Chirurgia plastica

A study was undertaken to determine the effect of tension on microvascular arterial and venous repairs. A standard length of rabbit femoral artery and vein was repaired under tension following excision of a central segment. As larger segments were removed repairs came under increasing tension. Anastomoses under mild or moderate tension which were patent immediately following repair remained open and were not affected by tension. Severe tension occurring after removal of 12 to 14 mm segments in arteries and 6 to 8 mm segments in veins resulted in greater tearing of the endothelium and internal elastic lamina, narrowing, ridging between sutures, and collapse of the vessel wall. Considering the length of the vessel segment mobilized, micro-arteries in the rabbit can be stretched over twice the distance of veins and still remain patent. Lumen narrowing and convolution, coupled with exposure of thrombogenic surfaces beneath the internal elastic lamina at tear holes around sutures, and in areas proximal and distal to the repair site in vessels repaired under tension, are the key factors in the formation of thrombus and anastomotic failure.

Two cases which illustrate past and present treatments of complete scalp avulsion are presented. One of these cases was treated by conventional dermatome graft ten years ago. Another was a recent case in which an attempt to revascularize a complete avulsed scalp was made using microsurgical techniques. In the latter case a successful replantation was obtained.

Surgical management of open neglected Achilles tendon injury and damaged overlying skin is very demanding. Here, we report a case of 50 year-old man who sustained an injury to the left Achilles tendon causing complete disruption of the tendon with an open wound. The patient came to us after 3 months and was managed by tendon debridement, reconstruction by the Bosworth method, and resurfacing with a distal posterior tibial artery perforator based turn-over adipofascial flap covered with a split thickness skin graft. There was minimal skin graft loss which healed by itself. A 9 month follow up of the reconstructed tendon showed a good functional result and a normal range of dorsi and plantar flexion of the foot. This technique provides an easy and quick solution to resurface the tendoachilles with minimal donor site morbidity.

Rhinophyma is classically a benign condition whose etiology and pathogenesis are not well understood. A few cases of giant rhinophymas have been reported in the literature. In this article, a case of gigantic, lobulated rhinophyma is presented. The appearance was unusual, and there was cyst formation histologically.

A method is presented for the treatment of mandibular fractures in which maxillomandibular fixation was achieved with a combination of an arch bar and screws which was not dependent on the condition of the patient’s teeth for the treatment of the mandible fracture. The technique and a representative case is discussed.

When a deformity is well defined the most appropriate treatment can be selected. The proposed classification provides guidelines for diagnosis and treatment.