Charalambos Georgiou

A Cadaveric Study of the Arterial Blood Supply of the Labia Minora.

Background: Labiaplasty has become a rather common operation. The main complication of the different surgical techniques is the dehiscence of the suture line. The dehiscence rate varies among the different techniques, and this may imply that the vascular anatomy is not respected in some cases. The detailed arterial anatomy of labia minora is not well described, so the aim of the authors was to describe this anatomy with a cadaveric study. Methods: Eleven fresh cadavers were dissected, and arterial study was made with injected computed tomography scans and rotational angiography. At the end, a cast of the arterial network was made and chemically exposed to verify the radiological findings. Results: The findings of this study allowed identification of a dominant central artery that was named “C” artery, two posterior arteries named “P1” and “P2,” and one small anterior artery, “A.” Furthermore, a connection between the anterior system of the external pudendal artery and the posterior system of the internal pudendal artery was confirmed. Conclusions: The arterial network of the labia minora was identified with this study. This may help surgeons orientate the wedge excision when they perform labiaplasties. More precisely, when this wedge is placed at the most anterior part of the labia minora, the least perfused area is removed, and a posterior flap is created that will preserve a robust blood perfusion.

Inferior Cubital Artery Perforator Flap for Soft-tissue Coverage of the Elbow: Anatomical Study and Clinical Application

BACKGROUND Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow. METHODS Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators. RESULTS A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months. CONCLUSIONS The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction. CLINICAL RELEVANCE The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

Total Upper and Lower Eyelid Reconstruction: A Rare Procedure--A Report of Two Cases.

Summary: Reconstruction after total amputation of the upper and lower eyelids with preserved globe is rare. The primary goal is immediate corneal protection. The second goal is to restore mobility, occlusion, and facial symmetry. Two women had full-thickness excision of both upper and lower eyelids to treat a melanoma. The reconstruction method required four steps over a period of 5 months. A buccal mucosal graft was used to recreate the conjunctival lining, and an oblique forehead flap was used to recreate the skin. Resection of the flap and replacement by a full-thickness skin graft made it possible to recreate a thin and mobile upper eyelid. Visual acuity remained unchanged, and the eyelids remained functional despite a degree of ptosis and lower eyelid retraction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Delayed Complications in Abdominoplasty: A Case of a Ten-Year-Old Abdominoplasty Abscess

Late abdominoplasty complications are not well-known, and some rare cases of patients having complications many years after may exist. In this chapter we expose a rather uncommon clinical expression of an insidious subcutaneous abscess 10 years after abdominoplasty. The tummy tuck was complicated by a postoperatory Staphylococcus aureus surgical site infection. After an adequate treatment, she was always almost asymptomatic with periods of itching and local soreness. After 10 years she had a blunt force trauma and an abscess erupted. What is intriguing in this case report is that the symptoms, patient history, and even the bacteriological results imply that the abscess is related to the initial abdominoplasty. Even if it is extremely rare, we suspect that quiescence in subcutaneous infections may exist especially after skin flap elevation.

External Rhinoplasty by Skin Excision to Correct Hypertrophic Tip of an Elderly Patient

An elderly patients aesthetic requirements to correct a large and drooping nasal tip are difficult to satisfy. When the skin is thick, hard and sebaceous, tip deformity cannot be corrected with a standard rhinoplasty procedure. The authors present a new two-step approach of hypertrophic tip correction combining skin excision, cartilaginous framework remodeling, dermabrasion, and the results for one patient after a two-year follow-up.

Treatment of ischial pressure sores. Our experience of 99 patients with 108 sores

BackgroundIschial pressure sores concern patients in the sitting position and particularly the rehabilitated patients. Spontaneous healing may be very difficult without surgery, and ischial pressure sores have the highest recurrence rate among other decubitus. Furthermore, there is no consensus concerning the ideal surgical technique in order to definitely treat the patients. This is a retrospective analysis of the surgical treatment of ischial pressure sores aiming to identify the ulcer recurrence rate per surgical technique and describe the early complications.MethodsThis was a retrospective study that was conducted in Marseille, France, between 1988 and 2007. The medical records concerning patients with ischial pressure sores were collected and analyzed. The main objective was to identify the ulcer recurrence rate after ischial pressure sore surgical treatment. The secondary objective was the identification and description of early complications.ResultsNinety-nine patients were finally selected and analyzed for 108 ischial pressure sore treatments. Primary endpoint analysis identified 25 recurrences for 108 sores (23.14 %). Hamstring V-Y advancement flap had 71 % recurrence rate. Wound dehiscence was the primary complication. Six out of seven hamstring V-Y advancement flaps had early complications.ConclusionsPressure sore treatment can be difficult and challenging. In this retrospective study, we have found that the hamstring V-Y advancement flaps have a much higher recurrence rate and a higher rate of complications. Our results may be limited by the retrospective nature of this study but they imply that the V-Y advancement flaps should not be used as a first choice for ischial pressure sore treatment.Level of Evidence: Level IV, therapeutic study.

Does quiescence exist in subcutaneous abscesses? A case of a 10-year-old abdominoplasty abscess.

Quiescence is the dormant state before the inevitable eruption of an infection. Several human diseases such as cancer may present with a relatively long period of inactivity, but soft tissue infections usually have a rapid progression. In this letter, we describe the rather uncommon clinical expression of an insidious subcutaneous abscess 10 years after abdominoplasty. It is our hope that this will be helpful in documenting this unique occurrence in the plastic surgery literature. A 61-year-old woman presented with tenderness in the infraumbilical region that was triggered after a blunt-force trauma (kick) in the abdomen 5 days before. Physical examination revealed normal periumbilical and abdominal scars (abdominoplasty sequelae), but the skin between the 2 scars was very firm and fixed to the underlying tissues, with associated localized inflammation (Figure 1). Apart from desquamation, no puncture point or other kind of wound was noted. The patient was a healthy woman and had no medical problems or treatment that could have compromised her immune response. Figure 1 Initial presentation. Note the skin deformation associated with desquamation and inflammation indicating an infectious subcutaneous collection. The patient had undergone an abdominoplasty 10 years before presentation that was complicated by a postoperative Staphylococcus aureus surgical site infection. The infection manifested an abscess of the infraumbilical region with no wound dehiscence; it was drained twice. No …