[Additional technics for the plastic correction of orbital hypertelorism].
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Biomedical subjects
Publications and source records attributed to D Montandon.
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The transfer of the omentum majus by microvascular anastomosis has been used for correction of a severe hemifacial atrophy (Romberg's disease) in a young woman. The operation was performed by two teams working simultaneously. The right gastro-epiploic artery was anastomosed to the facial artery and the corresponding vein to the jugular vein. 22 months later, new distribution and volume-reduction of the omentum was performed. During this last operation the exellent vascular condition of the transferred tissue and unexpected recovery of the atrophic skin was confirmed. The final esthetic result can be considered satisfactory.
Treatment of distal digital injuries with skin defect must be directed towards maximum conservation of length and mobility. Additional therapeutic aims are preservation of the nail and its bed, prevention of painful scarring and reconstruction of a sensible pulp. This paper summarizes and comments upon the most frequently employed techniques. Included are: controlled healing, skin grafts, triangular volar flap, cross-finger flap, thenar flap, and inguinal flap.
On the basis of 6 clinical cases where a breast carcinoma metastasis or another breast tumour were discovered during a routine preoperative medical examination or during reconstructive surgery, the author emphasises the role of plastic surgeons in detecting recurrent disease in patients consulting them for reconstructive surgery after breast amputation. Plastic surgeons who probably perform more breast operations than any other specialist should have a thorough knowledge of all the diseases and tumours which may affect these organs.
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A modification of the dermal-flap canthoplasty, described by Edgerton and Wolfort for the correction of paralysis of the lower lid, is described. It has produced excellent results in our experience.
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The authors stress the dangers presented by windshield fragments of tempered glass to soft parts of the cervicofacial region, in cases of traffic accidents. With the aid of seven recent clinical observations, the difficulties in emergency surgical treatment, late complications due to the persistence of foreign bodies, and permanent facial mutilations are successively discussed.
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The authors present the simple technics of eye lid repair. The loss of skin and possibly of M. orbicularis oculi, is differentiated from that of the complete thickness of the eye-lid. The first can be treated by free Thiersch or Wolfe-Krause-split-skin graft or full thickness skin grafts, the second by direct suture or by various local advancement flaps according to the "quarter" rule of Mustardé.
The repair of large defects of the lid region may require complex reconstruction using skin, tarsus and conjunctival grafts or flaps. The authors have classified the lesions in three groups: inner canthus, lower lid and upper lid. For each group, the more applicable technics are described.
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It is not possible to group the facial asymmetries in one single nosological entity. However, whatever the origin of these malformations, their surgical treatment is governed by the same principles. In this article, the author attempts to define certain aetiologies:genetic, congenital and developmental, of the minor assymmetries of the face. He then reviews the different techniques in current use, in plastic and reconstructive surgery:autogenic or homogenic tissue grafts (bone, cartilage, derm, fascia, etc.), implants of plastic material, osteotomies. He stresses the use of simple techniques which cause little mutilation, as well as the simultaneous correction of the profile which greatly enhances the aesthetic appearance and the psychological well-being of these patients.
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