Anomalous flexor digiti minimi brevis in Guyon's canal

In an adult male cadaver, the flexor digiti minimi brevis, a muscle of the hypothenar eminence, was found to arise from the superficial transverse septum (between the superficially placed flexor carpi ulnaris, palmaris longus, and flexor carpi radialis muscles, and the deeply placed flexor digitorum superficialis muscle) in the distal fourth of the flexor aspect of the left forearm. The muscle exhibited two strata of muscle fibers at its origin. The superficial stratum was a thin layer of transversely running fibers confined to the forearm, which has not been previously reported. The deep stratum, a thick layer of longitudinally running fibers, formed the bulk of the muscle. It traversed Guyon's canal superficial to the ulnar nerve and vessels to reach the hypothenar eminence. Its course through Guyon's canal could be a cause for ulnar tunnel syndrome. The ulnar nerve trunk innervated not only the anomalous flexor digiti minimi brevis muscle, but also abductor digiti minimi and palmaris brevis. This may be due to the common phylogeny of these three muscles from the same muscle mass.     

Fetal lung development in the elephant reflects the adaptations required for snorkeling in adult life

The adult elephant is unique among mammals in that the pleural membranes are thickened and the pleural cavity is obliterated by connective tissue. It has been suggested that this peculiar anatomy developed because the animal can snorkel at depth, and this behavior subjects the microvessels in the parietal pleura to a very large transmural pressure. To investigate the development of the parietal pleura, the thickness of the endothoracic fascia (ET) was measured in four fetal African elephants of approximate gestational age 111-130 days, and the appearances were compared with those in human, rabbit, rat and mouse fetuses of approximately the same stage of lung organogenesis. The mean thicknesses of ET in the elephant, human, rabbit, rat and mouse were 403, 53, 29, 27 and 37 microm, respectively. This very early development of a thick parietal pleura in the elephant fetus is consistent with the hypothesis of a long history of snorkeling in the elephant's putative aquatic ancestors.     

A modified temporalis transfer in facial reanimation

A modified surgical procedure for temporalis transfer in facial reanimation of five consecutive cases is presented. Instead of the traditional stripping of the temporalis from its origin, its attachment at the coronoid removed, and to its end, the harvested fascia lata graft was sutured to lengthen the muscle's action. These fibres were then passed to the Orbicularis Oculi and Oris to aid in reanimation and to improve their tone. The procedure is less extensive, provides a direct line of pull with good functional results, no muscle atropy since vascularity and innervation is maintained. No complaints of paresthesia, hyposthesia or scar on donor leg was noticed. None of the patients required a revision of surgery for unacceptable contour or asymmetry. This simple procedure has helped reconstruction of natural symmetrical smile with highly successful results.     

Arterial Embolization as a Treatment of Chronic Edema Following Free Cutaneous Flap Transfer to the Lower Limbs

Persisting chronic edema following postoperative free flap transfer is a common complication. We report 3 cases of successful treatment by selective arterial embolization of the feeding arterial branches without side effect. One session embolization is advocated as a first line treatment of this condition.     

Salvianolic acid B enhances in vitro angiogenesis and improves skin flap survival in Sprague-Dawley rats

Insufficient angiogenesis and microcirculatory intravascular clotting have been implicated in the pathophysiology of skin flap failure. Salvianolic acid B (Sal B), isolated from Salvia miltiorrhiza, has been reported to enhance angiogenesis in vitro. This study was aimed to determine the efficacy of Sal B on ischemia-reperfusion injury of the skin flap in Sprague-Dawley rats. Sal B was administered intraperitoneally 2 h before operation, and on the 2nd and 4th days after surgical elevation of an extended epigastric adipocutaneous flap (5 x 7 cm) in ketamine-anesthetized rats. Flap ischemia was achieved by ligating the right superficial epigastric artery and vein and clamping the left superficial epigastric artery and vein for 3 h and then released. Percentage of flap necrosis area (FNA) and plasma levels of aspartate aminotransferase, alanine aminotransferase, creatinine, and malondialdehyde were measured at 7 days after the operation. Animals were divided into six groups, including: vehicle, Sal B low dose (5 mg/kg), Sal B high dose (50 mg/kg) and each with [mesh(+)] or without mesh [mesh(-)] placement. In the three groups with mesh(+), FNA in control flaps was 53.7 +/- 6.9%, whereas low-dose and high-dose Sal B significantly improved flap survival with FNA 27.4 +/- 3.8% and 25.3 +/- 4.3%, respectively (P < 0.05, one-way ANOVA). In the three groups with mesh(-), control flaps were 35.9 +/- 4.5%, whereas high-dose Sal B also significantly improved flap survival with FNA 17.9 +/- 4.7% (P < 0.05, one-way ANOVA). There were no differences in aspartate aminotransferase, alanine aminotransferase, creatinine, or malondialdehyde between groups. We conclude that Sal B attenuates ischemia-reperfusion injury of skin flap, and provides therapeutic potential in reconstructive plastic surgery.     

