No abstract

Background:Large defects arising from extirpation surgery of buttock sarcomas requiring adjuvant radiotherapy are best closed with flap surgery. The traditional solutions are derived from an approach to pressure sores, which were designed for the ischial, sacral, or trochanteric areas, and have now been adapted for true buttock defects. This invariably destroys the esthetics of the buttock. We describe a novel technique of sigmoidplasty, which preserves most of the esthetic features.Methods:We report on a retrospective review of 11 consecutive buttock sarcomas managed at our institution between 2009 and 2014, focusing on those for which the described reconstruction method was used (N = 5).Results:The immediate outcome was very good. In 1 patient, partial loss of 1 of the flaps and the management thereof resulted in a minor contour deformity. In general, the buttock volume was significantly decreased but the shape was preserved. This was obtained without secondary donor defect and with minimal contour irregularity. Long-term follow-up remained pleasing, and all patients were satisfied with the outcomes.Conclusions:The described technique of buttock defect closure satisfies the oncoplastic principles of tumor surgery with the added benefit of superior esthetics. We suggest that it is a versatile adjunct to the reconstructive surgeon’s armamentarium for buttock reconstruction after sarcoma excision, particularly when the gluteal artery perforator systems are unavailable.

This research investigates the impact of improved (and improving) mortality experience in South Africa as a result of the increased (and increasing) access to antiretroviral treatment on South African life assurers, the entry-level insurance market and the wider South African economy. The research focuses on various potential impacts on the entry-level insurance market, including new business profitability, product development and pricing, market penetration and the potential for increased savings. This research has been done with the assistance of four of the main South African life offices and also draws on the new THEMBISA AIDS model on which a working paper has been produced. The research is based on the THEMBISA model in order to investigate the potential impact of alternative mortality scenarios on typical entry-level products within the industry where the scenarios have been based on actual current and proposed antiretroviral roll-out strategies by the Department of Health. Potential improvements to profitability, premium reductions, benefit enhancements and cashback benefits are quantified using a profit test model for entry-level market products.