Blue rubber bleb naevus syndrome (BRBNS) is characterised by vascular malformations of the skin and gastrointestinal tract. We present the rare case of BRBNS in an African child. She presented with large-volume gastrointestinal bleeding and was managed by on-table colonoscopic identification and surgical excision, of all her enteric, vascular malformations.
Extensive and complex defects after neurosurgical oncologic resections including dura are a challenge, as watertight closure is of paramount importance. This article illustrates the usefulness of a free myoperitoneal flap in closure of such a defect when located at the skull base or cranium. The vascularized peritoneum appears to be an excellent biological replacement for the dura and the well-vascularized muscle promotes wound healing and obliterates dead space.
INTRODUCTION:Multidetector computed tomography (MDCT) angiography is "the gold standard" for preoperative perforator selection. DIRT is based on the relationship between dermal perfusion and the change in rate and pattern of skin rewarming following a cold challenge. Can DIRT be an alternative to MDCT? METHODS AND MATERIALS: 23 patients scheduled for breast reconstruction with DIEP flap were included. Preoperatively arterial perforator sounds were located with a hand held Doppler. Afterwards a desktop fan was used to deliver a mild cold challenge to the lower abdomen. The rate and pattern of rewarming of the skin was registered with an infrared camera. The locations of first appearing hot spots on the skin were registered. Eight patients had an additional MDCT scan. RESULTS: A rapid appearing "hot spot" was associated with an arterial Doppler sound and a suitable perforator intraoperatively. All DIEP flaps survived and were based on the perforator as selected from DIRT. The selected hot spot could easily be related to a perforator on the MDCT scan. CONCLUSION: Perforator selection of DIEP flaps is facilitated with the use of DIRT. The technique is non-invasive, provides real-time information and does not require exposure to ionizing radiation or intravenous contrast medium. DIRT could be an alternative for MDCT in perforator selection.
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