Plastic Surgery / Chirurgie Plastique

Although the early benefits of endoscopic carpal tunnel release have been demonstrated, there is great controversy regarding the risks and safety of the technique. The present study reports early major complications in a series of 1278 consecutive cases performed by a single surgeon over a seven-year period. All procedures were performed under local anaesthesia on an outpatient basis using the Agee single portal technique. Mean follow-up was three months.

No vascular, tendon or permanent nerve injuries were documented. Recurrent or persistent symptoms occurred in 7% of patients for which 20 of 89 underwent subsequent open carpal tunnel release. No nerve injuries were found on re-exploration. Other complications were consistent with previously reported incidences.

This is the largest reported case series by a single surgeon and represents an accumulation of surgical experience at the upper end of the learning curve. Endoscopic carpal tunnel release is a safe procedure in this experienced single surgeon series.

This study specifically investigates whether the use of both large cervical vessels (the external carotid artery and the internal jugular vein) as recipient vessels with end-to-side anastomosis enhance free flap survival in head and neck cancer reconstruction, when compared with the use of other standard smaller neck recipient vessels and end-to-end anastomosis. A total of 84 consecutive patients were included and were divided into two groups (42 in each group) according to the recipient vessels. The overall vessel thrombosis rate was 6% (five of 84 cases) and the overall flap loss rate was 2.4% (two of 84 cases) yielding a flap salvage rate of 60%. Vessel thrombosis occurred in three cases of the smaller vessels group and in two cases of the large cervical vessels group. This was not statistically significant.

Two cases of post-traumatic stenosing flexor tenosynovitis (flexor tendon entrapment or trigger digit) are presented. The medical literature contains few reports of this uncommon etiology for a problem that afflicts at least 2% of the adult population.

Upper extremity arterial thrombosis, though rare, is more prevalent on the ulnar side of the circulation, with the most common etiology being repetitive blunt trauma to the hypothenar eminence. Radial artery thrombosis is even more rare and when it does occur, is associated most often with iatrogenic cannulation, producing subsequent thrombi and emboli.

Three cases of spontaneous thrombosis of the radial artery extending to the superficial palmar arch and the princeps pollicis artery are presented here. Two patients underwent thrombectomies and one underwent excision of the thrombosed segment and reconstruction with a reversed saphenous vein graft. The etiology of the thrombus was consistent with cancer in two cases and trauma in one.

The presence of an extensor digitorum brevis manus represents a variation of the normal anatomy of the fourth extensor compartment of the wrist. It usually presents as a swelling on the dorsum of the wrist and is often inaccurately diagnosed. An awareness of its existence and of its characteristic appearance on diagnostic imaging studies is the basis for diagnosis. Symptomatic cases require division of the extensor retinaculum or excision of the muscle, depending on subtype, while asymptomatic cases require no intervention.

Eccrine porocarcinoma is a rare form of skin cancer that is often con-fused with other types of skin malignancy The present paper high-lights a typical case to remind plastic surgeons of the natural history, pathological findings and current literature on the management of this cancer.

Lymphangioma is a rare benign proliferative lymphatic lesion that appears in chronic lymphedematous states in a variety of settings. Lymphangioma circumscriptum consists of clinically thin-walled, translucent vesicles appearing in groups most commonly located on the axilla, chest, mouth, and tongue. A 12-year-old male patient had been suffering from itching, pink-red colored, translucent vesicular lesions overlying the anterior axilla since birth. The lesions had slowly grown in size and number over the years. The patient had no history of trauma, or cellulites. The physical examination revealed clusters of pink-red colored vesicles, which released a clear exudate when punctured. The lesion was 50×120 mm in size. The lesion was totally excised and repaired with Z-plasty. Histopathological examination revealed slight epidermal acanthosis and enlarged lymph in the upper dermis, impinging directly onto the epidermis. These lymphatics were lined only by endothelium. The lower dermis and subcutis contained abnormally large muscle-coated vessels containing a proteinaceous fluid. Six months later, there was no recurrence and a cosmetically and functionally acceptable postoperative result was obtained.

A receding chin, colloquially known as a weak chin, is a significant aesthetic impediment to a pleasing face. Multiple techniques exist to evaluate the poorly projecting chin, but most are imprecise when it comes to choosing the proper implant size. This choice is further complicated by the impracticality of commercially available chin implants. Most implant manufacturers offer only three to four categories of implants (small, medium, large, etc) that differ in size from one company to another, making the choice of the proper implant size a real challenge.

The present paper discusses a new approach to precise sizing of the chin implant, based primarily on the degree of chin convexity (curvature of the chin pad) in the profile view. Examples of mentoplasties performed using the chin convexity principle are presented.