Vertical dermocrurolipectomy is a technique that in Italy has been named "DECLIVE," (which in Latin means something that moves downward). The first medial thigh lift with the DECLIVE technique was done in 1993. Since then, based on its excellent results 50 patients have been operated on, following DECLIVE. Therefore, DECLIVE should be considered just a variant in the medial thigh lift, because resecting a triangular portion from the perivulvar skin, it stops the displacement of the scar downward. Special acknowledgment goes to Ted Lockwood's studies for his role in the development of this technique.
Closed percutaneous wire fixation of hand fractures frequently requires protection with external splintage. This splintage increases the risk of joint stiffness, prolongs recovery time, and increases therapy input. We have developed a method of linking external Kirschner wires (K-wires), using a metal clamp, after their insertion, so as to increase the security of fixation and facilitate postoperative mobilization. The mechanical properties of this method have been assessed in vitro and compared with conventionally fixed, unlinked, K-wires. We have been able to establish that the linked K-wire system is better able to resist loosening. This work proposes that linkage of K-wires permits omission of all additional external splintage, with no detriment to management. The technique has been applied in clinical cases over the past 8 years and results of treatments were evaluated mainly to detect unexpected complications. We report a low rate of complications and good results in terms of bone healing and recovery of function.
Traditional pull-out techniques for tendon and ligament repair are still widely used in hand surgery, despite constant refinements and the development of other methods of fixation. We propose a modification of the classic technique which utilizes a K-wire as an external strut instead of the classic button. This fixation system can be usefully applied in the fixation of extensor and flexor tendons and reinsertions. It is particularly applicable in situations where a transarticular K-wire is to be used anyway, in situations of temporary joint immobilization and in other situations.
Background: The dorsal skin of the hand is well-known to be a real donor site for the dorsal metacarpal artery flap. Apart from the undisputable advantages, these flaps have also some major disadvantages, as: (a) sacrifice of the dorsal metacarpal artery; (b) useful only in covering the soft tissue defects over the proximal half of the long fingers; (c) the impossibility of early postoperative fingers mobilisation, due to the situation of the flap vascular pedicle proximally to the metacarpophalangeal joint. Material and methods: We describe a similar type of flap, as a design and donor area, with the classical metacarpal flap, but which can be used in covering more distally defects in both palmar and dorsal aspect of the long fingers, and allows an early postoperative mobilisation, due to the situation of the vascular pedicle distally to the metacarpophalangeal joint. The blood supply of this flap comes from a well-represented vascular anasthomosis in the proximal half of the long fingers, between the dorsal metacarpal arteries and the palmar common digital arteries or the collateral digital arteries. It is possible to harvest two types of flaps based on these vessels: (a) fasciocutaneous pedicled flaps and (b) fasciocutaneous transposition flaps. Results: The evolution was uneventful in 70% of cases; in 25% of cases we had some temporary venous congestion, which diminished and subsided spontaneously, and in 5% of cases we lost the flaps. In all the cases, the functional rehabilitation started after 24 hours. In conclusion, this flap has some advantages, as: (a) it does not sacrifice the dorsal metacarpal artery; (b) it can reach the most distal regions of the long fingers; (c) the distal location of the vascular pedicle to the metacarpophalangeal joint allows the early postoperative mobilisation of the fingers.
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