Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jun 2008
Case ReportsDeliberate self-harm by insertion of foreign bodies into the forearm.
Deliberate self-harm is common. It is usually by drug overdose or ingestion of other noxious substances, but self-harm by cutting or burning often comes to the attention of plastic surgeons. We report three variant cases involving insertion of paperclips, a ballpoint pen cartridge and sewing needles into the forearm. We discuss the management considerations of each case and emphasise the importance of actively addressing the underlying psychiatric problems for all instances of deliberate self-harm.
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J Plast Reconstr Aesthet Surg · Jun 2008
Preservation of lower extremity amputation length using muscle perforator free flaps.
Coverage of any lower extremity amputation stump must be durable to resist external forces, well contoured, and thin enough for proper shoewear or prothesis fitting. Preservation of bone length to maximise the ability to ambulate is also of paramount importance. If local soft tissues are inadequate to fulfil these prerequisites, consideration of a microsurgical tissue transfer is a reasonable option, especially to cover bone or save a major joint. ⋯ They can be sensate if desired. Of course, muscle function is by definition preserved. Complications are minimal and usually related to the reason for the amputation in the first place.
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J Plast Reconstr Aesthet Surg · Jan 2008
Case ReportsTotal upper and lower eyelid replacement following thermal burn using an ALT flap--a case report.
Upper and lower eyelid unilateral full thickness reconstruction in a patient with no available adjacent tissues because of burns or trauma sequelae is a surgical challenge. A case of severe thermal burn with unilateral complete defect of both upper and lower eyelids is reported, together with the surgical technique of reconstruction. The patient was a 65-year-old man who sustained deep burns of the head and neck with upper airway burns after falling into a fireplace. ⋯ Flap vessels were anastomosed to the superficial temporal artery and vein. The conjunctiva and the fascia replaced the new inner upper and lower lamella. To our knowledge, this is the first report of the use of a perforator flap, the ALT flap, in full thickness reconstruction of both upper and lower eyelids and may be a reliable option in such selected and challenging situations.
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Children with burns inflicted by other children represent a small proportion of referrals to our paediatric burns unit. The aim of this paper is to investigate any differences between them. ⋯ Older male children sustained significant burns outside their homes. They reported them as being deliberate assaults, although on closer inspection of the circumstances it was difficult to support their account of the events.
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J Plast Reconstr Aesthet Surg · Jan 2008
A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects.
The reconstruction of large soft-tissue defects at the elbow is hard to achieve by conventional techniques and is complicated by the difficulty of transferring sufficient tissue with adequate elasticity and sensate skin. Surgical treatment should permit early mobilisation to avoid permanent functional impairment. Clinical experience with the distal pedicled reversed upper arm flap in 10 patients suffering from large elbow defects is presented (seven male, three female; age 40-70 years). ⋯ Stable defect coverage led to long-term wound stability without any restriction of elbow movement. The lateral and medial upper arm flaps represent a safe and reliable surgical treatment option for large elbow defects. The surgical technique is comparatively simple and quick.