Since Bassett's 1912 description of block dissection of the groin, 1 Bassett A. L'epithelioma primitive du clitoris: son retenissement ganglionaire et son traitement operatoire (Thesis). Paris: G Steinheil; 1912. Google Scholar the high morbidity of this procedure has prompted the publication of a number of techniques and modifications to reduce the common complications of wound infection, breakdown and necrosis, seroma and lymphoedema. Published complication rates range from 6 to 20% for wound infection, 17 to 65% for wound breakdown, 6 to 40% for seroma, and 22 to 80% for post-operative lymphoedema. 2 Swan M.C. Furniss D. Cassell O.C.S. Surgical management of metastatic inguinal lymphadenopathy. Br Med J. 2004; 329: 1272-1276 Crossref PubMed Scopus (41) Google Scholar

An experiment has been performed on adult cats to investigate the sensory reinnervation of muscle spindles and tendon organs in peroneus brevis following immediate and delayed repair of the divided muscle nerve.The results demonstrate that delaying nerve repair for up to 6 weeks does not give rise to any significant detrimental effect on such reinnervation.

Sixteen patients undergoing compression treatment for scar hypertrophy were included in a study to evaluate physical indices of scar maturity. The results show that while thermographic measurements of scar temperature were not clinically valuable, rising levels of transcutaneous oxygen tension in treated scars correlated well with a reduction in scar thickness assessed both clinically and by ultrasound. It is postulated that low levels of tcpO2 in immature scars result from low oxygen diffusibility through scar tissue rather than from rapid metabolic consumption of oxygen by scar tissue.

A case report from Louisville, Kentucky was recently published in this Journal describing a patient with a desmoplastic malignant melanoma of the cheek (Man et al., 1981). Reference was made in that report to 15 previously described cases of this tumour, all from the United States of America. We wish to report a recent patient of ours with a tumour that was histologically consistent with a desmoplastic malignant melanoma but showed several atypical clinical and histological features. This is, as far as we know, the first recorded occurrence of the tumour outside the USA.

INTERNATIONAL ABSTRACTS OF PLASTIC AND RECONSTRUCTIVE SURGERY MEMBERS OF THE BOARD OF REVIEWERS: Nose: PDF Only

A comparison has been made between the traditional needle and syringe technique of injection and two differing types of needleless injector in the intralesional treatment of keloids with triamcinolone. This most reliable method of delivering a known quantity of drug into a keloid is by syringe and needle. However, the CO2-powered injector is far more reliable than the spring-powered injector in the reliability of the dose administered and its intralesional penetration and distribution.

Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns.Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated.Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups.Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.

The findings are presented of a retrospective survey of paraplegic patients who underwent surgical repair of pressure sores between 1973 and 1977. Forty-one patients with 56 sores were studied. The recurrence rate of repaired sores was 47 per cent. In an analysis of the data the only factor associated with a good long term result was a return home rather than chronic hospitalization following surgery. This finding applied to bedridden but not to sitting patients.

In attempts to improve the results of nerve grafting several modifications in technique have been advocated by Duel (1930), Davis and Cleveland (1934), Bunnell and Boyes (1939), Millesi et al. (1972), Dickson et al. (1977), but little attention has been paid to the recipient bed of the graft. Sanders and Young (1942), demonstrated that nerve grafts are revascularised rapidly in a segmental fashion. Thus the length of the graft is irrelevant to revascularisation, whereas the vascularity of the bed into which the nerve graft is laid is critical, a point verified by histological examination of autografts in man (Holmes, 1947). Prolongation of ischaemia for more than two days leads to progressive collagenisation of the graft preventing axonal downgrowth and for this reason Sunderland, (1968) states that the graft should occupy a well nourished and healthy bed, free from haematoma. There would, therefore, be clear surgical advantages in the provision of a well vascularised tunnel into which the graft could be introduced, without the necessity of wide dissection along the length of the bed. This would reduce the risk of haematoma and excessive scar formation around the graft. Further benefit from such a tunnel could arise in cases in which tendons or blood vessels had been repaired primarily. Secondary nerve grafting could be performed without the risk of damage to vessel repairs and the graft would be protected by its sheath from adhesion to healing tendons. The technique of using silicone rod implants to produce pseudo-sheaths prior to secondary tendon grafting is well established (Conway et al., 1970) and is known to have no detrimental effect on revascularisation of the tendon. Rayner (1977) has shown that the vascularity in these silicone induced sheaths is maximal four to six weeks after insertion, subsequently decreasing as the fibrous component of the wall matures. Thomson and Vanderby (1976), using guinea-pigs, and Anderl et al. (1977), using rats, have shown that the silicone induced capsule is capable of maintaining free grafts of bone, cartilage and dermis. This paper describes an experimental study of the survival and reinnervation of autografts inserted into sheaths propagated around silicone rods, compared with that of similar grafts treated in the conventional manner.