Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction

Introduction Reverse neurocutaneous and propeller perforator flaps are both used to reconstruct diabetic distal lower limb defects. Our study aims to compare outcomes between these two groups of flaps with an emphasis on indications and complication rates. Method A retrospective analysis was conducted, reviewing data from 54 diabetic patients who underwent reconstruction of acute or chronic wounds of the foot and ankle between 2005-2018. Thirty-four patients (Group A) had a reverse neurocutaneous flap (NCF): nineteen sural and fifteen lateral supramalleolar flaps. Twenty patients (Group B) had a propeller flap (PF) based on peroneal (n = 13) or posterior tibial artery perforators (n = 7). All patients had a preoperative Doppler examination to identify the nutrient artery of the flap. In both groups, we recorded patients' demographics, characteristics of the defect, postoperative complications and time to heal. Follow-up ranged from 6 to 59 months. Student's t-test and chi-squared test were used for statistical analysis. Results Mean patients' age was 59.1 and 50.8 years for Group A and B, respectively. Defects were located at the Achilles zone (n = 16), posterior heel (n = 14), foot dorsum (n = 9), lateral and medial malleolar areas (n = 8), anterior ankle (n = 5) and lateral foot (n = 2). Mean size of the defect was 42.8 cm² in Group A and 23 cm² in Group B. Uneventful healing was recorded in 20/34 neurocutaneous flaps and in 12/20 propeller flaps; complications included two complete flap losses (one NCF, one PF), seventeen distal flap necroses (10 NCFs, 7 PFs), fifteen delayed wound healing events over the donor or recipient site (12 NCFs, 3 PFs). Secondary surgeries were required in 15 NCF and 8 PF patients. Mean healing time was 48.1 and 40.7 days for Group A and B, respectively. All patients, except one NCF case, which resulted in leg amputation, returned to previous levels of ambulation. Conclusion Reverse neurocutaneous and propeller flaps may provide stable reconstruction of diabetic lower limb defects; neurocutaneous flaps are specially indicated for larger and more distally located defects, although they might be associated with longer healing time and additional revision surgeries. Propeller flaps were more frequently used in younger patients for smaller and more proximally located defects.

Can Cosmetics' Advertisements Be An Indicator of Different Perceptions of Beauty Amongst Countries?

INTRODUCTION

Concepts of beauty are different amongst different cultures and civilizations. The objective of this study was to evaluate beauty perceptions through cosmetic advertisements in an effort to further appreciate beauty understanding amongst lay people in various parts of the world. To achieve these objectives, we reviewed cosmetics' advertisements to study whether the concept of beauty varies amongst different countries.

MATERIALS AND METHODS

We used the keywords "cosmetics" and "advertisements" in YouTube search engine in all existing languages in Google translator and came up with advertisements from 18 countries. The faces of the models were compared against Marquardt^® beauty mask template in order to have a mean to objectively test symmetry with a mathematical computer model. The weak point of our study is that we can present no model photographs due to General Data Protection Regulation.

RESULTS

Advertisements retrieved in total were 257. Characteristics with no statistically significant difference (SSD) amongst models in different parts of the world were: symmetry (p = 0.187), high cheek bones (p = 0.325), small noses (p = 0.72), thin jaws (p = 0.98), lush hair (p = 0.54), clean and smooth skin (p = 0.367), and white toothed smile (p = 0.235). Characteristics with SSD were: in Latin America, USA, and Australia tanned models and fuller lips were preferred (p < 0.001), whilst in Asia milky white skin models and small mouth were preferred. Age ratio (p = 0.022) was lower amongst models in Southeast Asia compared to American, European, Indian, Australian, and Arab models. Arab and Southeast Asia women had intense eyebrows (p < 0.001) and used artificial eyelashes.

CONCLUSIONS

All the common characteristics noted by the two independent surgeons (GAS and LP) referred to symmetry, youthfulness, and health. Differences noticed reflected cultural influences in the perception of beauty.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction to: Can Cosmetics' Advertisements Be An Indicator of Different Perceptions of Beauty Amongst Countries?

Georgia-Alexandra Spyropoulou's name appeared incorrectly in the original publication of this article. It appears correctly here.

