Amir Sadri

iPad local flap pre-operative planning: a good training tool.

Planning of local flaps can be challenging for junior plastic surgeons. The ability to experiment and design various local flaps and discuss the pros and cons of each is an excellentway to build knowledge and confidence. Traditionally, this has been done with pen and paper, but this type of planning is limited by the 2 dimensional nature of such sketches, and the skill of the artist. In recent years tablet computers, such as the iPad, have entered widespread use in medical practice. Many powerful software applications are available for these devices including photo editing software.

Video recording of surgery to improve training in plastic surgery.

Video technology is not new in surgical practice. Specialties such as general surgery and ENT regularly perform procedures using video technology, which can be recorded and potentially used for training purposes. However, there are not reported cases of video technology in plastic surgery to assess trainee skills and progression. In our institution we have used a portable high definition, head mounted video camera (Gopro HD Hero 2, Woodman Labs, Half-Moon Bay, California, USA) to record trainees Figure 2 Video recording showing trainee operating.

The use of a template to accurately position the inframammary fold in breast reconstruction

Reconstruction of the inframammary fold (IMF) during breast reconstruction is vital in achieving good aesthetic outcomes and avoiding further corrective surgery. The IMF is usually reconstructed by comparing with the other side and estimating its correct position. The IMF template can be used to accurately and consistently mark the position of the IMF relative to the contralateral side thus aiding accurate reconstruction without the need to estimate.

Postsurgical Pyoderma Gangrenosum Versus Necrotizing Fasciitis: Can We Spot the Difference?

Background Pyoderma gangrenosum is a rare noninfectious cutaneous disease characterized by expanding areas of skin ulceration around necrotic centers with purulent debris. Exceptionally, it can be precipitated by surgery alone, and this entity has been described as postsurgical pyoderma gangrenosum (PSPG). Cases of PSPG in the literature are rare. Methods We performed a retrospective review of the current literature on PSPG and highlight some observed differences between these conditions. We also present our experience of PSPG imitating an infectious process post reduction mammoplasty. Results Although PSPG can demonstrate fever, malaise, systemic signs, and serology that mimic the sepsis of necrotizing fasciitis, we identify some features that can aid diagnosis of pyoderma gangrenosum in the absence of pathergy (which is pathognomonic). These include premorbid inflammatory bowel disease, hematological malignancy, or inflammatory polyarthritis; the exquisite and disproportionate pain associated (in particular within surrounding normal skin); symmetrical changes on both breasts; specific histopathological changes with absence of microorganisms; cutaneous wounds demonstrating an ulcerated, violaceous, and undermined edge; and, in this case, bilaterally spared nipple-areola complexes suggesting progression within continuous skin up to but not across incision lines. Conclusions We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.

Online resources for lymphoedema.

the reconstructed breast footplate. The abdominal closures are frequently tight and usually lower the inframammary folds. It is particularly pronounced in the patients with lower BMIs. Failure to elevate the inframammary folds will create unaesthetic low and flat reconstructed breasts and further exaggerate the volume deficits in these women. Consequently, reconstruction of inframammary folds should be performed before the completion of the flap inset and after the provisional closure of the abdominal wound. In summary, breast reconstruction results can be enhanced by meticulous attention to detail during flap inset (Figure 2). Planning of the lateral flap extension to increase its volume, in-folding the flap to improve shape and projection, multipoint suspension to the chest wall along the upper and lateral perimeter of the breast footplate, routine elevation of the inframammary fold, and lateral reduction of mastectomy pocket, are useful maneuvers that should be