We report the case of a female who had suffered from progressive lymphatic malformation in the orbito-temporal region since childhood. Many surgical interventions were performed, including radical excision and shunt drainage. Despite aggressive surgical treatment, recurrence was observed after every intervention. Eventually, the condition regressed after the patient began taking a contraceptive. Moreover, it virtually disappeared after pregnancy.

BACKGROUND A deepithelialized flap is used in almost all surgical fields, particularly in plastic, reconstructive, and aesthetic surgery. This article describes several operating techniques using deepithelialized flaps that in specific cases can improve silicone breast implant coverage. METHODS All the patients underwent surgery in our department. The operations described are subcutaneous mastectomies with immediate reconstruction using silicone implants, mastopexy with immediate augmentation using silicone implants in a patient with very thin skin, and reaugmentation with mastopexy and reimplantation of silicone implants in a patient with very thin skin and extremely thin pectoral muscles. In all the described operations, we used a superolaterally based deepithelialized flap from the lower part of the breast that we fixed to the thoracic wall to cover the inferior part of the implant. RESULTS The authors have extensive experience using this flap in such specific cases. To date, they have performed more than 30 operations using this technique. Each patient was followed for 2-7 years, and the findings show excellent postoperative results. None of the patients had implant extrusions, flap extrusions, or infections. The long-term cosmetic results were outstanding. CONCLUSION The use of deepithelialized flaps in patients with very thin skin or pectoral muscles is a safe and easy way to improve implant coverage and prevent implant extrusion. This technique provides an alternative surgical option that can be beneficial in certain mammary cases.

Malignant vulvar tumors must be treated by radical removal of the tumor as well as a sufficient amount of surrounding healthy tissue. The resulting defects can be resolved by skin transplants, local transfers, skin flaps, muscle flaps or free tissue transfers. We describe the case history of a patient who underwent radical vulvectomy for a malignant tumor with immediate reconstruction by local flaps from the area of inner thighs and mons pubis. The advantages and disadvantages of this method are compared to other reconstructive surgery methods.

BACKGROUND: The vasospasm has been studied to a considerable extent in the neurosurgical literature. Little experimental and basic scientific literature about vasospasm of flap pedicle is available in the field of reconstructive microsurgery. The purpose of the study was to investigate the effect of presence of blood around the pedicle on a flap perfusion. MATERIAL AND METHODS: Blood flow through a right groin flap was continuously measured using Laser Doppler flowmetry on 40 male Wistar rats. A segment of the flap's pedicle was surgically cleared of adventitia and bathed in blood. The blood used was either collected from the tail of the rat (group A) or from the bleeding branch of the pedicle itself (group B). The differences between the signal amplitudes before and after exposure of the pedicle to blood were recorded. RESULTS: The presence of blood around the pedicle resulted in a significant decrease in perfusion of the flap in both groups. However, no significant differences in the duration of impaired blood flow between the groups were observed. CONCLUSIONS: In conclusion, the presence of blood around the vascular pedicle may cause a significant decrease in the perfusion of a flap, while the origin of the blood does not appear to be an important factor.

BACKGROUND: Vasospasm frequently accompanies manipulation of small vessels during free flap surgeries and replantations. The purpose of this experimental study was to evaluate the effect of magnesium sulphate on vasospasm provoked by surgical manipulation (axial tension) on the flap pedicle. This kind of surgical manipulation of the vessel cannot be studied in a clinical environment without putting flap viability into risk. MATERIAL AND METHODS: Forty male Wistar rats weighing around 300 g each were classified in two experimental groups (n=20 in each). In the treatment group (group A) Magnesium Sulphuricum 10%(Biotika, Czech Republic) was applied; the second group (group B) served as a control. The vasopasm was provoked by pulling the pedicle of the right groin flap of the rat. The peripheral blood perfusion of the flap was continuously measured using laser-Doppler recording. In the study group, magnesium sulphate was applied topically on the flap pedicle to relieve vasospasm, and duration of the vasospasm was compared to the control group. RESULTS: A statistically significant difference (p=0.01) between the groups was found. The duration of vasospasm was significantly shorter in the treatment group A. CONCLUSIONS: We conclude that in an experimental environment magnesium sulphate is effective in relieving surgically provoked vasospasm of the flap pedicle. This finding is in accordance with our clinical observations.

