Bruno Coessens

The vertical mammaplasty: a reappraisal of the technique and its complications.

Since 1989, superior pedicle vertical scar mammaplasty as described by Lejour has been used in the authors’ department as the only technique for breast reduction. From 1991 through 1994, a series of 170 consecutive patients (330 breasts) underwent an operation. In these patients, minor complications were observed in 30 percent of the patients and major complications in 15 percent. Surgical revision for scar or volume corrections was necessary in 28 percent of the breasts, which seemed unacceptable. Therefore, the original technique was modified by decreasing the skin undermining and avoiding liposuction in the breast. Primary skin excision was performed in the submammary fold at the end of the operation if the skin could not be puckered adequately. This modified technique was used from 1996 through 1999 in 138 consecutive patients (227 breasts). In the second series, minor complications were observed in 15 percent of the patients and major complications in 5 percent. However, the technical modifications did not significantly change the rate of secondary scar and volume corrections, which were still necessary in 22 percent of the breasts. In large breasts, the addition of a horizontal scar at the end of the operation did not change the rate of secondary revision, which however compares favorably with the figures obtained with the inverted T, superior pedicle mammaplasty.

Carpal tunnel syndrome due to an haemangioma of the median nerve in a 12-year-old child.

A case of carpal tunnel syndrome due to an haemangioma of the median nerve in a 12-year-old male is reported. Radiological and histological data support a venous origin of the tumour. Interfascicular dissection and resection were performed, and 6 months later the patient remains symptoms free.

Simultaneous bilateral facial reconstruction of a Barraquer-Simons lipodystrophy with free TRAM flaps

Barraquer-Simons lipodystrophy is a rare disorder of unknown origin characterized by a progressive atrophy of the subcutaneous fat of the upper part of the body. Renal disease with abnormalities of complement factors is the most frequent accompanying feature. A case is presented in which bilateral facial contour has been restored simultaneously with two deepithelialized TRAM flaps.

Clinical experience with the reverse lateral arm flap in soft-tissue coverage of the elbow.

Coverage of soft-tissue defects of the posterior aspect of the elbow is a difficult problem. Many techniques have been published, mostly case reports. The radial recurrent fasciocutaneous flap as described by Maruyama and Takeuchi represents one of the best solutions for medium-sized defects. We used it successfully in five clinical cases. The anatomy of this flap, based on the radial recurrent artery, has been confirmed by our cadaver studies, and a technique to raise this flap safely will be described.

Dorsal carpometarcarpal dislocation of ulnar fingers. A case report.

Abstract Multiple dorsal dislocations of the carpometacarpal joints are rare. Diagnosis requires a high index of suspicion, careful examination and good radiography. Treatment is controversial and is based on the presence or not of associated fractures. This paper presents a case of combined fifth and fourth finger carpometacarpal joint dorsal dislocation, successfully treated with closed reduction and percutaneous pinning. A discussion of this pattern of injury is also presented.

Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: a review

Since the first publications in the early nineteenth century on surgical techniques for releasing congenital syndactyly, this pathology has received constant interest in the medical literature. Current techniques for separating syndactylized digits include three major steps that are discussed separately: commissure reconstruction, digital incision and ways to overcome the lack of skin. The use of the recently described commissural flaps – usually larger and more proximally-raised than conventional flaps – that allow for closure without a skin graft is discussed, based on the personal experience of the authors.

New mixture for simultaneous anatomical and radiological cadaver studies

SummaryA new mixture made out of lead oxide and rhodamine B is presented. Because it adequately colors even the small vessels, it offers the possibility of obtaining X-ray photographs of the injected territories, and dissection of the vascular networks. Advantages of this mixture are discussed.

Microsurgical reconstruction of small soft tissue defects on the lateral side of the calcaneal region

Abstract Soft tissue defects of the ankle are a challenging problem. Local flaps have several disadvantages because of functional and/or cosmetic problems. Free flaps, by nature, allow a greater choice of donor sites and therefore minimize problems resulting from local flap harvesting. Passing the vascular pedicle between the tibia and the Achilles tendon for anastomoses on the posterior tibial vessels can maintain satisfactory ankle contour. Three cases of free flap reconstruction of the lateral aspect of the calcaneal region are presented and the surgical approach is detailed. All the patients were able to wear normal shoes after the reconstruction.