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PubMed2005

Minimally invasive options for cutaneous defects: secondary intention healing, partial closure, and skin grafts.

Several wound management options are available for defects of the head and neck, and choosing the best option requires consideration of several variables. The physical characteristics of the defect, the experience and preferences of the surgeon, and the desires and medicosocial situation of the patient may influence the final reconstructive decision. As the concepts and techniques in the field of reconstructive surgery advance, conservative wound management options should not be overlooked. This article reviews the minimally invasive options for the management of cutaneous defects, including second intention healing, partial closures, and skin grafts. The authors review the basic concepts of wound healing.

Ear, External↗
PubMed2002

[Contemporary possibilities of thumb reconstruction. Part one--"classical" methods].

Loss of the thumb accounts for a 60% decrease of functional value of the hand, thus making its reconstruction a priority in the field of hand surgery. Basing on available literature and the author's own experiences classical methods (no microsurgery) are presented. The following methods are discussed: phalangisation, progressive lengthening (of the stump of the proximal phalanx and/or the first metacarpal bone), osteoplastic reconstruction, island flaps (Chinese flaps), pollicisation, vascular rein technique, along with respective indications, operative techniques, results and complications.

Humans↗
PubMed2005

Spectrum of oral and maxillofacial surgical procedures in Kano, Nigeria.

The goal of the maxillofacial surgeon is to correct facial deformity while eradicating surgical diseases, prevent recurrence or complication and restore function. The aim of this paper is to review the surgical procedures carried out in a new tertiary teaching hospital. A retrospective study of patients with maxillofacial surgical diseases seen at the Department of Dental and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria, between 2001 and 2003, was conducted. A total of 87 patients had various (primary and secondary) surgical procedures during the period under review. There were 51 males and 36 females, a male to female ratio of 1:0.61 with an age range of 3 days to 90 years and a mean age of 34.5 years. The majority of the patients were in the lower socio-economic group. Reduction and immobilization of the jaw fractures (n = 21, 23.3%) was the most common, followed by transosseous wiring (n = 12, 13.3%). The most common complications were malocclusion (n = 14, 29.8%) and facial defects (n = 12, 25.5%). Reduction and immobilization, and tumour surgery of the jaws seem to be the most common surgical procedures while osteotomy was the least. Reduction and immobilization with simple arch bars appeared to be very effective, more so when the patients could not afford more modern methods of treatment. Reconstructive surgeries of ablated jaws are advocated in view of the devastating aesthetic and psychosocial effects that these have on the patients.

Adolescent↗
PubMed2006

[A new minimally invasive procedure for the conservative treatment of uterine prolapse--the posterior IVS].

BACKGROUND: The risk of women who undergo surgery for the treatment of pelvic organ prolapse (POP) by the age of 80 is reported to exceed 10%, and is expected to rise with the increase in life expectancy. Most women affected are in their 5th or 6th decade, and the majority will suffer other medical problems. The current medical literature asserts that the vaginal surgical approach for POP operations are followed by less complications and provide a shorter rehabilitation period than the abdominal route. Hysterectomy is widely accepted as part of POP reconstructive surgery whenever the uterus is significantly prolapsed, however, there is no clear evidence to support the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure - the posterior intravaginal slingplasty (IVS) for utero-suspension in the presence of moderate and advanced uterine prolapse. AIM: To evaluate the feasibility, intra- and post-operative complications and short term results of the posterior IVS procedure and uterosuspension for uterine prolapse. METHODS: Reconstructive surgery using the posterior IVS was performed on 18 women with moderate to severe uterine prolapse who chose to preserve their uterus. Patients were then followed 1,6,12 months and 2 years post-operatively to assess any recurrence of pelvic organ prolapse. RESULTS: No major intra- or post-operative complications were reported. Follow-up of one to 13 months showed good results. CONCLUSIONS: Reconstructive POP surgery may not necessitate hysterectomy. The posterior IVS is a novel safe, minimally invasive, simple and effective surgical procedure for the treatment of POP, permitting uterine preservation. A larger number of patients and a longer follow-up period are required for proper evaluation of the actual safety and efficacy of this procedure.

Female↗
PubMed2004

Incisionless otoplasty.

Otoplasty surgery for correction of the "lop" protuberant ear deformity continues to evolve. A noninvasive method for achieving normal appearance and physiology for the protuberant ear pinna is presented. Incisionless Otoplasty surgery, involving a combined cartilage scoring procedure and a percutaneously placed retention suture procedure, creates a predictable and permanent correction of the missing antihelical fold. In addition, treatment of the protruding conchal bowl by endoscopic techniques further enhances the cosmetic appearance. A long-term follow-up period of over 10 years gives perspective on the efficacy of the operation.

Ear Cartilage↗
PubMed2001

Facial reconstruction on the abnormal skull model of a living patient.

