The dartos musculocutaneous flap

Brirish Joumal of Plastic Surgery (1991). 44,392-393

Letters to the Editor

(British Journal of Plastic Surgery, 43, 483), I would like to remark that a simple review of the British literature reveals a description of the technique, referred to as “our method” by the above-mentioned authors. In 1979 Mr Nicholas M Breach, then senior registrar in plastic surgery at Queen Victoria Hospital, East Grinstead, described this method, which he had used successfully and with no haematomata or skin necrosis in a series of 25 patients (50 axillae). Furthermore, the Japanese authors do not mention the use of local application of 20% aluminium chloride hexahydrate, which we think should be tried as treatment of choice in these cases. Only when this does not give relief should local surgery be considered (Hage and Karim, 1991).

Latissimus dorsi breast reconstruction Sir, It was with great interest I read the article entitled “Late results and current indications of latissimus dorsi breast reconstruction” (British Journal of Plastic Surgery, 44, 1). The authors report good cosmetic results in two thirds of cases. The main reasons for dissatisfaction were capsular contracture and upper displacement. The authors also report “ as the latissimus muscle keeps its contractility even after transposition, upward displacement of the breast may be a problem, especially during sporting activities.”

Yours respectfully, J. J. Hage, M.D., Department of Plastic Surgery, Academic Hospital Free University, PO Box 7057, N-1007 MB Amsterdam,The Netherlands.

References Breach, N. M. (1979). Axillary hyperhidrosis: surgical cure with aesthetic scars. Annalsof the Royal College of Surgeonsof England, 61,295. Hage, J. J. and Karim, R. B. (1991). Hyperhidrosis axillaris and

treatment updated. Nederl. Tijdschr. Geneesk. (submitted for publication). Some of our patients experienced severe distortion of the reconstructed breast with activities of the shoulder (see figure). These were so painful and troublesome that division of the pedicle and the attachment of the muscle to the humerus had to be carried out. Did the authors in their large study notice such complications? Yours faithfully, C. Balakrishnan, FRCS Dept. of Plastic Surgery, Royal Victoria Newcastle upon Tyne, NE1 4LP.

The dartos musculocutaneous Infirmary,

Sir, I am writing to comment on the paper “The Dartos Musculocutaneous Flap” by Tiwari et al. (Brirish Journal of Plastic Surgery, 44,33). I certainly agree with the authors that the scrotal myocutaneous (or dartos musculocutaneous) flap is a very useful and reliable flap for resurfacing the penis and for other applications, and I congratulate them for the seven successful flaps in the six cases reported. It is somewhat surprising and disappointing that in this day of readily available information, the authors failed to acknowledge and mention in their references previous publications and reports on this subject. The idea of using the scrotum as a flap was first described by Kaplan in this journal in 1972. Lanier and Neale reported its use for the treatment of penile necrosis in 1974. In 1977, Taube, Labandter and Kaplan used a testiculo-scrotal flap to cover a groin defect, and more recently we postulated the concept of the scrotal myocutaneous flap in PIustic and Reconstructive Surgery, 78,676.

Reference De Mey, A., Lejour, M., Declety, A. and Meythiaz, A. M. Late results and current indications of latissimus dorsi breast struction. British Journal of Plastic Surgery, 44, 1.

flap

recon-

Axillary osmidrosis and hyperhidrosis Sir, Further to the article of Yoshikata, Yanai, Takei and Shionome on the surgical treatment of axillary osmidrosis 392

Letters to the Editor It was the great philosopher, George Santayana, who once said, “Those who cannot remember the past are condemned to repeat it”. Respectfully, Miguel A. Mendez-Fenmdez, M.D., Northern California Plastic Surgery Medical Group, Inc., 2650 Edith Avenue, Redding, California 96001 U.S.A.

References Kaplan, I. (1972). The scrotal flap in ischial decubitus. British Journal

of PlasticSurgery, 25,22.

Lanier, V. C. Jr and Neale, H. W. (1974). Necrosis of penis with decubitus ulcer: debridement and closure with scrotal flap. Case report. Plastic and Reconstructive Surgery, 54,609. Mendez-Fernamlez, M. A., HoIian, C., Frank, D. H. and Fiier, J. C. (1986). The scrotal myocutaneous flap. Plastic and Reconstncctiw

Surgery, 78,676.

Taobe, E., Labandter, H. and Kaplan, I. (1977). Decubitus ulcer in the groin: repair using a testiculo-scrotal flap. British Journal of Plastic Surgery, 30,86.

The migrating tendon spacer Sir, The X-ray in the figure shows an unusual complication of tendon reconstruction. A thirty year old right handed dentist presented for two stage flexor tendon reconstruction, following a late rupture after tenolysis for adhesions secondary to repair of both

393 profundus and superficialis tendons of the right little finger, which initially had been lacerated. He underwent the first stage consisting of tenolysis of the profundus tendon with excision of its distal remnant. A silastic rod spacer was inserted, sutured distally with monofilament nylon and left free proximally in the palm. Two months later the second stage of reconstruction was attempted. However, at operation no spacer or flexor tunnel could be found and exploration of the hand proximally at this stage was fruitless. First stage reconstruction was then repeated with insertion of another silastic rod. An X-ray taken post operatively showed the first silastic rod in the distal forearm. He subsequently underwent successful tendon grafting. It is well known that implants can migrate, but this particular complication has not previously been reported. It would be interesting to know if any readers have encounterd this or similar problems. Yours faithfully, P.

Dziewulski,FRCS,

Dept. Plastic Surgery, Queen Mary’s Hospital, Roehampton, London SW15.