwent ultrasonographic examination with subsequent electroneurographic testing and surgical nerve inspection. Normal measurements of the deep branch of the radial nerve in 10 healthy volunteers served as comparison for measurements in the patients. Results. An enlarged deep branch of the radial nerve was found in all 4 patients at the affected side. Electroneurographic testing and surgical inspection confirmed the ultrasonographic findings. The mean transverse diameter was 4.2 mm (range, 3.8–4.5 mm), and the anteroposterior diameter was 3.3 mm (range, 2.5–3.8 mm). In volunteers, the mean transverse diameter was 2.13 mm (range, 1.7–2.6 mm), and the mean anteroposterior diameter was 1.3 mm (range, 1.0–1.5 mm). Conclusions. The deep branch of the radial nerve appears enlarged in patients with supinator syndrome.

Composite Skin Grafts for Basal Cell Carcinoma Defects of the Nose

Basal cell carcinoma is the most frequent cutaneous cancer of the nose and is characterized by its local spreading and exceptionally rare tendency to metastasize. Since a significant advantage has been seen in surgery compared to other treatments, surgical excision ensuring the highest chance of cure is frequently employed. Excision defects of the nose may be covered with either local flap or a full-thickness skin graft. In resurfacing such defects following excision of basal cell carcinomas, we favor the technique of composite-skin grafting which involves the harvesting of composite-skin graft including the epidermis, dermis and superficial layers of subcutaneous tissue to obtain the required thickness in the recipient site. This technique was used for defects remaining after the excision of basal cell carcinomas in a series of 15 patients. The areas involved were lateral nasal region (5 cases), nasal tip (4 cases), dorsum (3 cases), alar lobule (2 cases), and soft triangle (1 case). The mean follow-up was 14.2 months. The color, texture and thickness of the composite-skin graft harvested from the preauricular site and the neck compare favorably with the skin of the nose region. Satisfactory results, both clinically and in patient appreciation, have been obtained in both the reconstruction site and the appearance of the donor site in all patients.

Secondary end-to-end repair of extensive facial nerve defects: surgical technique and postoperative functional results.

Repair of the transected facial nerve is imperative for restoration of muscle function, including the ability to produce appropriate facial expressions. Injury might involve the main trunk and its several branches. Restoration of function presupposes meticulous repair of all injured nerve branches.

Sebaceous carcinoma of the eyelid: a rarity worth considering

The sebaceous carcinoma is a very rare malignant tumour primarily found in the area of the eyelid. Most of these carcinomas originate in the tarsal meibomian glands although they may in extremely rare cases originate in the glands of Zeis of the eyelashes or the sebaceous glands of the caruncle.1 The periorbital primaries are reported to behave aggressively with the tendency to metastasise early with a significant mortality in most series.2 In many cases correct diagnosis of a sebaceous carcinoma of the eyelid is delayed not only as a result of the rarity of this tumour but also because of its ability to masquerade as a variety of other eye conditions such as chalazion or chronic blepharoconjunctivitis. A high index of suspicion is vital if these tumours are to be adequately treated. We present a case of sebaceous carcinoma and discuss the clinical behaviour, the diagnosis, and the differential diagnosis difficulties as well as the therapy. A 78 year old patient presented with a localised inflammation in the centre of the right upper eyelid. Under local antibiotic therapy for 6 weeks …

Perforator-pedicled skin island flap for coverage of microvascular anastomoses in myocutaneous flaps in the lower extremity.

Successful reconstruction and salvage of the injured or diseased lower extremity frequently depends on the success of soft-tissue reconstruction.1,2 Trauma, vascular disease, tumor resection, prolonged pressure, or infection can cause soft-tissue defects of the lower leg, with exposure of underlying structures. Although the success rate of free flaps has improved, flap failure usually occurs because of arterial and venous circulatory disturbances.3 The greatest threat to the success of a free-tissue transfer is thrombosis of the microvascular anastomosis.4 The lower extremity free flap in particular has a high incidence of vascular complication.5 Besides an incorrect suture technique, the main reason for a thrombosis is tension and pressure of the overlying structures on the pedicle and its anastomoses.6 We describe a technique for moving a perforator-pedicled skin island of a myocutaneous flap in any desired direction to obtain a tensionfree wound closure above the vascular pedicle, thus reducing the risk of a thrombosis and expanding the surface of the flap without increasing donor-site morbidity.

Direct coaptation of extensive facial nerve defects after removal of the superficial part of the parotid gland: An anatomic study

In the surgical repair of facial nerve paralysis, a tension‐free end‐to‐end coaptation of the trunk or its branches with or without rerouting is functionally superior to grafting. Assuming that a lengthening of all branches of the parotid plexus can be attained by removal of the superficial part of the parotid gland and mobilization of the branches, we performed an anatomic study.

Isolated compression of the pectoral nerve resulting in atrophy of the major pectoral muscle.

We report on two cases of isolated damage to a muscle branch of the lateral pectoral nerve. Diagnosis was established by the clinical presentation and electromyographic examination. In the few reported cases of such injuries, the cause was trauma to this region. However, in both of our patients, focal muscle atrophy gradually developed after initiation of training schedules to increase the cross‐section of the major pectoral muscle; we therefore assume that compression injury to the nerve by repetitive muscle contractions may be of pathogenic relevance. Anatomical studies of this region showed that the nerve branches of the lateral pectoral nerve, having to pierce through a connective tissue septum that is thicker here by a few millimeters, may be subjected to additional risk of compression. Early recognition and treatment are vital to prevent associated morbidity of these rare but serious injuries. Muscle Nerve 28: 760–763, 2003