OBJECTIVE: The concept of using a skull as the armature upon which to reconstruct a face has been understood for many years. The objective of this study was to blindly test this technique by using a skull that was reconstructed from the computed tomography (CT) scans of a living 48-year-old man. DESIGN: The patient had a bilateral cleft lip, alveolus, and palate. A model of the complete skull produced by a computer-controlled milling machine that used data from the CT scans was used for the reconstruction. Surgery was then performed, and new dental prostheses were also constructed. After surgery, a second model of the relevant part of the skull was made and the reconstruction modified accordingly. CONCLUSION: Despite having no information about the patient apart from that which could be gleaned from the model skull, the reconstructions demonstrate the approximate appearance of the face before and after surgery. Even without the extra information routinely available in forensic cases, a face broadly similar to that of the living patient could be achieved.

Anatomy, Artistic↗
PubMed2005

Preoperative autologous blood donation for oral and maxillofacial surgery: an analysis of 913 patients.

PURPOSE: Autologous transfusions are frequently used with elective surgical procedures and are a mandated choice under California law. Because unused units cannot be transfused to other patients, it is important to assess utilization and minimize waste. METHODS: The transfusion needs of 913 consecutive patients scheduled for major oral and maxillofacial surgery at the University of California San Francisco were evaluated in 3 categories: oncologic and reconstructive surgery (563), orthognathic surgery (260), and temporomandibular joint surgery (90). RESULTS: 24.9% of patients chose to undergo preoperative autologous blood donation. 24.2%, 20.6%, and 11.4% of oncologic and reconstructive surgery, orthognathic surgery, and temporomandibular joint surgery patients, respectively, who made an autologous donation preoperatively, subsequently received a transfusion postoperatively. CONCLUSION: Transfusion needs for most oral surgery procedures are clearly overestimated; the relatively low risk of blood loss associated with these procedures today should be taken into account when asking patients to participate in preoperative autologous blood donation.

Adolescent↗
PubMed2003

Clinical outcomes for the surgical treatment of sinonasal headache.

OBJECTIVE: This study was designed to explore the changes in patient-relevant clinical outcomes in a selected group undergoing surgery for nasal septal and turbinate abnormalities. Study design Seventy-nine consecutive patients with headache and correctable anatomic nasal obstruction were seen at the study institution from March 1998 to May 2000. These patients were evaluated for changes in patient-relevant clinical outcomes measures after surgical correction of their anatomic abnormalities. RESULTS: Seventy-one patients underwent surgical correction of nasal obstruction. More than half of these patients had contact points preoperatively. Statistically significant improvements were observed in the patient population with respect to 8 of the 10 clinical outcomes measures. Importantly, a decrease in the severity and frequency of headaches was noted after surgery, especially after the correction of contact points. CONCLUSION: The surgical correction of the septum and turbinates resulted in predictable improvement in headache and a majority of other important outcomes measures. Clinical significance Pain may improve after surgical correction of septal and turbinate abnormalities in a properly selected group.

Adolescent↗
PubMed2006

Long-term results of free radial forearm flap used for oral reconstruction: functional and histological evaluation.

PURPOSE: The aim of this study was to evaluate the radial forearm flap with regard to recovery of sensory function, general performance status, cutaneous blood flow and histological observations. PATIENTS AND METHODS: Thirty patients (23 male and 7 female) with oral carcinoma underwent immediate reconstruction with radial forearm flap after ablative surgery and returned for evaluation. Interviews were conducted to assess the degree of articulation and mastication. RESULTS: Sensory function tests suggested the restoration of cutaneous sensibility of the forearm flap. Histological findings indicated mucosa-like changes of flaps about 10 months after reconstruction. The clarity of conversation recovered favorably in most patients. However, the degree of recovery was generally related to the time after surgery. CONCLUSION: The radial forearm flap is a unique flap with specific characters that allowed for best available functional reconstruction of the oral cavity in terms of restoration of sensation, performance, and histological changes to adapt to the new oral environment.

Adult↗
PubMed2005

Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes.

OBJECT: Metastatic spinal tumors continue to represent a major problem for patients and treating physicians. The purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery. METHODS: A prospective database was established and 58 patients were identified who had undergone thoracolumbar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%). Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery. CONCLUSIONS: Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.

Humans↗
PubMed2001

[One stage total thumb reconstruction using MP II joint pollicisation] and free transfer of distal part of great toe: report of two cases].

Indications, treatment and late results of thumb reconstruction in two males aged 28 and 29 are presented. The thumbs had been amputated on the level of the middle first metacarpal with concomitant amputation in the middle of proximal phalanx of the index. Besides, one of the patients lost all other fingers in this hand. Reconstructions of the thumbs were carried out in the third and sixth months after the injury using pollicisation of the index stump and transferring free distal part of the trimmed great toe. FHL and EHL tendons were left intact. Some complications were observed in one of the patients. The complications included: spasm of the vein in the recipient site on the second day after the operation, wound dehiscence on the foot on the tenth day and nonunion of the index phalanx. Another surgery using bone graft was necessary. Grip reconstruction in one patient with metacarpal hand needed additional two toes to hand transfer. Results of the treatment were evaluated 8 and 6 years after the reconstruction. The new reconstructed thumbs were very similar to those on the contralateral hands with good sensation and sufficient movement (40 and 60 degrees of the flexion) to obtain strong and precise grip.

