Search

Many patients throughout the world have had breast augmentation using injectable materials. In the Far East, an adulterated impure silicone has been used by non-medical persons and unlicensed 'cosmetic surgeons' as well as by licensed physicians. The injected material usually causes a granulomatous reaction, tenderness, erythema, pain or discomfort and even skin necrosis. Eventually, the injected breast becomes very hard and develops a distorted contour. Previous treatment was by subcutaneous mastectomy with immediate or delayed reconstruction using a silicone prosthesis. The results of this were often unsatisfactory. We obtained more satisfactory results in 11 patients who had the siliconoma removed by subcutaneous mastectomy and the breast reconstructed with a de-epithelialised TRAM flap., (Copyright 2001 The British Association of Plastic Surgeons.)

Reconstruction of all four fingers that were amputated at the metacarpophalangeal (MP) joints of the right hand of a 17-year-old male patient was performed by simultaneous transfer of the combined second and third toes from each foot at the level of the metatarsophalangeal joint. Fifteen-month follow-up showed acceptable cosmesis with satisfactory functional results. The patient had no foot discomfort, even after prolonged walking and running.

This prospective clinical comparison of the three commercially available Biobrane preparations indicated that: (1) All three products of Biobrane are excellent skin substitutes. (2) Regular Biobrane has satisfactory wound adherence, however, its non-porous structure allows limited wound drainage. Because of this, it has the highest incidence of haematoma and fluid accumulation (13.3 per cent) and delayed epithelialization (18.8 per cent) of the three products. (3) Thin Porous Biobrane has poor adherence which limits patient activity and provides poor pain relief. The infection rate of 10 per cent was the highest of the three products. (4) Regular Porous Biobrane demonstrated superiority to the other two Biobrane products in this study. It provided good wound adherence while maintaining wound drainage because of its porous structure. The incidence of blood or fluid accumulation (7.1 per cent) was the lowest in the three products. (5) Most of the complications such as infection, delayed epithelialization, pain and activity impairment were related to fluid or blood accumulation. Adherence was found to be more important and reliable than pore structure. Operative haemostasis thus should be emphasized when using porous Biobrane, as with all skin substitutes.

In 24 patients, corrosive injuries involving the floor of the mouth, the pharynx, and the esophagus were repaired in two stages using a combined free forearm flap and colon for functional restoration of the alimentary tract. The results were satisfactory. Morbidity was decreased, complications were minimal, and there were no failures. In the first stage, early reconstruction with a forearm flap for the oral floor, the pharynx, and the cervical esophagus can be done safely 3 months after the original injury when the acute inflammation of the tissue has disappeared. The forearm flap is thin and pliable, and has a good blood supply for primary healing without failure or stricture. Dysphagia is eliminated because food passes down by gravity. There is no constriction or hyperperistalsis of the colon, both of which are occasionally seen with the traditional colon interposition. In the second stage, the traditional method is used to finish the reconstruction of the remainder of the esophagus.