RESUMEN
The role of total calvarial reconstruction in the treatment of sagittal synostosis remains controversial, especially in patients younger than 1 year of age. The purpose of this study was to prospectively evaluate the efficacy of a single surgical technique for total calvarial reconstruction (the reversal exchange technique) in patients younger than 1 year of age who had a radiographically confirmed diagnosis of sagittal synostosis. Twenty-three consecutive patients underwent the reversal exchange technique of total calvarial reconstruction at a median age of 3 months (age range, 6 weeks to 10 months). Quantitative assessments were performed on the basis of preoperative and postoperative (minimum, 6 months) measurements of the cephalic index (cranial width/cranial length x 100) taken from three-dimensional computed tomography scans, which were obtained in 18 of 23 patients. Aesthetic assessments were performed on the basis of the grading of preoperative and postoperative photographs, obtained in 17 of 23 patients, by three independent raters who were blinded as to the surgical technique. The mean preoperative cephalic index was 65.0, and the mean postoperative index was 76.4, yielding a mean improvement of 11.4 (17.5 percent). By photographic evaluation, 12 of 17 patients (70.6 percent) were classified as having a normal head shape (grade 4) and five of 17 (29.4 percent) as having minor residual deformities (grade 3). No patients were identified as having significant residual deformities (grades 1 or 2). There were two intraoperative complications and one postoperative complication, none of which resulted in permanent morbidity. It was concluded that the reversal exchange technique of total calvarial reconstruction provided significant improvement in head shape on the basis of quantitative measurements (cephalic index) and independent evaluations of aesthetic improvement.
Asunto(s)
Craneosinostosis/cirugía , Procedimientos de Cirugía Plástica , Cráneo/cirugía , Cefalometría , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
The vermilion myomucosal advancement flap was successfully used to reconstruct the oral commissure for a wide range of deformities in three patients with facial gunshot wounds. In one case, a delayed cross lip flap was later used to restore the philtrum of the upper lip, despite the fact that the cutaneous perforating vessels of the cross lip flap had previously been divided.
Asunto(s)
Labio/cirugía , Boca/lesiones , Boca/cirugía , Colgajos Quirúrgicos , Heridas por Arma de Fuego/cirugía , Adolescente , Adulto , Preescolar , Contractura/cirugía , Humanos , Labio/lesiones , Masculino , Cicatrización de HeridasRESUMEN
A composite chondrocutaneous advancement flap is described for the reconstruction of full thickness marginal defects of the ear. It has been used successfully in two patients to reconstruct defects involving the helix and scapha and is recommended for defects whose wound dimensions exceed the limitations of both wedge excision and Antia and Buch's chondrocutaneous flap.
Asunto(s)
Oído Externo/cirugía , Colgajos Quirúrgicos/métodos , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/cirugía , Neoplasias del Oído/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Reinnervation of the posterior cricoarytenoid (PCA) muscle with a nerve-muscle pedicle (NMP) has been proposed for patients with bilateral abductor vocal cord paralysis. Since its success has been controversial, a glycogen depletion histochemical technique was used to examine reinnervation. An ansa cervicalis NMP was implanted into the denervated PCA in nine cats. Eight months later, vocal cord activity was evaluated. The NMP nerve was stimulated extensively in seven cats (experimental group). Optical densities of NMP-supplied PCA muscle fibers from experimental and control groups were compared to detect differences in glycogen content. The results demonstrated quantitative evidence of reinnervation in two experimental animals. Electrical stimulation of the NMP produced abduction in one of these two animals, but was never observed during spontaneous respiration or airway occlusion. These observations indicate that reinnervation can occur but abduction requires electrical stimulation. The NMP technique may be more successful with an electrical pacer.