Reconstructive Surgery

Oral and Maxillofacial Surgeons have increasing opportunities to train in head and neck oncologic and reconstructive surgery. The development of a fellowship training programs within our speciality has had a transformative effect on the speciality. This survey by the commitee on Maxillofacial Oncology and Reconstructive is aimed to evaluate the impact of fellowship training on the careers of the fellows and speciality from 2005-2015.

Microtia is a congenital abnormality with low incidence but considerable morbidities. Reconstruction of the microtia deformity is a complex and difficult process that requires a proper planning. The primary technique of reconstruction employs patient's own rib cartilage. Irradiated homograft cartilages previously have been used in facial reconstruction but its application in microtia surgery has not been reported yet. This study is designed to compare the results of autograft versus homograft auriculoplasty. Between 1992 - 2002, 23 patients underwent auricular reconstructive surgery by the senior author in our department. Autograft implantation was performed in one stage but homograft auriculoplasty was done in two stages. Auricular deformity was right-sided in 13, left-sided in 8, and bilateral in 2 cases. Implanted graft was autograft in 9 patients and homograft in 14 patients. During mean follow-up of 4 years, cartilage graft resorption was detected in two cases, one in autog...

The diagnosis of breast cancer can cause a significant anxiety in someone's life. The care of the breast cancer patient requires in many centres. The care of breast cancer patient is undertaken as a joint venture between the surgeon, medical oncologist, radiotherapist, pathologist and allied health professionals such as the clinical nurse specialist as well as counsellors. This is a case of a 39-years-old Malay woman presented to HUSM with a history of ulcerating breast lump with bloody pus discharge on the right breast. An initial mammogram study showed lesion suspicious of malignancy, and histopathological examination was consistent with invasive ductal carcinoma. She received neoadjuvant chemotherapy before proceeding to right modified radical mastectomy with axillary clearance and immediate chest wall reconstruction. Detailed discussion on the diagnosis, treatment, surgical intervention and progress of the patient with reference to available literature reviews are presented.

The diabetic triad of neuropathy, vasculopathy, and foot deformity can be surgically challenging to the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. It is critical to have adequate blood flow and to debride the wound to clean healthy tissue before considering reconstruction. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail perioperatively due to postoperative shear forces created by premature joint motion and/or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing in the Charcot foot by providing temporary but reliable offloading and/or immobilization of joints. Using a team approach is critical to ...

The use of flaps to reconstruct lip defects requires detailed knowledge of the local vasculature. New flaps for surgery around the mouth can be devised if the surgeon knows the distribution of the perioral arterial branches. Examination of the anatomy of perioral branches of the facial artery (FA) confirmed the consistent presence of septal and alar branches in the upper lip and a labiomental branch in the lower lip. Mucosal flaps from the upper lip based on the deep septal branch or the alar branch of the FA can be used to restore lower lip defects. A composite flap from the lower lip supplied by the labiomental branch of the FA can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. We studied the vascular anatomy of the perioral region in 25 cadaver dissections. Fixation was by 10% formaldehyde solution. Red latex was injected into the common carotid arteries before dissection. In the 50 specimens, the primary supplying vessels were identified and the size and distribution of the vessels were investigated. The FA was symmetrical in 17 (68%) of 25 heads. It terminated as an angular facial vessel in 11 (22%), as a nasal facial vessel in 30 (60%), as an alar vessel in six (12%), and as a superior labial vessel in two (4%) facial halves. It terminated as a hypoplastic type of FA in one (2%) facial half. The average external diameter of the superior labial artery (SLA) was 1.6 mm (min-max: 0.6-2.8 mm) at its origin. The origin of the SLA was superior to the angle of the mouth in 34 of 47 specimens (72.3%), and at the angle of the mouth in 13 of 47 specimens (27.7%). In two of the remaining three specimens, the SLA was the continuation of the FA and the other was of the hypoplastic type. The SLA supplied the columellar branches in all specimens except for the hypoplastic type (49 specimens). Columellar branches were classified according to their number and their type. In five specimens (10%) the inferior labial artery (ILA) was not found. In the other specimens, the site of origin of the ILA varied between the lower margin of the mandible and the corner of the mouth. Its external diameter measured min-max: 0.5-1.5 mm. The ILA arose from the FA above the angle of mouth in 4 specimens (8%), inferior to the angle of mouth in 11 specimens (22%), and at angle of mouth in 30 specimens (60%). We observed that the labiomental arteries, which formed anastomoses between the FA, ILA, and submental artery, showed variations in their course in the labiomental region. We suggest that knowledge of the location of arteries with respect to easily identifiable landmarks will help to avoid complications at surgery. Clin. Anat. 18:330-339, 2005. V V C 2005 Wiley-Liss, Inc.

