Eyelid reconstruction using a hard palate mucoperiosteal graft combined with a V-Y subcutaneously pedicled flap: palatal versus buccal mucosal grafts.
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Blepharoplasty↗
Biomedical subjects
J C van der Meulen
Publications and source records attributed to J C van der Meulen.
[Fifty years of plastic surgery in the Netherlands. VIII. Craniofacial surgery].
Craniofacial surgery has developed its own identity in the last 3 decades. The Frenchman Tessier can be seen as the founding father. His concept of intracranial correction of craniofacial malformations is still valid today. There have been many new developments such as distraction osteogenesis and biodegradable miniplate fixation. Microvascular surgery and vascularised calvarial bone grafts help to obtain more predictable results. Three-dimensional CT imaging techniques and modelling result in better surgical planning and help to understand the underlying pathology. Biomolecular knowledge of gene mutations leads to better understanding of the clinical diagnosis. The future will bring minimalisation of surgery and more therapy focused on biomolecular science. The psychosocial welfare of the patient will play a central role in the multidisciplinary team treatment.
Craniofacial Abnormalities↗
Treatment modalities for hypospadias cripples.
Hypospadias cripples can be defined as patients with remaining functional complications after previous hypospadias repair. A retrospective follow-up study was performed on the long-term results of a group of 94 patients disabled by hypospadias. The records of 94 patients showed that they presented with the following problems: 82 had a major meatal dystopia (87 percent), 43 (46 percent) had residual curvature of the penile body, 19 (20 percent) showed meatal stenosis, and only 5 (5 percent) had one or more fistulas. The techniques used to solve these problems were circumferential advancement of penile skin, dorsal transposition flap of preputial skin, distally based transposition flap of penile skin, and full-thickness skin graft. Between one and nine operations were needed to achieve the desired result (mean and median of two operations). The complications after these procedures were 11 fistulas in nine patients, meatal stenosis caused by tight scarring in six patients, and a residual curvature after an orthoplasty that had to be released once before a urethroplasty could be performed. Forty-three men were seen at long-term follow-up (range, 2 to 25 years; mean, 12 years). Functional complaints that were seen included spraying at micturition (5 patients, 12 percent), dribbling (6 patients, 14 percent), and deviation of urinary stream (7 patients, 16 percent). No patients complained of painful miction, hesitation, or straining. At physical examination, 4 patients had a residual curvature (three of which were mild without functional problems), 5 had a skin surplus, 1 presented with a fistula after an operation in another hospital, and 13 had a penile torsion. Only 6 patients had a penile torsion greater than 10 degrees, which was evenly distributed to the left and right. There was no correlation between any functional complaint and the presence of a physical abnormality.
Adolescent↗
Blepharoptosis repair by selective use of superiorly based muscle flaps.
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Blepharoplasty↗
The amniotic band syndrome.
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Amniotic Band Syndrome↗
Urodynamic evaluation of hypospadias repair.
PURPOSE: We performed a cross-sectional evaluation of voiding in a population undergoing hypospadias repair to determine whether patients had urinary obstruction at various intervals of followup after the last operation. MATERIALS AND METHODS: Of approximately 600 patients undergoing hypospadias repair at our department during a 30-year interval 175, 40 months to 66 years old were evaluated. Therefore, we created a cross-sectional study group for evaluation of voiding function. All patients had undergone the final operation for hypospadias at least 1 year previously and were toilet trained. Severity of the initial hypospadias was scored together with the operative technique. Parameters evaluated were medical history, physical examination and uroflowmetry using a rotating disk. Uroflowmetry data (maximum flow rate and voided volume) were plotted in age-related nomograms in 4 different age groups: less than 8 (28 patients), 9 to 14 (18), 15 to 21 (39) and more than 21 (91) years old. All flow charts were evaluated by 2 of us (J. F. A. v. d. W. and E. B.). RESULTS: The severity of initial disease was grade 1 in 30% of the patients, grade 2 in 57%, grade 3 in 10%, grade 4 in 2% and unknown in 2%. The operative technique performed was a van der Meulen repair in 113 patients (65%), a combined Byars-Denis Browne repair in 56 (32%) and miscellaneous in 6 (3%). According to the uroflowmetry nomograms there was a tendency for an increased number of patients to have a normal maximum flow rate with increasing age. A total of 14 patients had a flow curve that suggested distal urethra obstruction and none was symptomatic. There was no difference in uroflowmetry characteristics regarding the operative technique. CONCLUSIONS: No difference in uroflowmetry could be established among the operations. There seemed to be a tendency towards improvement in uroflowmetry with increasing followup. There was no direct relationship between low maximum flow rates and clinical apparent obstruction.
Adolescent↗
The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat.