A New Method for Correction of Inverted Nipple with Three Periductal Dermofibrous Flaps

The inverted nipple may be congenital or caused by repeated inflammation and breast surgery. The reported prevalence of congenital inverted nipple ranges from 1.77% [1] to 3.26%, and most of them are bilateral and umbilicated [2]. The inversion has been linked to many aesthetic, functional, and psychological problems. Many methods have been proposed to correct this deformity since the first surgical correction by Kehrer in 1879. I propose a new method with three periductal dermofibrous flaps to add bulk to the nipple base and to form a hammock to prevent recurrence. The design also shortens the circumference of the root of the nipple without compromise of the neurovascular supply. We have corrected 46 nipples of 25 patients with this method successfully since 1996. This method can be applied to all types of inverted nipple without significant complications.     

Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia

We describe method for reconstructing full-thickness ear defects using conchal cartilage graft covered by a pedicled temporoparietal fascial flap with a full-thickness skin graft. We treated eight partial, full-thickness defects of the ear in eight patients, two males and six females. The patients' ages ranged from 10 to 68 years. In five patients, the ear defects were caused by malignant tumor resection (three) and trauma (two). In the remaining three patients, the defect was created after correction of congenital ear deformity (constricted ear). In all cases, the defect included the helical rim and involved the upper third of the ear. The defect size to be reconstructed ranged from 10×14 mm to 16×20 mm. The ipsilateral conchal cartilage could be harvested without any problems in all cases. Grafted skin was obtained from the lower lateral abdomen. In all cases, the blood supply to the fascial flap was good, and the grafted skin took completely. The post-operative course was uneventful in all donor sites for cartilage, temporoparietal fascia, and full-thickness skin. Post-operative shrinkage was not significant and the reconstructed ear was close to the expected contour and size. In all cases, the defects were reconstructed almost completely satisfactorily in terms of contour of the helical rim and support. Although the color match of the grafted skin was not ideal, all patients were satisfied with the results. No donor deformity of the conchal cartilage was found in any case, and the donor scar of the temporoparietal fascia was hidden by the hair. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with full-thickness skin graft is useful in one-stage reconstruction of medium-sized full-thickness defects of the ear.An invited commentary to this paper is available at     

Skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap

BACKGROUND: It is important for breast reconstruction after mastectomy to recreate immediately good breast symmetry with an adequate amount of soft tissue. METHODS: Eight patients with breast cancer underwent skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap. This operative technique, and the results, advantages, and disadvantages of the technique were assessed. RESULTS: Seven patients had stage IIA disease, and one patient had stage I disease. An arc-shaped incision was made just at the lateral border of the breast in all patients. Three patients had a separate periareolar incision, and one had a circumferential nipple incision. There was 100% flap survival, and good breast symmetry was achieved in all patients. No major perioperative complications occurred in this series. A small amount of fat necrosis occurred in one flap. One patient had slight abdominal bulging. Minor wound-healing problems at the lateral breast skin envelope occurred in two patients. CONCLUSION: These data indicate that skin-sparing mastectomy and immediate reconstruction with a DIEP flap is a reliable and safe technique. This method is a potentially useful surgical technique, which has achieved very promising results.     

原长法联合前唇唇红"M"瓣整复双侧唇裂畸形

目的：探讨整复双侧唇裂畸形的技巧和美学问题。方法;对本组24例双侧唇裂畸形患者采用原长法,前唇唇红利用“M”瓣整复,并对其设计特点,前唇“M”瓣的应用等问题进行探讨。结果：除1例因感染唇红部裂开外,其余整复效果较为满意,唇红正中部组织较丰满,唇珠外形恢复良好。结论：参照自然唇的特点,审美水平,灵活的设计及手术技巧是整复双侧唇裂畸形的关键。     

Palatal reconstruction with the palatal island flap

OBJECTIVES/HYPOTHESIS: The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects. METHODS: All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral-based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function. RESULTS: Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow-up ranged from 3 months to 6 years, with an average follow-up of 18.5 months. Delayed donor site re-epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae. CONCLUSION: The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.