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Twenty-one patients underwent excision of a Campanacci grade III giant cell tumour of the distal radius and had reconstruction using a proximal fibula autograft. We compared the functional results of wrist arthrodesis versus arthroplasty. All 21 patients healed in an average of 8 months, and all have remained disease free. The Musculoskeletal Tumor Society 93, the Disabilities of the Arm, Shoulder, and Hand scores and the grip strength of the operated wrist compared with the contralateral wrist were 93%, 7, and 71% for the arthrodesis group and 83%, 17, and 40% for the arthroplasty group. Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty.Level of evidence: III

Hip abductor deficiency is most commonly encountered in the context of degeneration of the hip, and techniques for reconstruction pioneered by arthroplasty surgeons. We adopted a local muscle transfer technique utilizing the anterior half of the gluteus maximus for abductor reconstruction following soft tissue tumour excision in a young female patient. The patient of concern had a solitary fibrous tumour located between the right gluteus medius and minimus detected as an incidental finding. Marginal excision of the mass resulted in removal of the gluteus medius. The anterior half of the gluteus maximus was transferred and attached to the decorticated lateral greater trochanter by means of suture anchors and transosseous sutures. The patient initially demonstrated a Trendelenburg gait and limited abduction against gravity. By 1-year post-operation, there was return of normal gait and recovery of hip abductor power. This is the first report of anterior gluteus maximus transfer being successfully applied for soft tissue reconstruction around the hip subsequent to tumour excision.

A vascularised bone segment of the distal radius was harvested as a distally based flap to treat segmental metacarpal bone loss in three patients. One reconstruction followed resection of a giant cell tumour excision and the other two were to replace traumatic bone loss. The bone defects were in the second metacarpal in two cases and in the second and third metacarpal in one case and included three shaft and one distal metacarpal reconstruction. The mean length of the metacarpal defects was 6 cm. All of the flaps survived and no complications occurred at the donor site. Clinical and radiological union was established in all cases after an average of 3 months.

Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest.To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice.The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe.Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area.Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite.The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.Les anomalies ou la perte du lobe de l’oreille peuvent être d’origine congénitale ou être acquises en raison d’un traumatisme, de morsures, de brûlures ou d’excision d’une tumeur. Diverses interventions en une ou deux étapes ont été décrites pour reconstruire le lobe de l’oreille. L’intervention de Gavello est l’une des plus anciennes.Examiner l’intervention de Gavello compte tenu de la capacité vasculaire du lambeau et exposer la pertinence de cette technique dans la pratique actuelle.Les auteurs abordent la base vasculaire du lambeau de Gavello et décrivent l’application clinique de l’intervention de Gavello en une étape dans diverses situations, y compris l’absence congénitale de lobe d’oreille, une malformation du lobe de l’oreille après une brûlure et une amputation traumatique du lobe de l’oreille.Les auteurs ont remarqué d’excellents résultats esthétiques dans toutes sortes de situations cliniques, qui permettent de préserver la forme et le volume du lobe de l’oreille ainsi que d’obtenir une bonne correspondance de la couleur et une cicatrice bien cachée au foyer du donneur.L’intervention de Gavello est une intervention simple en une étape qui fait entièrement appel à des tissus locaux pour reconstruire le lobe de l’oreille. Le lambeau a une capacité vasculaire prévisible, la greffe de peau est inutile et l’intervention peut être utilisée pour des anomalies importantes. La région de la mastoïde postauriculaire du donneur doit être intacte.L’intervention de Gavello, qui est simple et existe depuis un siècle, est toujours très précieuse pour la reconstruction d’anomalies du lobe de l’oreille d’étiologies variées.

Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions.To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region.Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma.All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed.This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.Il est difficile de reconstruire des anomalies du canthus interne après l’excision d’une tumeur, en raison de la minceur de la peau et de la concavité des repères anatomiques, qui incluent des structures complexes comme le ligament du canthus interne et le système lacrymal. Les modes de reconstruction locale incluent la cicatrisation secondaire, les greffes de peau totales et les lambeaux cutanés des régions frontale, transnasale, glabellaire et de la paupière supérieure.Démontrer la combinaison utile de deux lambeaux locaux pour corriger de larges anomalies de la région du canthus interne.Entre 1998 et 2012, 11 patients ayant de larges anomalies complexes après l’excision (incluant le périoste), d’un carcinome basocellulaire invasif, ont été soignés par une combinaison de rotation glabellaire et de lambeaux nasolabiaux d’avancement en VY.Les patients, qui ne présentaient plus de tumeur, ont subi une reconstruction fonctionnelle et esthétique de la région du canthus interne. Ils n’ont pas présenté de complications majeures et n’ont pas subi de récidives.Cette technique assure une belle concordance de couleur et de texture et des résultats satisfaisants sur le plan esthétique et fonctionnel. Par ailleurs, la morbidité est minime dans la région du donneur, et la technique chirurgicale est simple.

The distal radius and its articulations clearly have a vital role in the functional abilities of the hand and wrist. The treatment of tumours of the radius, therefore, needs to achieve satisfactory clearance of the lesions while also preserving as much wrist function as possible. We have employed osteoarticular autologous fibula grafts to reconstitute the distal radius after tumour excision. Since 1992, 13 patients have been treated by this technique for tumours of the distal radius. The group comprised patients with primary and recurrent giant cell tumours of bone, osteosarcoma, chondrosarcoma and Ewing’s tumour. This technique achieves a satisfactory functional result without compromise of the prognosis for the tumour.

Vascularized fibular transplantation has found wide application for long bone reconstruction in both congenital and acquired defects. However, in children the growth of these transplants is limited and requires the epiphysis if it is to be substantial. Also, the reconstruction of a joint is best achieved with autologus hyaline cartilage. Vascularized fibular epiphyseal transplantation, thus, may play a role in limb salvage procedures in children to both preserve joint function and facilitate long bone growth. The present paper discusses the history of vascularized epiphyseal transplantation both in the laboratory and clinical realm. In discussing its advantages and associated problems, special emphasis is directed at the vascular factors, the endocrine environment, the innervation, mechanical stressors, the recipient site and the donor site. Two case examples are presented to demonstrate the technique, the results and the long term outcome.

Primary nasopharingeal craniopharyngioma is extremely rare, although nasopharyngeal extension of primary intracranial craniopharyngioma occurs uncommonly. Only fifteen cases of primary nasopharingeal craniopharyngioma have been reported to date. We describe CT scan findings in a case of a large histologically proven nasopharyngeal craniopharyngioma with contiguous extension into the suprasellar cistern. The patient has been asymptomatic for the past one year following complete tumour excision.