The prenatal diagnosis of fetal cerebellar lesions is challenging. Involvement of the vermis seems to be a risk factor, especially for impaired cognitive function and social behavioral deficits. We report the case of a 33-year-old primipara with a normal and completely investigated pregnancy (first trimester screening), with a normal second-trimester ultrasound screening. Ultrasound examination at 26 weeks of gestation revealed the appearance of a translucent, round-shaped in axial section, well-defined formation. This image was localised on median line, beneath tentorium, cranial to cerebellar vermis who was pushed in the caudal direction. MRI examination at 27 weeks ‘gestation denied the presence of any cystic structure with described localisation, denied the presence of any focal lesion, specifying the slightly diffuse hypoplastic appearance of cerebral parenchyma, above and below the tentorium. Follow-up 3D ultrasound examination at 31 weeks’ gestation has demonstrated that the 2/3 cranial vermis was replaced by a translucent structure with the same features as described above. The lesion was accompanied by significant hypoplasia of cerebellum (cerebellar transverse diameter under 2nd percentile) and enlarged cisterna magna. Both hemispheres were with regular contour aspect and homogeneous hypoechogenic content. Ultrasound evaluation revealed at 35 weeks the appearance of a significant Blake pouch cyst, mega cisterna magna (13 mm) and hydramnios (amniotic index 30 cm) which required amniocentesis for maintaining the amniotic index under 20 cm. Any other structural anomaly or vascular abnormality was not found either in second trimester or in 3rd trimester of gestation. Caesarean section was performed at 38 weeks of gestation. Postnatal MRI was not performed yet, but the infant had unremarkable neurological development at 1 month of extrauterine life. Parents refused genetic studies.
In this study, we evaluate the feasibility of propeller flaps, for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Five patients (average age, 72 years old), presenting with necrosis of several foot units, were diagnosed with stage IV PAOD and diabetes mellitus. All underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4 × 7 cm to 8 × 31 cm. Perforator origin was the peroneal (5 flaps) or the tibial posterior artery (1 flap). Average operative time was 190 minutes. Overall patency was 83.3%; 1 case was complicated with total flap loss followed by below-knee amputation; 1 case developed partial necrosis necessitating skin grafting. All flaps developed mild postoperative edema, which resolved spontaneously. Propeller flaps prove to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, easy technique with fast learning curve, and low complications rate.
1Victor Babes University of Medicine and Pharmacy, Division of Reconstructive Microsurgery, Timisoara, Romania 2Victor Babes University of Medicine and Pharmacy, Department for Transplantation Immunology and Cell Therapies, Timisoara, Romania
Plastic compounds have been used for several decades to generate anatomical constructs for the training of new surgeons and medical students alike. The present study seeks to highlight the advantages and disadvantages of two different plastic compounds (Technovit 7143 and Epoxi BIODURÒE12) used to create corrosion casts of the vascular branching patterns in free muscle flaps. Porcine latissimus dorsi muscle free flaps were used in this study to create corrosion casts of their vascular branching tree by injecting the two different plastic compound into the main arterial supply. The casts generated by Epoxy BIODURÒ E12 have superior qualities compared to the casts injected with Technovit 7143, because the injection process is smoother at all branching levels, without dilation, strictures or intramuscular extravasation of the injectable plastic compound. The corrosion casts resulted from injecting Epoxy BIODURÒ E12 exhibit better elasticity and better resistance to mechanical handling compared to the ones injected with Technovit 7143.
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