Septoplasties and septorhinoplasties are common procedures in otolaryngology, aimed at addressing septal and/or bony pyramidal deflections to improve functional and cosmetic outcomes. The nasal septum as well as regulating air flow provides structural support to the nasal tip. The attachment of the nasal septum to the anterior nasal spine must be structurally resilient to prevent saddling or tip ptosis. This can be achieved by direct attachment with absorbable suture material to the periosteum of the anterior nasal spine or a drill fitted with 0.6 mm diamond tip burr (Ultrabur, Invotec International), to create channel through which the nasal spine can be secured to the anterior nasal spine. We describe a novel, and cost-effective alternative utilising a blunt fill needle and simple absorbable suture. A blunt fill needle (Sol-Millenium®, cost £0.03 per unit) is passed through to form a securing channel. The neoseptum is then secured using a figure-of-eight suture. Our novel technique enables the nasal septum to be secured to the anterior nasal spine in a cost effective and efficient manner. © 2019 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.Background The use of conventional techniques in treating cleft foot deformities with two central ray deficiencies often yields unsatisfactory outcomes. This study describes the flap-bag technique, a novel technique using both a dorsal rectangular flap and a plantar triangular flap that was designed to yield more favorable outcomes in the treatment of this condition, and the outcomes obtained for three patients surgically treated with this technique. Methods After the proper width of the forefoot was measured by manually holding the toes to maintain a transverse arch around the metatarsophalangeal (MTP) joint, a plantar triangular flap was designed. A dorsally based rectangular flap was subsequently designed on the dorsal side of the interdigital portion, including the deepest side of the cleft, to create a natural dorsal slope. Results Application of this technique yielded favorable outcomes by maintaining the width and transverse arch of the forefoot, preventing dorsal scarring, and creating a natural interdigital space and dorsal slope. Conclusion Compared to the use of conventional techniques, use of the flap-bag technique achieves correction of a cleft foot with a more cosmetically desirable outcome. © 2019 The Author(s).Arhinia (congenital absence of the nose) is a congenital rare disease, which has been reported in less than 60 cases in the literature. It consists of the absence of external nose, nasal cavities and olfactory apparatus and is generally associated with midline defects, microphthalmia, blepharophimosis and hypotelorism. Aesthetic problems as well as associated functional anomalies can potentially impact on the development and interpersonal relationships of the child at a later stage in life. Arhinia requires extensive management in early life in order to ensure airway patency and protection by means of tracheostomy, and to allow adequate pharyngeal and feeding function to the child. Aesthetic issues are managed with reconstructive surgery or an external prosthesis. There is no previous description in Literature of internal prosthetic devices used to sequentially shape soft tissues in complex reconstruction. We present an example of design and manufacturing of a bespoke nose implant produced by means of 3D printing and directly assessed on-table by means of 3D surface scanning. © 2019 The Authors.For routine brachioplasty, conventional intra-operative positioning involves abducted arms resting on two tables with the patient supine. This technique does not facilitate intra-operative comparison for symmetry and engages one assistant to hold the arm at all times. We describe a novel positioning technique for brachioplasty using Chinese finger traps and drip stands which is safe, easy to reproduce, obviates the need for a positioning assistant and facilitates symmetrical resection. © 2019 The Authors.Malignant melanoma is a skin neoplasm with a rising trend of incidence. Positron Emission Tomography in combination with Computed Tomography (PET-CT) imaging is an essential diagnostic tool for both staging and surveillance of melanoma patients; especially in metastatic disease, where prognosis is poor. We report a case of a patient with known Neurofibromatosis type 1 (NF-1) who presented to the Skin Cancer Multidisciplinary meeting with 11 mm Breslow thickness malignant melanoma of the left forearm. His extensive dermal neurofibromatoses proved a diagnostic challenge to the team. There have been published studies linking NF-1 with malignant melanoma. However the incidence and significance of this has yet to be established. We also discuss the use of PET-CT imaging and skin surveillance in the monitoring and staging of this patient. Crown Copyright © 2019 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.Anabolic steroids have attracted attention from the media with regard to misuse, but overuse of medically prescribed steroids also has a propensity to cause harm. Gluteal necrotising soft tissue infections are an uncommon presentation for plastic surgeons, and therefore, abdominal sources may be overlooked. We report a rare case of a 57-year-old male who presented with a necrotising lower limb infection on a background of long-term corticosteroid overuse and recurrent pelvic anastomotic leaks. Crown Copyright © 2019 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.Touraine-Solente-Gole syndrome (pachydermoperiostosis [PDP] or primary idiopathic hypertrophic osteoarthropathy [HOA]) is a rare hereditary disorder that is characterized by a triad of manifestations that consists of skin changes (pachydermia), abnormal bone and joint manifestations (periostosis and/or artritis), and digital clubbing (acropachia). Here, we report the case of 24-year-old male who presented with severe bilateral true eyelid ptosis. Physical examination revealed severe ptosis with poor function of the levator palpabrae superioris muscle, thickening of and deep grooves in facial skin (especially at the frontal region), and abnormal appearance of the scalp with accentuating folds and deep furrows (cutis verticis gyrata). Abnormal bone enlargement of the hands, knees, and feet was also observed. Frontal rhytidectomy and levator resection and advancement were performed to alleviate symptoms. At the short-term follow-up, the patient described being satisfied with the outcome of treatment.  https://www.selleckchem.com/products/PD-0332991.html  This patient will be routinely followed over the long term to evaluate disease progression.