Dimitrios Dionyssiou

Our experience with the lateral supramalleolar island flap for reconstruction of the distal leg and foot: A review of 20 cases

We describe our experience with, and evaluate the reliability of, the lateral supramalleolar flap that was used in 20 patients for reconstruction of the distal leg and foot. There were 14 men and six women, age range 20–83 years. Nine were diabetic. The causes of the skin defects included trauma, diabetic ulcer, and deep burn. Sites of defects were the lower leg, the Achilles tendon, the dorsal and lateral aspect of the foot, and the ankle. Nineteen flaps survived and provided satisfactory coverage of the defect. Four flaps showed partial necrosis and required revision. We think that the lateral supramalleolar flap is a good way to reconstruct soft tissue defects of the lower extremity. Based on a secondary vascular axis, it has a large skin paddle and a wide rotation arc that reaches the distal areas of the foot.

The effectiveness of intralesional injection of platelet-rich plasma in accelerating the healing of chronic ulcers: an experimental and clinical study.

The purpose of this prospective experimental and clinical study is to evaluate the effectiveness of the intralesional injection of platelet‐rich plasma (PRP), in the management of non‐healing chronic wounds. Skin defects were created in the ears of 20 white New Zealand rabbits. In the study group, autologous PRP was injected intralesionally. The control group was treated conservatively. Nineteen out of 20 cases of the study group healed within a mean time of 24·9 days. In the control group, seven defects healed within a mean period of 26·7 days, seven ulcers did not heal at day 28 and in six cases a full thickness ear defect was recorded. For a 3‐year period, 26 patients with chronic ulcers underwent surgical debridement and intralesional injection of PRP. A histological study was performed before and 7 days after PRP injection. Ten patients healed within a mean period of 7 weeks. In 16 cases, PRP prepared the wound bed for the final and simpler reconstructive procedure. Intralesional injection is a newly described method for application of PRP and represents an effective therapeutic option when dealing with non‐healing wounds.

A Simple Method for Determining the Breast Implant Size in Augmentation Mammaplasty

The authors describe a modified method for determining the size of implants in augmentation mammaplasty. Preoperatively, 35 women filled their brassieres with rice bags and expressed their opinion and wishes. Postoperatively, all of them were satisfied with their new breasts.

Severe Extravasation Injuries in Neonates: A Report of 34 Cases.

Extravasation injuries are a common and challenging problem in hospitalized newborns. Accidental infusion leakage into the surrounding tissues in immature infants may frequently result in skin necrosis, with significant risk of functional and cosmetic impairment.

Reconstruction of a degloved finger with a heterodigital reverse dorsal digitometacarpal flap.

We used a reverse dorsal digitometacarpal flap to reconstruct a degloved finger in a 60-year-old patient who had an avulsion digital amputation. The digitometacarpal island dorsal flap was raised on the vascular axis of the ring finger and wrapped around the degloved little finger. The long term results were good.

Predesigned Breast Shaping Assisted by Multidetector-row Computed Tomographic Angiography in Autologous Breast Reconstruction

Background: Free abdominal flaps are the first option in autologous breast reconstruction using the multidetector-row computed tomographic angiography for mapping the abdominal perforators. The authors aim to evaluate the impact of using a preoperative design for shaping the new breast symmetrical to the contralateral breast, assisted by multidetector-row computed tomographic angiography. Methods: Thirty-two consecutive patients who underwent delayed unilateral breast reconstruction with free abdominal flaps were divided into two groups. In group A, the new breast was shaped intraoperatively and inset, whereas in group B, a preoperative design of the new breast was used. All patients underwent multidetector-row computed tomographic angiography before the operation and the flaps were centralized around the selected perforators. Both groups were evaluated for the time spent on flap harvest, time spent on breast shaping and inset, complication rates, and secondary operations required for breast symmetrization. Independent surgeons evaluated the final aesthetic outcome. Results: The mean time spent on harvesting the flap was not significantly different between the two groups (p > 0.05); the mean time spent on breast shaping and inset was significantly shorter in group B (p < 0.001). There were no differences between the two groups regarding complications recorded, whereas symmetrization surgery was significantly less in group B (p < 0.05). At a mean follow-up 17.3 months, the final aesthetic outcome was greater in group B. Conclusion: Predesigned breast shaping assisted by multidetector-row computed tomographic angiography promotes a significant reduction in the overall operative time and the need for secondary symmetrization procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Single stage arteriovenous short saphenous loops in microsurgical reconstruction of the lower extremity

The short saphenous vein can be used “in situ” to create a temporary arteriovenous shunt for lengthening the recipient vessels of the injured limb in microsurgical reconstructions of the lower extremity. We report our results using this single-anastomosis turnover technique in three high-energy trauma patients who presented open tibial fractures associated with vascular injuries. The construction of the arteriovenous fistula provided arterial access and venous drainage to a free latissimus dorsi flap that was transferred to cover the soft tissue defect. In all three cases, this single stage procedure was successful; the flap survived and provided good long term results. The use of the ipsilateral small saphenous vein “in situ” for immediate arteriovenous loop formation may be of great value in complex lower leg reconstructions. It is a reliable adjunctive technique that provides healthy vessels to supply the free flap, permitting stable wound coverage and high rate of limb salvage.

Multiple recurrent dermatofibrosarcoma protuberans of the hand

We present a rare case of a dermatofibrosarcoma protuberans arising on the dorsum of the hand in a 51-year-old woman, who had experienced four recurrences of the tumour following local excisions. We performed a radical surgical excision of the lesion and covered the defect with a distal ulnar artery skin island flap. Adjuvant radiation therapy followed the surgical treatment. Forty months postoperatively, the patient has a functional hand without signs of recurrence and no evidence of disease. Wide surgical excision with margins of 2.5-3 cm is the optimal treatment for dermatofibrosarcoma protuberans. For selected patients, like those presenting large tumours involving the hand, adequate removal is not easily obtainable, or may result in major functional deficits. An alternative strategy may be the combination of less extensive surgery and radiotherapy, in order to prevent mutilation, decrease the local recurrence rates, and minimize the risk of metastases.

Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

This study aims to present the case of a female patient with Polands syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Polands syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Parks classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Polands syndrome female patients with chest wall and breast deformities.

Abstract: 10.10 Benfotiamine

Results: Endothelial cells exhibited high viability (>90%) as measured via confocal microscopy using Hoechst 33342 and propidium iodide staining. Following 7 days of incubation, the necessary structural integrity of the endothelial monolayer lining the lumen was achieved. This was proven by the formation of a well-defined network of actinfilaments, stained with Alexa Fluor 488 ̈ phalloidin. Additionally, the diffusional permeability of this conduit was evaluated using fluorescent labeled dextran molecules. Future studies are focused on perfusing the lumen with media with a digital-control peristaltic pump.