Microsurgeons suspect that cigarette smoking reduces the survival of free vascularized flaps and replantations, but this has never been proven. This experimental study investigates the effect of smoking on free-flap survival. A fasciocutaneous epigastric flap was used in 30 rats as a free flap and in 30 rats as a pedicled flap. Of each group, 10 rats were smoked 6 weeks before and 2 weeks after surgery, 10 rats were smoked only 6 weeks before surgery, and 10 rats underwent the sham smoking procedure. Also, a distally based dorsal skin flap was cut in all rats, representing a random vascularized flap. Vitality and size of both flaps and patency of the vascular anastomoses were assessed 14 days after surgery. The epigastric flaps were monitored by laser Doppler flowmetry and thermometry during the experiment. Survival of the free vascularized epigastric flaps was significantly lower in smoking rats. All pedicled flaps except one survived. The epigastric flaps only necrosed or survived completely, exactly correlating to the patency of the vascular anastomoses. The mean surviving area of the dorsal flaps was best for nonsmoking rats, worse for only preoperatively smoking rats, and worst for preoperatively and postoperatively smoking rats. The differences were statistically significant. Postoperative laser Doppler flow differed significantly between surviving and dying flaps, affirming the value of laser Doppler flow monitoring in microvascular surgery. In conclusion, this study proves that smoking of cigarettes is detrimental to the survival of free vascularized flaps.
Anastomosis, Surgical↗
Median cleft of the lower lip and mandible: case reports, a new embryologic hypothesis, and subdivision.
Median clefts of the lower lip and mandible are rare. In the literature so far, about 62 cases have been described. In addition, three more patients are presented here. These cases show a broad variation in the severity of this deformity, ranging from a simple notch in the vermillion to a complete cleft of the lip involving the tongue, the chin, the mandible, the supporting structures of the median of the neck, and the manubrium sterni. Several hypotheses concerning the pathogenesis of median clefts of the lip and mandible have been proposed. Most authors consider it to be a failure of fusion of the first pair of branchial arches or failure of mesodermal penetration into the midline. From our embryologic point of view, however, instead of paired branchial arches, only one first branchial arch develops during the early embryonic period (< or = 17 mm crown-rump length). Within this first branchial arch, two mandibular processes grow out, separated by a groove in the median. These mandibular processes do not fuse but merge during the late embryonic period (> or = 17 mm to < or = 60 mm crown-rump length). In the same developmental period, there is formation of the lip and the alveolar process and the anlage and outgrowth of one membrane bone center in each mandibular process, resulting in the formation of the mandible with its symphysis. As a consequence of the preceding, we propose the following subdivision of the median clefts of the lip and/or mandible: Hypoplasia of the mandibular processes during the early embryonic period will lead to the severest cleft of the mandible extending into the neck. During the late embryonic period, the less severe median clefts will develop. Disturbances of the outgrowth of bone centers of the mandible, resulting in nonformation of its symphysis, cause clefting of the mandible with involvement of all related soft tissues. Defects in the merging process produce just a notch of the vermilion or a higher cleft of the lower lip with or without involvement of the alveolar process of the mandible. In conclusion, the variety of the clefts in the median of the lower lip and/or mandible as well as the low rate of incidence can be explained by the embryologic hypothesis proposed here.
Female↗
The role of bone centers in the pathogenesis of craniosynostosis: an embryologic approach using CT measurements in isolated craniosynostosis and Apert and Crouzon syndromes.
This paper describes the role of the displacement of bone centers, i.e., the tubers, in the pathogenesis of craniosynostosis. This displacement was studied in 54 patients with isolated or syndromic craniosynostosis in the form of CT scans as well as in two dry neonate skulls with Apert syndrome. For comparison, 49 fetal and 8 normal infant dry skulls were studied. Our investigation was restricted to the coronal and metopic sutures. The results showed a significantly more occipital localization of the frontal bone center and a more frontal localization of the parietal bone center at the side of a synostotic coronal suture in the isolated form as well as in Apert syndrome. In contrast, this was not the case in Crouzon syndrome, thus showing that these two syndromes have a different pathogenesis. For trigonocephaly, a more anteromedial localization of the frontal bone centers was found.
Acrocephalosyndactylia↗
Comparison of laser Doppler flowmetry and thermometry in the postoperative monitoring of replantations.
Reliable postoperative monitoring in microvascular surgery is necessary to improve the success rate of reexplorations following vascular compromise. Surface thermometry is known as an easy and inexpensive objective postoperative monitor and therefore is used by many microsurgeons. Reliability, however, is not satisfactory, and therefore several other instrumental methods have been tested of which laser Doppler flowmetry shows the most promising results. This study compared laser Doppler flowmetry to thermometry in the postoperative monitoring after replantation surgery. In 34 patients, 45 replantations and revascularizations were monitored by laser Doppler flowmetry and thermometry. A reliable alarm value of 10 PU was defined for replantations and revascularizations, with a sensitivity of 93% and a specificity of 94%. Thermometry showed a sensitivity of 84% and a specificity of 86% at 29 degrees C.
Adolescent↗
Plagiocephaly--new classification and clinical study of a series of 100 patients.
The term of 'plagiocephaly' coined by Virchow in 1851, that literally means 'cranial asymmetry' has been applied to dysmorhic skulls that look similar but which sometimes have a different etiology. The authors report a new clinical classification of plagiocephaly in order to simplify the categorization of this disease. A series of 100 patients with plagiocephaly were observed and treated. A clinical investigation of these cases, some considerations about the techniques used, the analysis of the results and a long-term follow-up complete the study reported.
