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Clinical curiosities
British Journalof Plastic Surgery (1990), 43,632-634
0007-1226/90/0043-0632/%10.00
0 1990 The Trustees of British Association of Plastic Surgeons
Letters to the Editor of an attempt to find a cause for the patient’s headaches). As he pointed out, this was the only hairless area on the front of his chest and he had therefore consistently applied the patches in this one limited area. Manufacturer’s warnings on these patches refer only to transient rash and contact dermatitis but recommend daily changes ofthe application site. It would be interesting to know if any similar cases have been encountered by readers. Mr G. Cormack. FRCSEd, Bangour General Hospital, Broxburn, West Lathian. Scotland.
Clinical curiosities Sir, Readers
of this Journal who also receive the British will have noted the appearance during the past year of a regular boxed item in Minerva’s columns. This always takes the form of a photograph or radiograph illustrating a clinical curiosity with an accompanying brief commentary. In order to add interest to the sometimes lacklustre correspondence columns and to provide a means of recording curiosities which, since the demise of the socalled “hen’s teeth bureau” of BAPS, have no place to call their own, I wonder whether it might be appropriate for the BJPS to do something similar to the BMJ but different in that items would be solely of plastic surgical interest. This would also provide a place for recording some of those oddities which have until now been padded out into case reports and might also go a small way towards easing the log-jam of case report submissions presently engulfing the Editor’s desk. Illustrated below is the sort of thing I have in mind. Yours faithfully, George C. Cormack, FRCSEJ. Plastic Surgery Unit, Bangour General Hospital, Broxburn, West Lothian, EH52 6LR. Medical
Journal
This is an excellent idea. The Editor will welcome reports of this nature.
further
brief
Confusion of the use of the term “septocutaneous” Sir, Development of the concept of the fasciocutaneous flap has induced surgeons to investigate the cutaneous vasculature in detail, and several new flaps have been described. In particular, Song et al. (1982) reported the upper arm free flap supplied by septal vessels originating in the intermuscular septum in the upper arm. They gave the name “septocutaneous artery flap” to those flaps supplied by septal vessels in the intermuscular septum in the extremity. They extended this nomenclature of the septocutaneous artery flap to include the radial forearm flap. Moreover, they reported the free thigh flap supplied by a cutaneous artery emerging from the intermuscular space, not in the intermuscular septum, and they confused matters by calling this a “septocutaneous artery” (Song et al., 1984). Afterwards, the word “septocutaneous including mine vessel” was used in other articles (Carriquiry et al., 1985; Satoh et al., 1988) even if those vessels are running through the intermuscular space or in the intermuscular septum. “Septocutaneous flap” is used in the same way. However, the word “septocutaneous” should be restricted to the anatomical intermuscular septum. Cutaneous vessels running through the intermuscular space should not be called “septocutaneous” but “intermuscular cutaneous” vessels. The anatomical intermuscular septa are the loose connective tissue extending from the periosteum of the bone to the deep fascia in the extremity. They are limited. From textbooks of anatomy (Lanz and Wachsmuth, 1972; Pernkopf, 1980) there are two intermuscular septa in the upper arm (lateral and medial), two in the forearm (lateral and medial), two in the thigh (lateral and medial)
The picture shows a basal cell carcinoma situated in the left inframammary crease area of a 58-year-old furrier with no past history of any type of skin lesion, nor of any significant exposure to the sun. This lesion had grown from a tiny spot to the size shown (1.5 x 4.0 cm) over a three-year period. The interesting point is that he first noticed the lesion some weeks after discontinuing the application of transdermal glyceryl trinitrate patches at this site (discontinuation was incidental and was part 632
0007-1226/90/0043-0632/%10.00
0 1990 The Trustees of British Association of Plastic Surgeons
Letters to the Editor of an attempt to find a cause for the patient’s headaches). As he pointed out, this was the only hairless area on the front of his chest and he had therefore consistently applied the patches in this one limited area. Manufacturer’s warnings on these patches refer only to transient rash and contact dermatitis but recommend daily changes ofthe application site. It would be interesting to know if any similar cases have been encountered by readers. Mr G. Cormack. FRCSEd, Bangour General Hospital, Broxburn, West Lathian. Scotland.
Clinical curiosities Sir, Readers
of this Journal who also receive the British will have noted the appearance during the past year of a regular boxed item in Minerva’s columns. This always takes the form of a photograph or radiograph illustrating a clinical curiosity with an accompanying brief commentary. In order to add interest to the sometimes lacklustre correspondence columns and to provide a means of recording curiosities which, since the demise of the socalled “hen’s teeth bureau” of BAPS, have no place to call their own, I wonder whether it might be appropriate for the BJPS to do something similar to the BMJ but different in that items would be solely of plastic surgical interest. This would also provide a place for recording some of those oddities which have until now been padded out into case reports and might also go a small way towards easing the log-jam of case report submissions presently engulfing the Editor’s desk. Illustrated below is the sort of thing I have in mind. Yours faithfully, George C. Cormack, FRCSEJ. Plastic Surgery Unit, Bangour General Hospital, Broxburn, West Lothian, EH52 6LR. Medical
Journal
This is an excellent idea. The Editor will welcome reports of this nature.
further
brief
Confusion of the use of the term “septocutaneous” Sir, Development of the concept of the fasciocutaneous flap has induced surgeons to investigate the cutaneous vasculature in detail, and several new flaps have been described. In particular, Song et al. (1982) reported the upper arm free flap supplied by septal vessels originating in the intermuscular septum in the upper arm. They gave the name “septocutaneous artery flap” to those flaps supplied by septal vessels in the intermuscular septum in the extremity. They extended this nomenclature of the septocutaneous artery flap to include the radial forearm flap. Moreover, they reported the free thigh flap supplied by a cutaneous artery emerging from the intermuscular space, not in the intermuscular septum, and they confused matters by calling this a “septocutaneous artery” (Song et al., 1984). Afterwards, the word “septocutaneous including mine vessel” was used in other articles (Carriquiry et al., 1985; Satoh et al., 1988) even if those vessels are running through the intermuscular space or in the intermuscular septum. “Septocutaneous flap” is used in the same way. However, the word “septocutaneous” should be restricted to the anatomical intermuscular septum. Cutaneous vessels running through the intermuscular space should not be called “septocutaneous” but “intermuscular cutaneous” vessels. The anatomical intermuscular septa are the loose connective tissue extending from the periosteum of the bone to the deep fascia in the extremity. They are limited. From textbooks of anatomy (Lanz and Wachsmuth, 1972; Pernkopf, 1980) there are two intermuscular septa in the upper arm (lateral and medial), two in the forearm (lateral and medial), two in the thigh (lateral and medial)
The picture shows a basal cell carcinoma situated in the left inframammary crease area of a 58-year-old furrier with no past history of any type of skin lesion, nor of any significant exposure to the sun. This lesion had grown from a tiny spot to the size shown (1.5 x 4.0 cm) over a three-year period. The interesting point is that he first noticed the lesion some weeks after discontinuing the application of transdermal glyceryl trinitrate patches at this site (discontinuation was incidental and was part 632