Adult↗
PubMed1991

[Repair of enlarged orbital exenteration cavities].

An empty orbital cavity is always unesthetic-looking, but several plastic surgery procedures exist to attenuate the cosmetic damage. In case of exenteration affecting periorbital tissues and cavities, spontaneous epithelialization is preferable than a split skin graft. Except for rare cases, where it is indicated to preserve the conjunctivae and eyelids, covering up may be realized with minimal scarring using two flaps, one superficial jugotemporal, and the other deep mid-frontal.

Eye Enucleation↗
PubMed2003

Inexpensive self-retaining retractor for minor surgical procedures.

The need for adequate surgical exposure frequently leads to the use of hand-held retractors, tying up operating room personnel and depriving the assistant a direct view of the procedure. Self-retaining retractors are a great help because they assist in obtaining and maintaining the exposure needed for surgery. Traditional self-retaining retractors often have sharp tips that are capable of damaging tissue. Our self-retaining ring retractor uses material already present in the sterile field and can be constructed in less than 3 minutes. It is efficient, easy to use, and exerts a known and finite amount of force, thereby avoiding tissue damage.

Equipment Design↗
PubMed1998

Salvage procedures for complex soft tissue defects of the knee.

The management options for complex soft tissue defects about the knee are varied. Limb threatening conditions such as exposure of joint prosthesis or bone requires stable coverage to avoid amputation. A study was conducted to review the authors' management protocol and experience with complex defects about the knee. A retrospective analysis from 1986 to 1996 of 35 patients with complex defects about the knee was performed. Treatment options were based on the nature, size, location, and depth of the wound. A specific management protocol was applied for each patient. Treatments included local wound care, debridement and skin graft, fasciocutaneous flap, pedicled muscle flap, and free muscle transfer. Postoperatively, patients were evaluated using Knee Society objective and functional scores and other instruments to measure outcome. Successful salvage of the lower extremity was obtained in 34 (97%) patients. Salvage of the total knee prosthesis was obtained in 24 of 29 (83%) patients. Secondary plastic surgery procedures were necessary in eight (23%) patients. Secondary orthopaedic procedures were necessary in five (15%) patients. No patient required an amputation.

Adult↗
PubMed2004

Current concepts in lip reconstruction.

PURPOSE OF REVIEW: Approximately 25% of all oral cavity carcinomas involve the lips, and the primary management of these lesions is complete surgical resection. The management of the resulting lip defect remains a significant reconstructive challenge, requiring meticulous preoperative planning and surgical technique to optimize the functional and cosmetic outcome. Reviewed here are the accepted techniques of lip reconstruction, as well newer techniques that have been reported. RECENT FINDINGS: There have been no major advances in lip reconstruction; rather, continued improvement on accepted techniques. The main goals of reconstruction remain the restoration of oral competence, maintenance of oral opening, and the restoration of normal anatomic relations such that both the active (smile) and passive (form) cosmetic outcome is acceptable. The reconstruction should be tailored to the individual needs of the patient and should take into account the patient's condition, local tissue characteristics, previous treatment(s), and functional needs (eg, denture use), in addition to the size and location of the defect. SUMMARY: The lips play a key role in facial expression, speech, and eating. This requires meticulous attention to preoperative planning and surgical technique to maximize the functional and cosmetic outcome. It is important to assess local tissue characteristics (skin laxity) and previous treatment (surgery and/or irradiation) before the surgical plan is made final. Local tissue should be used whenever possible to provide the least donor site morbidity and the best overall tissue color and texture match. Whenever possible, dynamic reconstruction should be attempted. Careful preoperative assessment and planning will allow the surgeon to reach an acceptable balance between form and function with the reconstruction.

Carcinoma↗
PubMedDate not supplied

Use of the pericranial flap in medial canthal reconstruction: another application for this versatile flap.

PURPOSE: To describe the use and outcomes of a versatile surgical technique in the reconstruction of deep soft tissue and bony defects of the medial canthus. METHODS: A retrospective review of consecutive cases requiring reconstruction of medial canthal defects involving loss of periosteum or bone by a median forehead pericranial flap and full-thickness skin grafting in a tertiary referral hospital setting. Two techniques were used: an open technique, using a midline forehead incision; and an endoscopic technique, using 2 incisions behind the hairline. RESULTS: Twenty-one cases were identified: 19 open and 2 endoscopic. The average length of follow-up was 13 months (range, 6-50 months). Ten cases required additional oculoplastic procedures including local periosteal flaps and mucous membrane grafts. Two cases (10%) had complete flap failure; one of these was caused by infection. Five (24%) had partial (< 50%) skin graft necrosis. Two cases (10%) have required further surgery. CONCLUSIONS: Our experience shows the pericranial flap to be versatile, robust, and easy to manipulate, offering advantages over alternative techniques when used for the repair of deep medial canthal defects. It is a valuable reconstructive technique that can yield good cosmetic and functional results.

Adult↗
PubMed2005

Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement.

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.

Administration, Topical↗