A critical survey of a dedicated craniofacial surgery outpatient's clinic within a public health service structure

The management of craniofacial conditions, especially in the setting of a large general hospital, is ideally achieved by a focused team in a multidisciplinary clinic. The purpose of this article was to present the design, modus operandi and outcomes of a newly formed dedicated craniofacial multidisciplinary outpatients' clinic at the first year of operation endpoint within a public healthcare structure.

Our experience with the lateral supramalleolar island flap for reconstruction of the distal leg and foot: A review of 20 cases

We describe our experience with, and evaluate the reliability of, the lateral supramalleolar flap that was used in 20 patients for reconstruction of the distal leg and foot. There were 14 men and six women, age range 20-83 years. Nine were diabetic. The causes of the skin defects included trauma, diabetic ulcer, and deep burn. Sites of defects were the lower leg, the Achilles tendon, the dorsal and lateral aspect of the foot, and the ankle. Nineteen flaps survived and provided satisfactory coverage of the defect. Four flaps showed partial necrosis and required revision. We think that the lateral supramalleolar flap is a good way to reconstruct soft tissue defects of the lower extremity. Based on a secondary vascular axis, it has a large skin paddle and a wide rotation arc that reaches the distal areas of the foot.

Histological observations of palatal malformations in rat embryos induced by retinoic acid treatment

Malformations of the palate were induced in white rat embryos following maternal exposure to retinoic acid (tretinoin). Five experimental groups and the controls were treated by the following protocol: Group 1: pregnant rats received 100 mg retinoic acid (RA)/kg b.w. suspended in corn oil on gestational day (GD) 11.5; Group 2: 20 mg RA/kg b.w. from GD 8-12; Group 3: 20 mg RA/kg b.w. from GD 7.5-11.5; Group 4: 100 mg RA/kg b.w. on GD 10-11; Group 5: 100 mg RA/kg b.w. on GD 10 and 12; Group 6 received corn oil vehicle from GD 7-14.5; and Group 6: served as non-injected controls. In all retinoic acid treated groups, varying degrees of clefts with occasional attempts of fusion were noted. The severity and frequency of the malformations were dependent on dosage or gestational day of drug treatment. Our results indicate that RA, even at the lowest dose tested (20 mg/kg b.w.) severely affects the various tissues constituting the embryonic palatal shelves by altering cell interaction and possibly programmed cell death. These events would then result in lack of or inadequate differentiation with subsequent formation of aberrant craniofacial architecture.

[Anatomic anomalies of P. Robin syndrome and therapeutic management]

The authors present their experience in the treatment of the Pierre Robin Syndrome in 32 cases. The purpose of this anatomical and clinical study is to guide and codify the surgical treatment of this malformation.

[Anatomic abnormalities of the genital tract in ano-rectal malformations]

Of 152 patients with imperforate anus, 16 girls -25%), 10 boys (15%) have an abnormality of the genital tract and real frequency seems underevaluated. In girls, vaginal septum, bicornuate and didelphys uterus are mostly diagnosed, associated with severe unilateral upper urinary tract malformations. Absent vagina and uterus (Rokitansky syndrome) must be seen at birth, to preserve perineal fistula used to fashion a vagina at the time of the abdomino-perineal fistula pull through. In boys hypospadias, ectopia and uretero-vas anastomosis are the most frequent malformations.

[Anatomy and physiology of the muscles in cleft lip and palate]

The authors present the anatomy and the physiology of the normal and pathological muscles of the cleft lip and palate. The authors insist not only on the anatomic defects but mainly on the muscle functions which are the most disturbed. The purpose of this study is to guide the surgical technique in order to improve not only the cosmetic but the functional results as well.

[Anatomy of the naso-labial muscles and the mesethmoid in labiomaxillary cleft. A new surgical approach of cheiloplasty]

The authors analyse the role of the ectomesenchyme in facial organogenesis, and the biology of fetal and infant cephalic development, supply valid arguments for the application of new principles in cheiloplasty for labial or labiomaxillary clefts. Instead of dermatoplasty alone, the procedure involves anatomically selective muscle reconstruction of the nasolabial confines, a structure that is predominantly muscular. Cheilomesethmoidoplasty of the transverse and nasolabial muscles of the orbicularis of the upper lip is therefore a totally valid procedure. This procedure has applied by the authors in 36 cases.