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PubMedDate not supplied

Temporoparietal fascial flap in orbital reconstruction.

OBJECTIVE: To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. PATIENTS: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. INTERVENTIONS: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. MAIN OUTCOME MEASURES: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. RESULTS: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. CONCLUSIONS: The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.

Adult↗
PubMed2006

Horizontal advancement flap for lateral dorsal nasal defects.

BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps.

Basal Cell Carcinoma↗
PubMed1998

Reconstruction of lateral skull base oncological defects: the role of free tissue transfer.

Surgical ablation for oncological disease of the lateral skull base can result in extensive defects, with exposed bone and dura. Inadequate coverage can result in meningitis, osteomyelitis, or delay in adjuvant therapy. Successful reconstruction requires well-vascularized soft tissue and often a large cutaneous component. This study evaluates the role of free tissue transfer in reconstruction of lateral skull base defects. This study is a retrospective review of all patients undergoing lateral skull base resection for oncological disease and immediate reconstruction from 1993 through 1997. There were 18 patients with a mean age of 57 years. The temporal bone was resected in 50% of patients. All defects were reconstructed with free tissue transfers from the following donor sites: rectus abdominis (N = 14), latissimus dorsi (N = 2), anterolateral thigh (N = 1), and lateral arm (N = 1). A cutaneous skin island was employed in all patients. Free flap survival was 100%. Flap-related complications occurred in 33% of patients but did not delay the onset of adjuvant therapy. Vein grafts were not required to lengthen the vascular pedicle. Two patients required split-thickness skin grafts because of inadequate size of the skin island. Four patients underwent flap revision for contour deformity a mean of 4 months postoperatively. Free tissue transfer is a highly reliable method of reconstructing lateral skull base defects in a single stage. Careful flap selection and design can minimize the need for skin and vein grafts. The rectus abdominis donor site is preferred because of its location, large skin island, and excellent vascular pedicle.

Adolescent↗
PubMed1988

Lateral nose and perinasal defects: options in management following Mohs micrographic surgery for cutaneous carcinoma.

Primary and recurrent cutaneous carcinomas of the nose and the adjacent perinasal tissues often invade more deeply than cutaneous carcinomas in other areas. The operative defect may be large. The physician who has to close these defects is faced with a challenging problem that requires an appreciation of facial anatomy and function. There is often more than one option in the repair of these defects. Important concepts in the management of lateral nose and perinasal surgical defects are discussed.

Humans↗
PubMed2006

Atrial septal defect repair through limited lateral thoracotomy in children.

OBJECTIVE: We have developed a surgical method for atrial septal defect repair through a limited right lateral thoracotomy in which the incision line begins 2 cm caudal from the lower angle of the scapula and ends at the midaxial line, thereby improving patient satisfaction with the cosmetic results of treatment. METHODS: We performed a retrospective review of 28 patients who underwent isolated atrial septal defect repair through a limited right lateral thoracotomy between January 2002 and August 2004. The mean age and mean body weight at the time of the operation were 85.8 months (range 9-236 months) and 23.0 kg (range 8.0-56.0 kg), respectively. All repaired defects were the ostium secundum type. RESULTS: There was no operative or late mortality and no late morbidity after a mean follow-up of 26 months (range 12-41 months). Echocardiography showed no residual shunt in any of the patients. The mean length of the skin incision was 7.8 cm (range 5.0-11.0 cm), and almost all the patients had satisfactory cosmetic results. CONCLUSION: The atrial septal defect repair through a limited right lateral thoracotomy in pediatric patients showed satisfactory surgical results and excellent cosmetic results.

Adolescent↗
PubMed1980

Lateral wall cecal filling defects following successful hydrostatic reduction of cecalcolic intussusceptions.

Two children less than 1 yr of age were found to have a lateral wall filling defect following successful hydrostatic reduction of cecalcolic intussusceptions. Both filling defects were thought to be due to invagination of the lateral wall between the tinea coli. One child was explored due to recurrence of the intussusception despite despite a decrease in size of the filling defect. In the second child the filling defect had disappeared three days after the initial barium enema reduction. When confronted with a typical cecal filling defect in an infant following successful reduction of a cecalcolic intussusception, we believe that one is justified in assuming a cautious "wait and see" attitude. If the child recovers clinically the barium enema may be repeated in three days to access reduction in size or disappearance of the filling defect.

Barium Sulfate↗
PubMed1986

Histopathology of growth plate changes in induced abnormal bone growth in lambs.

Unilateral hip excision arthroplasty in lambs resulted in osteochondrosis developing in distal tibiae and metatarsi of the contralateral pelvic limb. The physeal cartilage of distal tibiae and metatarsi developed clefts which probably represent shear failure. The histopathology of the meataphyseal defects differed between the medial and lateral growth plate sectors. Medially, the lesions were typical of physeal osteochondrosis in other mammals, with disorganized chondrocyte columns, cell death and matrix necrosis. Laterally, metaphyseal defects were predominantly fibrous, and islands of bone formed in physeal cartilage from re-established endochondral ossification. Both medial and lateral metaphyseal defects were associated with disturbed primary spongiosa formation. It is suggested that, in some instances at least, traumatic physeal clefts, resulting from shear failure in previously normal growth cartilage, may interfere with endochondral ossification and produce osteochondrosis.

Animals↗
PubMed2001

[Vault fixation by fascial sling (Williams-Richardson technique) or sacrospinous/sacrotubed fixation (Amreich-Richter technique) - Is there a difference in indications?].

There are many techniques in the treatment of female genital descent. We analysed sacrospinous/sacrotuberal fixation in comparison to abdominal fixation using fascial slings. One of the aims of the study presented was to determine whether there is a differentiation in indications in the use of either technique. There was no difference in recurrence rates, stress incontinence did not occur in a significant number of cases postoperatively. Recovery was different in both techniques. Apparently the fascial sling technique is effective in cases where intraabdominal surgery has to be performed at the same time and descent is limited to the upper third of the vagina. The use of sacrospinous/sacrotuberal fixation is only limited by simultaneous appearance of excessive lateral detachment defect. It seems to be most effective in cases where larger recto-enteroceles have to be treated at the same time. A lateral defect has to be approached differently in all cases.

Adult↗
PubMed1984

Digital nerve-grafting for traumatic defects. Use of the lateral antebrachial cutaneous nerve.

We used segments of the lateral antebrachial cutaneous nerve to graft defects in forty-two digital nerves in thirty-five patients. Age was a more important prognostic indicator for functional sensibility than either the length of the nerve graft or the time-interval from injury to grafting. The younger patients did better. A battery of eight tests was used to determine functional sensibility scores. All patients improved and 40 per cent had completely normal sensibility.

Adolescent↗
PubMed1989

[High resolution electron microscopy of the crystalline structure in remineralized enamel].

The present work was designed to elucidate crystallographic changes in enamel that had been demineralized in a 0.01 M acetate buffer (pH 4.0) for 2 days at 50 degrees C and then remineralized in a solution containing 1 mM Ca, 0.6 mM P, and 0.05 mM F for 1 or 2 weeks at 37 degrees C. The demineralized and remineralized enamel samples were observed by means of high-resolution electron microscopy, electron-probe analysis, and small area X-ray or electron diffraction. Before remineralization, demineralized enamel had been composed of sparsely arranged apatite crystals with either a central perforation or lateral surface defects or both. Measurements of crystalline (001) planes indicated that crystals in demineralized enamel were significantly larger than those in intact enamel, thus suggesting that crystal growth had taken place during demineralization. Small, newly formed, hexagonal crystals occurred in remineralized enamel. In some cases, precipitation of such small crystals together with localized enamel-crystal regrowth restored central perforations and lateral defects. A number of the small, newly formed crystals and preexisting enamel crystals aggregated to form a group with a roughly hexagonal outline. After the growth and fusion of these grouping crystals, a large, regular-hexagonal crystal formed. Such various kinds of lattice defects as edge dislocation, small-angle grain boundary, and lattice displacement were frequently detected in fusing crystal boundaries. Prolonging remineralization duration seemed to reinforce these lattice defects. Electron-probe and X-ray diffraction studies led to the assumption that the large hexagonal crystals were fluoroapatite. These results indicate that remineralization of demineralized enamel proceeds through several stages, including formation and growth of new crystals and regrowth of preexisting enamel crystals.

Crystallography↗
PubMed1998

Defective lateralisation in children with congenitally malformed hearts.

Defects in lateralization can be studied from the stance of populations, the individual, or the systems of organs within each individual. Unfortunately, and confusingly, the same terms are being applied to each of these situations, but inevitably with different meanings. Thus, there is presently no consensus on how we should use terms such as "heterotaxy" and "situs ambiguus". By far the least ambiguous use of these words is encountered when they are applied to the organs. In fact, each system of organs can accurately and simply be described in terms of its left-right morphology. All those organs which are paired then can be described, when interpreted on the basis of their intrinsic morphology, as being usually arranged, mirror-imaged, or as showing left or right isomerism. Within the heart, these changes are seen only in the atrial segment. The criterion for distinction of rightness or leftness within the atrial segment is the extent of the pectinate muscles relative to the atrioventricular junction. Application of this criterion permits unequivocal recognition of symmetry as opposed to lateralization. The same holds good for the other organs. Within any individual organ, therefore, the situation is neither ambiguous nor heterotaxic. Instead, it is lateralised or symmetrical. Within the individual, in contrast, there may well be discrepancies in the expected disposition of the systems of organs which produces potential ambiguity. To dispel this ambiguity, it is necessary to provide a full catalogue. For example, persons with otherwise normally arranged organs may have left bronchial isomerism. Other persons may have discordance between the thoracic organs, which are usually arranged, and the abdominal organs, which are mirror-imaged, but no evidence of isomerism. Within the population, however, we are unaware of any genetically or environmentally induced syndrome in which all individuals show evidence of mirror-imagery, or of isomerism, or of specific discordance between the systems. In fact, all known syndromes encompass all types of defective lateralization. When attempting to identify the genetic mechanisms for production of the syndromes, therefore, it could be positively misleading to attempt to separate isomerism from other perceived forms of"heterotaxy". Our preference is to consider any deviation from the usual arrangement as heterotaxy, and to specify the specific arrangement of the organs within each malformed individual.

Child↗