Biomedical subjects
Publications and source records attributed to R Icochea.
Double lip is a term used to describe a deformity of the upper or lower lip and consists of an accessory fold of redundant mucous membrane inside the vermilion border. Double lip is an uncommon congenital anomaly and is usually diagnosed and treated by a dentist or an oral surgeon. We present an unusual case of double lip--unusual because it was diagnosed and treated by a dermatologist and because of the histopathologic findings.
Poland's anomaly is an uncommon congenital aberration of the chest wall characterized by absence of the pectoralis major muscle and other nearby musculoskeletal components. In this series, a wide spectrum of thoracic deformities was associated with the Poland anomaly, ranging from segmental agenesis of the ribs, sternum, and nearby muscles, to simple aplasia of the pectoralis major muscle. Although little disability was associated with the syndrome, the patients primarily sought operative correction due to the asymmetry and their perception of adverse cosmesis. Over a 10-year period, 53 operations were performed on 27 individuals with the goal of correcting the abnormal contour of the chest wall. The most successful reconstructions involved the use of the latissimus dorsi muscle, which was detached and transferred to the anterior chest wall while preserving the neurovascular pedicle. In women, this was accompanied by insertion of a mammary prosthesis. Reconstruction of the so-called "herniation" of the lung with rib grafts or alloplastic materials was found to be unnecessary, and the use of custom-made chest wall prostheses is not recommended, since four of five of these devices had to be removed due to migration, erosion of local tissues, and adverse cosmesis.
This case represents an option a surgeon has when confronted with an extraordinary dilemma. A 43-year-old male presented to the emergency room with a septic ankle joint along with a fracture through the body of the talus. The surgeons incised and drained the ankle joint and performed a talectomy after finding intraoperatively that the soft, fractured, deformed talus was severely osteomyelitic. After weeks of intravenous antibiotics, a more definitive procedure was needed. After consulting different specialties for their opinion, a procedure was decided upon. The rectus abdominis muscle was hosted with its vascular supply intact and relocated into the ankle joint. The artery to this muscle was anastamosed to the anterior tibial artery. This, acts as both a spacer and a joint between the calcaneus and the tibia. After a few operations and months of physical therapy, this patient walks without a limp, free of pain or any gait-supporting device. There has not been any mention of this type of procedure in any of the literature to date.