Leonidas Pavlidis

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.

Rare benign tumours of the nipple

Benign lesions of the breast in total are much more frequent than malignant ones. However, there are no epidemiologic data on the prevalence of benign or malignant tumours of the nipple, and the bibliography on benign nipple tumours in general is limited.

Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs

Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.

A 35-year-old woman presenting with an unusual post-traumatic leiomyoma of the nipple: a case report

IntroductionLeiomyoma of the mammary papilla is one of the most uncommon nipple tumors with only 50 cases reported in the literature until now. To the best of our knowledge we present the first report of a nipple leiomyoma that originated from a traumatic abrasion caused by breastfeeding.Case presentationA 35-year-old healthy Caucasian female with a cauliflower-like tender and pink nodular mass that was approximately 10mm in diameter presented to our out-patients department. The patient suggested that the mass originated from a traumatic abrasion caused by breastfeeding three years ago and it has been slowly growing ever since.An excision biopsy was performed. The histological and immunohistochemical examination confirmed the diagnosis of leiomyoma. There were no postoperative complications or any sign of local recurrence four years postoperatively.ConclusionsLeiomyoma of the mammary papilla is a rare benign neoplasm that usually appears as a solid tender nodule. Differential diagnosis comprises breast carcinoma, leiomyosarcoma and myoid hamartoma. The recommended treatment is complete excision of the tumor with histologically confirmed tumor-free margins otherwise recurrence is possible. A detailed history of the patient’s disease can reveal the original etiology. This is an original case report that will have particular interest to plastic surgeons, dermatologists, and pathologists. The pathogenetic mechanism was trauma of the nipple. According to our review of the literature this particular information has never been reported and we think that it may advance our knowledge of this very infrequent tumor.

The effect of transverse carpal ligament lengthening on carpal tunnel volumetry: a comparison between four techniques.

Transverse carpal ligament (TCL) reconstruction after open carpal tunnel release has been advocated to restore wrist kinematics and grip strength. This study investigates the effect of TCL reconstruction in carpal tunnel volume (CTV). Thirty-eight cadaveric wrists were volarly approached and TCL was exposed to its proximal and distal edges. Carpal tunnel contents were removed and the CTV was measured considering that carpal tunnel resembled the shape of a truncated cone. TCL was then dissected and subsequently reconstructed by using 4 different surgical lengthening techniques. Three of these techniques were retrieved from the literature. The fourth was proposed and performed by the authors. Postreconstruction calculation of CTV was done with the same method. In 6 cadavers, a magnetic resonance imaging-based measurement of CTV was performed to assess the validity and reliability of simulation method. The average increase of CTV ranged from 31% to 44% (P < 0.001 for all techniques). However, no statistical significant difference was found between the 4 techniques (P = 0.097). Magnetic resonance imaging volumetric values were equal to simulation measured values before and after reconstruction of TCL (P = 0.224 and P = 0.674, respectively). Lengthening of TCL substantially increases the carpal tunnel capacity regardless the applied surgical technique. The simulation model method seems to be an accurate, precise, and cost-effective approach for the evaluation of CTV.

Soft tissue reconstruction of the thumb with the dorsoradial forearm flap

The dorsoradial flap is a recently described cutaneous flap, which is harvested from the distal forearm and indicated for covering dorsal soft tissue defects of the hand and thumb. Vascularization of the flap is assured by a cutaneous branch of the radial artery, which arises at the level of the first intermetacarpal space and supplies the skin of the distal quarter of the forearm dorsum. This area corresponds to the skin island of the dorsoradial flap. We report our clinical experience on seven patients where this flap was used for covering post-traumatic defects of the thumb. Dimensions of the defect varied from 18 to 28 cm2. The donor site was skin grafted. All flaps survived and provided satisfactory coverage of the defect. Based on a secondary vascular axis, the flap has a large skin paddle and a wide rotation arc that allows soft tissue reconstruction of the dorsal and radiopalmar areas of the thumb.

A systematic review of the factors predicting the interest in cosmetic plastic surgery

Background: A systematic review of the literature was performed to clarify the psychosocial characteristics of patients who have an interest in cosmetic plastic surgery. Methods: Medical literature was reviewed by two independent researchers, and a third reviewer evaluated their results. Results: Twelve studies addressing the predictors of interest in cosmetic surgery were finally identified and analysed. Interest in cosmetic surgery was associated with epidemiological factors, their social networks, their psychological characteristics, such as body image, self-esteem and other personality traits and for specific psychopathology and found that these may either positively or negatively predict their motivation to seek and undergo a cosmetic procedure. Conclusions: The review examined the psychosocial characteristics associated with an interest in cosmetic surgery. Understanding cosmetic patients’ characteristics, motivation and expectation for surgery is an important aspect of their clinical care to identify those patients more likely to benefit most from the procedure.

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.

Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients.

Sir:We read with great interest the article by Raffaini et al.1 concerning facial feminization surgery satisfaction assessment. Despite our personal high resistance in operating on transgender patients who want to undergo facial feminization, we feel that in some cases such operations are an unavoid

Intravenous Hyaluronidase with Urokinase as Treatment for Arterial Hyaluronic Acid Embolism.

371e irreversible pathophysiologic alterations appeared. Another possible reason is that hyaluronidase and urokinase were not administered intravenously as Chiang et al.1 have proposed, but instead urokinase intravenously and hyaluronidase subcutaneously. Which is the most effective way that medications should be administered in similar cases is a question that remains to be answered. Similar cases presented in the literature resulted in necrotic skin areas that needed to be débrided surgically, leaving permanent scars.2,3 Use of a few medications has been proposed in the management of arterial hyaluronic acid embolism.4,5 Because of the small number of cases in the literature, the experience on dealing with these cases is limited. Further research needs to be performed to understand the nature of this complication and pathways for treatment. The article presented by Chiang et al.1 is a positive step in this direction. DOI: 10.1097/PRS.0000000000002377