WARNING - MAY CONTAIN GRAPHIC CONTENT
ROAD ACCIDENT - HAND RECONSTRUCTION
This young man sustained a serious hand injury when his cherry picker truck overturned at a bend on the road. His right dominant hand was crushed and unfortunately he lost the ring and little fingers. After debridement an initial attempt was made to restore the circulation to his middle finger and cover the wound on his palm with tissue from his right thigh - an antero-lateral thigh (ALT) free flap – but due to the complexity of the reconstruction this first flap did not survive and had to be removed. A few days later a second attempt was made with another ALT flap from his left thigh. It was again a highly complex operation taking many hours and this time it was successful. The flap has gone on to settle down and at an early stage he is already able to pinch with his thumb and index finger and use his right hand again. Although he faces further reconstructive surgery in future he is a very determined and brave young man who should get a decent function back for his right hand.
THE TROUBLE WITH SILICONE
Left Breast Reconstruction with DIEP flap:
This lady who previously underwent a left mastectomy and silicone breast implant reconstruction presented with a painful distorted left breast from implant hardening which had failed to improve with release of the capsule. She underwent removal of the implant and reconstruction with an abdominal flap (DIEP) using microsurgical procedure. This has resulted in a good shape and a comfortable soft left breast that is permanent and does not require any further surgery to that breast in future. In addition she has had a tummy tuck thrown in as a bonus!
Right Breast Reconstruction with LD flap:
Five years later she presented with similar problem of painful implant hardening on the right side. She previously had an uplift of the breast and a silicone implant inserted by another surgeon. An initial capsulectomy and replacement of the implant was followed, after a short period of time, by repeat severe capsular contracture and so she chose to have the right breast implant removed and replaced with her natural tissue. Since her abdomen cannot be used anymore it was decided to reconstruct her right breast with a latissimus dorsi (LD) muscle and skin flap taken from her back to fill the defect left by the removal of the silicone implant. After an uneventful recovery she now has both breasts reconstructed with her own tissue which are soft and natural and which will not need any further surgery in future.