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Resurfacing extensive malar and preauricular cutaneous defects with pedicled temporoparietal fascia.

BACKGROUND: The pedicled temporoparietal fascial flap (TPFF) is useful for preparing extensive cutaneous facial defects for skin grafting. OBJECTIVE: The purpose of this work is to describe the use of the pedicled TPFF for preparation of extensive cutaneous malar and preauricular facial defects for skin grafting and contour improvement. METHODS: Two patients underwent transposition of a TPFF and immediate skin grafting. Patient demographics, diagnoses, wound characteristics, and outcome are described and documented through photographs. RESULTS: The TPFF greatly simplified reconstruction in the cases presented. The TPFF provided a vascularized tissue bed that resulted in complete survival of the skin grafts. It also effectively replaced lost volume and corrected contour deformities. CONCLUSION: The use of the pedicled TPFF for extensive malar and preauricular cutaneous defects provides a vascular tissue bed for skin grafting and soft tissue replacement. The TPFF may obviate the need for more complicated and morbid reconstructive procedures.

Basal Cell Carcinoma↗

Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey's syndrome.

PURPOSE: The purpose of this retrospective study was to evaluate the incidence of Frey's syndrome after parotid gland surgery with elevation of a skin flap versus the interposition of musculoaponeurotic tissue between the skin and the facial nerve. MATERIALS AND METHODS: The standard skin flap was used in 122 patients (1981 to 1989), whereas interposition of temporoparietal galea or superficial musculoaponeurotic system was performed in 146 consecutive patients (1989 to 1998). RESULTS: The incidence of Frey's syndrome was reduced from 33% to 4% with the use of a musculoaponeurotic layer, and the mean duration of postoperative facial nerve paresis decreased from 3 months to 6 weeks. CONCLUSIONS: Consideration should be given to the use of an interpositional layer of tissue between the facial nerve and the skin flap to reduce the incidence of Frey's syndrome after parotid gland surgery.

Aged↗

Temporal galeal fascia cover of custom-made gold lid weights for correction of paralytic lagophthalmos: long-term evaluation of an improved technique.

BACKGROUND: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. PURPOSE: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. MATERIAL: After empiric evaluations with lead fisherman's weights 'glued' to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. METHODS: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36-96 months), 14 of these for a minimum of 5 years. RESULTS: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. CONCLUSION: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.

Adult↗

The vascularized fascia of the scalp.

The fascial layers of the temporal and occipital regions of the scalp were examined in 11 fresh cadavers. In the temporal region, three independently vascularized layers were isolated, all of which could be elevated on a single superficial temporal artery, but separated to remain independently vascularized from specific branches of this parent trunk. In the occipital area, the occipital vessels could be dissected to yield a long pedicle for an independent, fascial territory that could be transposed locally or elevated as a free flap and that will, in all likelihood, carry vascularized occipital bone. Realized and as yet unrealized uses of these ultrathin vascularized tissues remain boundless. Three representative cases are presented.

Adult↗

[Fascia compartment syndrome of the iliac-psoas compartment].

The iliacus compression syndrome has a kind of exceptional position--as to genesis, development and therapy--in comparison with the other compartment-compression syndromes of the limbs. Indeed there exist similar pathophysiological, rules, but the special anatomic facts enlarge the etiological, differential-diagnostic and therapeutic spectrum. Thus, concerning the frequency of causes, not the trauma but the spontaneous bleeding in coagulation disturbances takes the first place, and unusual causes, such as rupturing aortic aneurysms, have to be included in the differential diagnostic discussion. The finest diagnostic sign besides pain is the palsy of the Nervus Femoralis. As to the treatment, operative measures are possible. The exact knowledge of the anatomy is important for the understanding of the specialties mentioned above.

Adult↗