Bone Transplantation↗
Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study.
PURPOSE: We studied the psychosexual adjustment, sexual behavior and genital appraisal of 9 to 18-year-old hypospadias patients. MATERIALS AND METHODS: We interviewed 116 hypospadias patients and 88 comparison subjects in a semi-structured manner. RESULTS: Hypospadias patients had a more negative genital appraisal and anticipated more ridicule by a partner because of penile appearance than comparison subjects but they did not have a different sexual adjustment. No significant impact of medical treatment (surgical procedures, number of operations or age at final surgery) was noted. Many hypospadias patients (38.8%) desired functional or cosmetic penile improvement. CONCLUSIONS: In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.
Adaptation, Psychological↗
Psychosexual adjustment of men who underwent hypospadias repair: a norm-related study.
PURPOSE: Psychosexual adjustment, sexual functioning and genital appraisal were studied in adult hypospadias patients. MATERIALS AND METHODS: A total of 73 hypospadias patients and 50 comparison subjects received a semi-structured interview. RESULTS: More hypospadias patients (32.8%) than comparison subjects (12.8%) had been inhibited in seeking sexual contacts. Hypospadias patients reported a more negative genital appraisal than comparison subjects but did not have a different sexual adjustment. The severity of hypospadias negatively affected genital appraisal. Patient age at final operation positively correlated with sociosexual development. Many patients (37%) desired functional or cosmetic penile improvement. CONCLUSIONS: The majority of hypospadias patients experienced a normal adult sex life. They were reluctant to seek advice for problems. We recommend followup of patients through adolescence.
Adaptation, Psychological↗
Treacher Collins syndrome: early surgical treatment of orbitomalar malformations.
In the past various materials have been used for the correction of the malar bone defect, such as cartilage, dermis fat, silicone, autograft, homograft, xenograft, and free bone transplantation. The disadvantages of inorganic implants are well known: dislocation, extrusion, and capsular contraction. The bony autograft has no growth potential, and children may need several complementary corrections. None of these procedures is totally satisfactory. To solve these problems malar reconstruction is performed with the help of a temporal bone flap. Two varieties of these flaps have been described: one anteriorly with a muscular pedicle vascularized by the deep temporal artery and one posteriorly with a galeal pedicle vascularized by the superficial temporal artery. The main advantage of an osteomuscular flap is the survival of bone once it has been transferred. The second advantage is related to the osteogenic potential of the cambium layer of the periosteum, which may prove to be an ongoing concern. Our series of patients includes 20 children. Correction of the eyelid coloboma was obtained by transposition and advancement of a superior palpebral flap.
Adolescent↗
Heat recordings at tips of Kirschner wires during drilling through human phalanges.
The temperature was recorded during drilling through fresh human cadaveric fingers with thermocouples built in the tips of Kirschner wires. High temperatures up to 190 degrees C were measured. This may contribute to osteonecrosis around the wires and to loosening and infections.
Bone Wires↗
Clinical evaluation of techniques used in the surgical treatment of progressive hemifacial atrophy.
We critically review 13 patients with progressive hemifacial atrophy treated with three basic surgical procedures (free flap transplantation, alloplastic implants, micro-fat injections 'lipofilling') and further ancillary techniques. In spite of the satisfactory results achieved with the procedures, with the exception of alloplasts, we feel that lipofilling may be considered an interesting solution for soft tissue augmentation of the face especially for moderate adipose defects, due to its repeatability, no donor site morbidity, no complications at the recipient site such as lesions resulting from dissection, bleeding, necrosis, etc. This technique can be performed in a day-hospital with short surgery time, at low cost and without a highly skilled team. For severe grades of adipose atrophy, because of the low blood supply to these tissues which interferes with take of any type of autograft, we think that free flaps actually represent one of the best solutions for soft tissue augmentation.
Adipose Tissue↗
Progressive hemifacial atrophy in a patient with lupus erythematosus.
This is a single case report describing a young woman with progressive facial atrophy that began at age 15. After she underwent commissuroplasty and collagen injection at age 29, her symptoms continued to progress, and she was ultimately shown to have serologic evidence of systemic lupus. She had a "remission of symptoms" after commencement of medical treatment (chloroquine and topical steroids) for her lupus. The association of progressive hemifacial atrophy and lupus is not new. This case and other cases associated with different autoimmune diseases suggest an autoimmune collagen-vascular origin for some cases of progressive facial atrophy. Furthermore, there is a need to modify the surgical approach in light of concurrent disease.
Adult↗
Early excision of nasal hemangiomas: the L-approach.
The presence of a nasal hemangioma may have a severe negative effect on the personality of a child. Early surgery in the involution phase has proved to be beneficial in this respect. The treatment of a consecutive series of nine patients who had surgery shortly after they were first seen for consultation is discussed. An extended rhinotomy (L-approach) was used in four of these patients. The results were uniformly good.
Child↗