Plastic Surgery

The extensor tendons to the index, long, ring and small fingers are motored by the common extensor digitorum communis muscle body. Effective function of this muscle can only occur if the gliding amplitude of each of its four extensor tendons is normal. As a corollary, limitation of the excursion of any of the individual tendons by adhesions at a fracture or tendon repair site, a fixed flexion contracture at the metacarpophalangeal joint, or by rupture, attenuation or laceration of a saggital band or juncturae tendinum, will result in reduction of the excursion of the adjacent extensor tendons. This pathological state has been termed the extensor quadriga because of its similarities to the analogous pathology affecting the flexor digitorum profundus system. Improper management of this clinical entity may lead to an abnormal pathomechanical kinematic chain imbalance. Early identification and treatment is critical to address this entity appropriately.

The most frequently used method in two-stage reconstruction of a tendon is the placement of a silicone rod, forming a canal where the tendon can glide easily, that is subsequently replaced with a tendon graft. However, there is a disadvantage in that the formation of a qualified gliding canal requires at least three months after the placement of the silicone rod. In the present report, the authors evaluated the effects of tetracycline on the time period required for the formation of a qualified gliding canal in rats after the placement of a silicone rod. Tetracycline was administered through an 18 gauge needle inserted into the silicone rod in the test side (right) and saline solution was administered in the same fashion to the control side (left) in each rat. Histopathological and macroscopic examinations at weeks 1, 2, 3, 4 and 8 after the operation showed that a significantly thicker and more mature sheath was formed after two weeks in the sides that had been treated with tetracycline.

Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.

Juvenile xanthogranuloma is a type of non-Langerhans cell histiocytosis that occurs most frequently in infants and children. It is usually asymptomatic and can present as either a cutaneous or extracutaneous lesion. The present case is believed to be the first reported in the English literature of juvenile xanthogranuloma presenting as an ulcerated bleeding lesion on the dorsum of the nose.

A case of a 67-year-old man with recurrent basal cell carcinoma of the nasal tip and an incidental symptom of epiphora (volunteered by the patient) is presented. Epiphora is an abnormal overflow of tears that fail to drain into the inferior nasal meatus via the nasolacrimal system. Within the differential diagnosis of epiphora and nasolacrimal obstruction is neoplasm – primary, secondary or metastatic. On further investigation, including computed tomography imaging, he was subsequently found to have invasive disease extending along the left embryological cleavage plane superiorly to the medial canthal tendon. An excision attempt using Mohs technique by the dermatological surgeon was unsuccessful in adequately clearing the margins, and revealed a diagnosis of morphea-like basal cell cancer. This failure, taken together with the extent of disease identified by computed tomography scan, resulted in significant alteration of the operative approach. The patient underwent extensive tumour extirpation and nasal reconstruction using a forehead flap.

The present case alerts surgeons involved in the management of skin cancers to the importance of the anatomical relationship of the nasolacrimal apparatus to embryological soft tissue cleavage planes when dealing with recurrent and aggressive lesions. In addition, it serves as a reminder to inquire about the signs and symptoms associated with nasolacrimal obstruction. Moreover, when preparing for surgical excision of recurrent aggressive basal cell carcinoma, high-quality imaging is essential to tailor the operative plan.

Myositis ossificans (MO) is a benign, progressive, ossifying lesion that displays a characteristic zonal histological appearance. MO traumatica is a localized form of heterotopic bone formation, associated with repetitive micro- and/or macrotrauma in the majority of cases. The importance of imaging to differentiate MO from sarcomatous change and to determine maturity of the lesion is identified because suboptimal operative intervention on immature MO inevitably results in recurrence. A severe case of MO in a 24-year-old paraplegic man with chronic bilateral greater trochanteric pressure sores is presented, and the importance of the MO in the etiology and treatment of this case is discussed. An extensive review of the literature is included and integrated.

The present paper describes a previously unpublished complication of the application of a circumferential head dressing after cranial neurosurgery. A 34-year-old woman developed a large area of skin necrosis on her forehead from a circumferential head dressing applied after the surgical removal of a colloid cyst. Neurological recovery was excellent but plastic surgical repair of her iatrogenic cosmetic injury was required.