RESUMEN
The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible.
Asunto(s)
Calcáneo/lesiones , Fijación Interna de Fracturas/efectos adversos , Fracturas Abiertas/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Infección de la Herida Quirúrgica/cirugía , Adulto , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/cirugía , Calcáneo/cirugía , Desbridamiento/métodos , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fracturas Abiertas/diagnóstico por imagen , Humanos , Hiperemia/etiología , Hiperemia/cirugía , Masculino , Radiografía , Reoperación/métodos , Medición de Riesgo , Infección de la Herida Quirúrgica/diagnóstico , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
UNLABELLED: Abdominoplasty is a surgical procedure designed to rejuvenate truncal aesthetics, in which restoring "normal" waistline definition is one of the most challenging elements. Advancement in surgical techniques is reducing surgical risk and improving aesthetic outcomes. In this study we adopted the "Brazilian" abdominoplasty technique, originally presented by Ramos at the International Society of Plastic Surgeons Meeting in Australia (2008). Waist definition is improved by medially advancing Scarpa's fascia and repairing any divarication of the rectus abdominis muscles before vertically reducing redundant skin. In our study we demonstrated the role of Scarpa's fascia as an important part of the superficial fascial system, which helps define waist contour. The technique we demonstrate shows improved contouring and waist definition with lower complication rates (by minimising dissection and dead spaces). LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Asunto(s)
Abdominoplastia/métodos , Adulto , Anciano , Fascia , Femenino , Humanos , Masculino , Persona de Mediana Edad , OmbligoRESUMEN
Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using 'permanent' fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites.