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PubMed2002

New microsurgical applications: implications for the infrastructures of plastic surgery.

As a technical innovation, microsurgery has changed concepts and strategies throughout plastic surgery. The infrastructures of plastic surgery currently are evolving in ways that make the identity and future of the specialty uncertain. Microsurgery also may be a basis for fresh thoughts in these areas of infrastructure. This article touched on some areas where microsurgery could be an important element in organizational development, namely patient population identification, economic strategies, academic organization, and medical education. More thorough exploration of these ideas and identification of others may result in a new foundation for plastic surgery with microsurgery as a key element.

Bone Transplantation↗
PubMed2004

Residual deformities after repair of clefts of the lip and palate.

Every effort should be made to achieve the best possible results at the time of lip and palate repair. Appropriate and extensive evaluation, short- and long-term planning with optimal timing for each procedure, close cooperation with the members of the craniofacial team, selection of the most appropriate technique(s), careful execution, and close follow-up are prerequisites for success. Additional surgical procedures or revisions are required to improve appearance and function and to manage unfavorable results of previous interventions. Such procedures should be also planned carefully, taking into consideration all aspects of the deformity to provide our patients with superior habilitation.

Adolescent↗
PubMed1999

Monocanalicular lesions: to reconstruct or not.

OBJECTIVE: To evaluate the success rate of a simple surgical method for the treatment of a monocanalicular lacrimal lesion. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirteen consecutive patients with monocanalicular trauma who were seen from August 1995 to March 1998. In six patients, the canaliculus was lacerated as a result of an external injury and in seven patients as a result of tumor removal (iatrogenic injury). INTERVENTION: Reapproximation of the orbicularis muscle and skin overlying the torn canaliculus without reanastomosis of the lacerated canaliculus. In those patients in whom the canaliculus was sacrificed as part of the removal of an eyelid tumor, no attempt was made to reconstruct the canaliculus. MAIN OUTCOME MEASURES: Symptomatology, patency of the lacrimal passage, fluorescein dye disappearance test, and patient satisfaction. RESULTS: In all patients the injured canaliculus was totally blocked, but despite this none of the patients complained of inconvenient tearing either indoors or outdoors. The ipsilateral unharmed canaliculus was functioning normally in such a way that the fluorescein dye instillation test showed residual dye in six patients after 2 minutes and in none of the patients after 5 minutes. All patients were satisfied with the functional and cosmetic result. CONCLUSION: Nonrepair of a monocanalicular lesion is a valid approach that results in little or no morbidity.

Adolescent↗
PubMed2002

[Techniques for repair of chondral and osteochondral lesions in the knee. Principles of rehabilitation].

The objective of the present study is to assess the techniques, indications and management of the three principal repair methods of cartilaginous lesions of the knee. Arthroscopic irrigation and debridement are excluded. The most important articles of the last 20 years have been evaluated favouring those written by the protagonists of the technique and those with the longest follow-up. Each technique, i.e. the microfractures, the osteochondral grafts and the chondrocyte grafts, is explained in detail with its surgical principles, management of specific reeducation and results. Postoperative treatment is not very different during the first weeks; for condyle lesions protection of the graft site is mandatory by strict avoidance of non weight bearing, whereas immediate mobilisation of the knee is possible; for patellar lesions, weight bearing is permitted whereas flexion is limited. Later, the delay concerning resumption of weight bearing, muscular training and sports is specific for each technique. These three techniques are only apply to symptomatic lesions of the condyle at the weight-hearing zone or the femoro-patellar site in young patients. The degenerative knee, even in its beginning, is excluded. Those lesions can be linked to rupture of the anterior cruciate ligament and immediate cartilaginous repair is discussed.

Anterior Cruciate Ligament↗
PubMed2003

Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity.

OBJECTIVE: To compare the efficacy of vascularized bone grafts and bridging mandibular reconstruction plates for restoration of mandibular continuity in patients who undergo free flap reconstruction after segmental mandibulectomy. Study design and setting A total of 210 patients underwent microvascular flap reconstruction after segmental mandibulectomy. The rate of successful restoration of mandibular continuity in 151 patients with vascularized bone grafts was compared to 59 patients with soft tissue free flaps combined with bridging plates. RESULTS: Mandibular continuity was restored successfully for the duration of the follow-up period in 94% of patients who received bone grafts compared with 92% of patients with bridging mandibular reconstruction plates. This difference was not statistically significant. In patients who received bone grafts, most cases of reconstructive failure occurred during the perioperative period and were due to patient death or free flap thrombosis. In patients who received bridging plates, all instances of reconstructive failure were delayed for several months and were due to hardware extrusion or plate fracture. CONCLUSIONS: Vascularized bone-containing free flaps are preferred for reconstruction of most segmental mandibulectomy defects in patients undergoing microvascular flap reconstruction. However, use of a soft tissue flap with a bridging mandibular reconstruction plate is a reasonable alternative in patients with lateral oromandibular defects when the nature of the defect favors use of a soft tissue free flap. SIGNIFICANCE: Both bone grafts and bridging plates represent effective methods of restoring mandibular continuity following segmental mandibulectomy, with the former being the preferred technique for patients undergoing microvascular reconstruction.

Adult↗
PubMed2002

Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases.

Despite the popularity of the donor region 'laterodorsal calf' with the fibula, the flexor muscles and the overlying skin for microsurgical bone and soft tissue transfer some limitations and possible pitfalls have to be considered. We report on 93 patients who had 96 reconstructions, 65 with and 31 without soft tissue transfer in 8 years using microvascular fibular grafts for mandibular replacement and oromandibular reconstruction. Six patients died within 4 weeks and eight flaps were lost. Necrosis of the skin paddle occurred in 7 (11%) of 61 cases with uncomplicated bony healing.

Adolescent↗
PubMed1997

Temporalis myofascial flap in maxillofacial reconstruction: clinical and histological studies of the oral healing process.

OBJECTIVES: To report our experience with temporalis myofascial flaps (TMF), describe the healing process of uncovered flaps in the mouth, and the histology of the repaired mucosa in the long term. DESIGN: Prospective clinical and histological study. SUBJECTS: 36 patients who received a TMF over a 6.5 year period for serial assessment of the oral healing, 24 patients whose scars over the reconstructed area were assessed clinically, and 11 whose repaired mucosa was assessed histologically. MAIN OUTCOME MEASURES: To follow the clinical process of oral healing of the TMF and describe the repaired mucosa healed over the flap. RESULTS: The uncovered TMF in the mouth healed gradually starting with an acute inflammatory phase, going through chronic inflammatory and proliferative phases with eventual epithelialisation of the oral mucosa. There were no major complications. The healed mucosa showed mild scarring in 70% of cases and the repaired mucosa had characteristic histological features that were distinct from the normal mucosa. CONCLUSION: The TMF is an extremely reliable and versatile flap for maxillofacial reconstruction which heals gradually with eventual coverage by mildly scarred repaired mucosa.

Adolescent↗
PubMed2003

The temporal fasciocutaneous island flap for oncologic oral and facial reconstruction.

PURPOSE: This study reports the anatomy, operative technique, and postoperative results of the temporal fasciocutaneous island flap (TFCIF), as used for facial and intraoral reconstruction. MATERIALS AND METHODS: Retrospective study of 15 patients who underwent TFCIF reconstruction. The anatomic basis and surgical technique are described. The flap was used for mucosal reconstruction after cheek or maxillary resection. It was used for facial tissue loss in 2 cases: orbital osteoradionecrosis and exposure of a mandibular reconstruction plate. RESULTS: This technique provides a safe and rapid solution for intraoral reconstruction; however, it cannot be used for the anterior floor of the mouth. The best indication that we have found is the reconstruction of hemimaxillectomy, allowing closure of buccosinusonasal communication and prosthetic rehabilitation. The main disavantage is that hair regrowth limits its use to patients who need postoperative radiotherapy. Donor site morbidity is minimal. Only a partial failure was observed. CONCLUSION: The TFCIF is a rapid, safe, and useful flap for oral and facial reconstruction after oncologic resection. Its arc of rotation limits, however, its use to the posterior part of the oral cavity.

Carcinoma, Squamous Cell↗
PubMed2003

Sternocleidomastoid myocutaneous flap for intraoral reconstruction after resection of oral squamous cell carcinoma.

PURPOSE: The sternocleidomastoid (SCM) myocutaneous flap remains an important tool in head and neck reconstruction. This article retrospectively reviews 40 consecutive SCM myocutaneous flaps used for the reconstruction after resection of oral squamous cell carcinoma with respect to reliability and complications. PATIENTS: From 1987 to 1997, 40 patients underwent SCM myocutaneous flap reconstruction of the oral cavity. The age and gender of the patients, site of primary tumor TNM stage, type of associated operation, and clinical course were analyzed. RESULTS: In 8 cases, partial epithelial loss over the skin paddle occurred with survival of the muscle and at least some of the dermis. Unilateral supraomohyoid neck dissection (SND) was performed in 11 cases, and unilateral functional neck dissection, which preserves SCM and/or internal jugular vein and/or accessory nerve, in 16 cases. Pathologically positive nodes were recognized in 14 of these 27 neck dissection cases; in 11 of these 14 cases, the neck lesion was controlled. CONCLUSION: The SCM myocutaneous flap appears to be simple to use and useful for reconstruction of the defect after resection of oral carcinoma, and the indications for this flap will be extended in accordance with the recent increases in the number of supraomohyoid and functional neck dissection cases.

Aged↗
PubMed2000

Low-velocity knee dislocation with sports injuries. Treatment principles.

Knowing that the injured MCL and PCL can heal and that the injured ACL and lateral side, predictably, will not heal are the bases for the treatment approach to these injuries. (1) Allow MCL healing nonoperatively. (2) Allow PCL healing to occur as long as PCL laxity is 2+ or less (reconstruct the PCL acutely if posterior drawer is > 2+ initially). (3) Initially delay ACL treatment and reconstruct later, if needed posterior drawer. (4) Perform acute lateral side repair to reattach structures to their distally torn site.

Athletic Injuries↗
PubMed2002

[Should residents operate?].

Surgical training requires that residents have the opportunity to operate. This tradition has now become complicated for teaching surgeons due to work surcharge, to the objective of reducing health costs, and to medical lawsuits. We support the necessity for residents to operate because academic hospitals have a moral and legal obligation to train future surgeons. This objective should be achieved without impairing the quality of care provided, and this must be explained to patients. More widely, the management of surgical training for residents should be rethought to maintain efficiency.

Humans↗