Roberto Rudge Ramos

A severe case of Beare-Stevenson syndrome and associated congenital deformities.

A severe case of congenital anomalies is described, with several characteristics of Beare-Stevenson syndrome, such as cutis gyrata, acanthosis nigricans, craniofacial anomalies, ear defects, enlarged umbilical stump and anogenital anomalies. He does not have craniosynostosis or clover leaf skull, which has also been described in this syndrome. This patient also shows hands and feet anomalies, absence of skin adnexa in several locations and dental anomalies, which could suggest an associated ectodermal dysplasia.

V-Y ADVANCEMENT FLAP FOR THE RECONSTRUCTION OF PARTIAL AND FULL THICKNESS DEFECTS OF THE UPPER LIP

We analysed the records of 25 patients who had their upper lips reconstructed after resection of a tumour. All the repairs were done with triangular cutaneous and musculocutaneous flaps with a skin island with V-Y advancement, and a subcutaneous or muscular pedicle with or without mucosa. The choice of flap was based on the width of the defect after the tumour had been resected. A subcutaneous pedicled flap was used in 14 patients; a musculocutaneous flap not including the mucosa in 5, and including the mucosa in 6. This flap can be used to repair upper lip defects of any thickness. The procedure is quite safe from a circulatory point of view and the flap has the advantage of requiring only one procedure. It is aesthetically satisfactory in most patients and maintains the good function and sensitivity of the lip.

A gracilis myocutaneous flap for reconstruction of the scrotum

A gracilis myocutaneous flap was used in a case of severe avulsion of the scrotum and loss of both testicles. The flap was transposed and inset in such a way as to simulate a scrotum of the right volume, shape and texture: the operation gave the patient good psychological support and a very good aesthetic repair of this mutilating injury.

Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents

Introduction: Herein, we present two cases of post-burn retraction of the axillary region, which were subsequently surgically corrected using multiple Z-plasties. We present a marking strategy to facilitate the learning of this procedure by plastic surgery residents. Methods: Two patients with axillary and upper limb retractions due to burns with hot liquids were surgically treated using multiple Z-plasties. The strategy proposed in this study recommends the marking of the triangular flap located at the midpoint of the axillary retraction, which then advances and crosses the axis of the scar. Then, subsequent flaps are made at an angle of 60° to each other. We believe that this systematization of marking facilitates the planning and learning of Z-plasty. Results: The study patients achieved an adequate range of motion and functional recovery of the affected limb postoperatively. We observed no cases of necrosis of the flap ends, which should be carefully worked and slightly rounded. The execution of the procedure was simple using the suggested marking strategy. Conclusion: The presented marking strategy was reproducible and easy to learn. Multiple Z-plasties were effective in restoring the range of motion of the areas affected by burns that were treated using this method. ■ ABSTRACT

Sub fascial flap based on the supraclavicular artery in reconstruction of neck burn contractures

This study presents 3 cases of women ages ranged from 25 to 52 years with anterior cervical contractures caused by burns that resulted in functional and aesthetic deficit. Contracture release in 3 patients and reconstruction was done using a sub-fascial flap whose main pedicle was the supraclavicular artery and the occipito-postero-cervical vessels that were preserved. The flap was designed differently from the classically described that uses the skin of the shoulder but which presents differences of color and texture with relation to the skin of the neck. The results were satisfactory and no complications such as infections or necrosis.