Interferon alpha-2A therapy for keloids

Keloid is a frustrating condition both for patient and sur eon. In spite of the availability of many therapeutic modalities such as steroids, radiotherapy, vitamin E, penicillamine and colchicine in some cases keloid management can be unsatisfactory. A 16-year-old boy who was burned in an automobile accident, sustained keloids on the anterior and posterior chest, right face, and left arm. The extensive scarring of the right arm caused him to lose function. Interferon alpha-2a was used for treatment and most of the lesions returned to baseline levers. At IS months follow-up he continued to be symptom-free with good function

Histologic analysis of prefabricated, vascularized bone grafts: An experimental study in rabbits

Purpose: The purpose of this study was to investigate the cellular quality of prefabricated bone grafts

Management of chronic calcaneal osteomyelitis with pull-through abductor hallucis muscle flap - a report of three cases

Three patients who had chronic osteomyelitis of the calcaneus were treated with radical debridement of all involved soft tissue and bone and obliteration of dead space with a pull-through abductor hallucis brevis muscle flap. Two patients had calcaneal osteomyelitis without soft tissue loss resulting from previous comminuted calcaneal fractures while a third patient had a large soft tissue defect and calcaneal osteomyelitis resulting from a destructive infection. All of the patients had undergone several surgical procedures for treatment of the osteomyelitis with histories ranging 18 months to 30 months. Following treatment with the pull-through muscle flap there has been no recurrence over the longterm (>two years). We believe that radical removal of all contaminated tissue and immediately coverage with a muscle flap provides an effective single stage treatment of chronic calcaneal osteomyelitis

TOTAL SCROTAL RECONSTRUCTION WITH VERTICAL RECTUS-ABDOMINIS MUSCULOCUTANEOUS (VRAM) FLAP IN THE TREATMENT OF PENOSCROTAL LYMPHEDEMA

A 37-year-old man with scrotal and penile lymphedema was treated by total excision of the scrotal and penile skin and subcutaneous tissue. Split thickness skin grafts were used to cover the penis and the pubic area. An inferiorly based left rectus abdominis muscle with a 12 x 16 cm skin island from the epigastric region was used to reconstruct the scrotum. The VRAM flap is a simple, reliable flap and it provides sufficient coverage of the exposed testicles after total excision of diseased scrotal skin. It also gives a satisfactory esthetic result. The VRAM flap may be another source for reconstruction of the total scrotum

Use of reverse abdominal fascio-cutaneous flap in reconstruction of large chest wall defect after mastectomy owing to malign tumor

Defects resulting from resection of advanced breast cancers can be quite large, posing a difficult reconstructive challenge. Lots of patients are presented with local recurrences after radiotherapy and/or chemotherapy treatments. Abdominal fascio-cutaneous flap, pectoralis, latissimus dorsi, rectus abdominis and omentum pedicled flaps or free flaps may be used for reconstruction of the chest wall. The described rotation flap extends from the posterior axillary line to linca alba and inferior line is determined like abdominoplasty. We preferred this flap, which is safe, reliable and leaves minimal donor morbidity, particularly in patients with late stage tumors. The technique was used on 11 female patients with major chest-wall defects after mastectomy between 1999 and 2001. Chest wall defects after resection varied between 9 x 11 and 12 x 15cm (vertical x horizontal). Marginal skin necrosis of about 1 x 2cm was observed in one patient but didn't require any correction. In our opinion, this technique is a viable alternative in repairing large defects in the anterior chest wall

THE FOLDED DOUBLE PADDLED FREE FLAP FOR ORAL CAVITY RECONSTRUCTION

Six radial forearm flaps, two transverse rectus abdominis flaps and one latissimus dorsi myocutaneous flap were used in a bipaddled fashion for full thickness defects of the cheek and the floor of the mouth resulting from cancer resection. The flaps provided both intraoral lining and skin cover in all cases. Immediate reconstruction was carried out following tumor resection in six cases. In three patients who presented with large full thickness defects due to failure of primary reconstruction, late reconstruction with double paddled free flaps was performed. All transfers were successful, in the latissimus dorsi transfer a minimal area of necrosis occurred at the tip of the flap. A salivary fistula developed in two cases, both healed spontaneously up to three weeks postoperatively. The average operating time was 5.5 h; the average hospital stay was 13.4 days

Sculpturing a fibular flap: Combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap

A fibular flap has great versatility in reconstructive procedures. Osteomies and ostectomies enable the flap to be used for variable defects. We used combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap in two patients. Vertical osteotomy transforms the tubular structure of a fibula into a flat bone that can be used for reconstruction of wider defects with less vertical height. Neither vertical osteotomy nor ostectomy had negative effects on viability and bony healing of the segments in our patients. We think that the fibular flap, thanks to its versatility, can be used for reconstruction of complex orbito-zygomatic and orbito-cranial defects successfully. (c) 2005 Wiley-Liss, Inc