The authors present a case study of a patient with ischemic subtotal hand amputation in the palm. They describe an option to primarily reconstruct the arcus palmaris superficialis and common digital arteries by using a venous graft from the vena saphena magna with its several branches.

BACKGROUND: Facelift is currently one of the most requested procedures among consumers of aesthetic plastic surgery. Like any operation, it is accompanied by a variety of potential complications, with postoperative bleeding probably the most frequent. Hematomas can cause hyperpigmentation, contour changes due to subcutaneous scarring, prolongation of healing, and necrosis of the skin flap. The most common treatment is manual expression of the blood coagula. Needle aspiration sometimes cannot be used because of the viscosity of the coagula. METHODS: Seven patients underwent a new method of hematoma removal from wounds. One to two sutures were removed above the hairline under local anesthesia and a short liposuction cannula, 2.5 mm in diameter and 10-15 cm in length with one or two openings, was used for coagulum suction. RESULTS: All treated patients had the hematoma suction procedure without complications and with satisfactory outcomes and no subsequent bleeding. CONCLUSION: Coagulum suction is a simple and fast method that can shorten the recovery following a facelift. This method cannot replace surgical revision in cases in which there is substantial and/or persistent bleeding. However, it can reduce hematomas that are large enough to delay healing and interfere with convalescence, yet too small to warrant surgical revision.

Men with clefts often have limited or even missing moustache growth in scar areas or in the upper lip prolabium. However the histological testing showed the absence or at least the inactive form of androgenic receptor in hair follicle of cleft site, transplantation of autologous grafts harvested from hair was successful in all six cases either into scars or the prolabium. A more natural effect was achieved by using micrografts. The positive reaction of patients proved there is a need for detailed treatment in highly outgoing individuals.

The arterial system of fingers is anatomically well described, and so, usually no difficulties arise during its preparation and the making of anastomoses in replantation surgery. Difficulties may occur, however, during manipulation in the dorsal vascular bed of fingers, known only as a random venous network. There are minimal references to its existence and the location of its valvular apparatus. Using a microscopic preparation, a contrast staining, and a histological assessment, topographic relations and the course of veins of the dorsal venous network, as well as the existence and location of their valvular apparatus, was investigated on 72 three-phalanx fingers. The specimens were either harvested from fresh cadavers or traumatically amputated. We found that veins of rather significant caliber predominantly run along the dorsal aspect of the finger on both the radial and ulnar sides above the proximal phalanx of three-phalanx fingers. Proximally, venous systems of respective neighboring fingers connect in the interdigital space. The valvular apparatus was found at all levels ranging from metacarpophalangeal joints to the distal phalanx. The valves were always located distally from the confluence of two veins. Aside from this confluence, the existence of valves was not observed. The exact description of architecture of this venous system, in practice, contributes to faster orientation, better preparation, and the creation of safer anastomoses of these structures, and thus, to an increased success of replantation. Clin. Anat. 19:, 2006.(c) 2006 Wiley-Liss, Inc.

The authors present a case report of reconstruction after a degloving injury to hand by a combination of microsurgery and standard pedicle flaps. Degloving injury high on the hand was solved by free sensitive fasciocutaneous flap transfer from the radial forearm (Chinese flap), which covered the defect in the palm, while finger defects were covered by pedicle flaps from the abdomen. Dorsum of the hand was treated with a mesh skin graft. The authors also describe techniques of treatment and the relevant results prior to the time of microsurgery and compare them to the possibilities offered by microsurgery today, and they include comprehensive illustrations.