To document the experience at a tertiary referral hospital in India with managing complex and complicated vesicovaginal fistulae (VVF) by the transvaginal route, and to document the complications and the long-term outcome of the patients.The medical records of 102 patients with complex or complicated VVF who underwent transvaginal surgical repair during 2000–2009 were reviewed retrospectively.The mean age of the patients was 24 years and the mean duration of urinary incontinence was 3 years (range 6 months to 12 years). The patients were followed up for a median of 48 months. In total, 78 patients had obstetric fistulae, 20 patients had surgical (gynecologic) fistulae, and 4 patients had postradiation fistulae. The overall success rate for the transvaginal approach was 86.3%. Fourteen patients remained incontinent despite the surgical repair. Early failure of the repair was observed in 11.8% of the patients and delayed failure in 2.0%. Postoperative complications included stress urinary incontinence (9.8%), urge urinary incontinence (7.8%), dyspareunia (5.9%), and chronic labial pain (2.0%).The transvaginal approach to the repair of complex and complicated VVF gives good long-term results with low complication rates.

Complex posttraumatic forearm deformities, have a significant impact on the integrity of the upper extremity leading to pain, instability in both the proximal and/ or distal radioulnar articulation and reduced range of forearm motion. Corrective osteotomy or more advanced procedures for malunited fractures or other posttraumatic deformities of the upper extremity, especially in the forearm are challenging procedures. In this review we will discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the pathway from preoperative planning to the actual deformity correction surgery, either with one- stage correction or using gradual lengthening with external fixation ("callotasis techniques") and finally the functional outcome we can expect for our patients. In addition we will analyse the modern computer- assisted techniques available to date.

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.
Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.
Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.
Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco- regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.

PURPOSE To define the order and frequency of elongation in tendon junctions in extensor carpi radialis longus (ECRL) to flexor digitorum profundus tendon transfer and its correlation to grip strength and lack of finger flexion. METHODS Forty-seven tetraplegic patients had surgery involving the reconstruction of finger flexion with the transfer of the ECRL in a total of 62 arms. During surgery metal markers were placed on both sides of the tendon-to-tendon attachment site. After surgery the distance between the markers was measured on radiographs. Any increase in the distance between the markers was judged as elongation. The grip strength and mean pulp-to-palm distance were evaluated a minimum of 6 months after surgery. Three arms had a second surgery because of insufficient functional results. RESULTS The average final elongation was 9 +/- 10 mm (mean +/- SD). The mean grip strength was 16 +/- 12 kPa (range, 0-50). The lack of flexion (mean value of pulp-to-distal palmar crease of 3...

Objective-To evaluate the use of subdermal plexus skin flaps for closing defects after excision of cutaneous and subcutaneous tumors in dogs and to compare outcome of flaps secured with sutures and those secured with butyl-cyanoacrylate and intermittent sutures. Study Design--Clinical study. Animals-Fifteen dogs. Methods-After excision of cutaneous or subcutaneous tumors the skin defect was reconstructed by random flaps based on the subdermal plexus. Flap skin edges were apposed with simple interrupted 4-0 monofilament nylon sutures (group 1; 5 dogs) or nylon sutures alternated with butyl-cyanoacrylate adhesive (group 2; 10 dogs). Flaps were evaluated every 48 hours when bandages were changed, until complete healing. Results-Random flaps based on the subdermal plexus were effectively used to close wound defects; mean flap survival was 89%. Partial flap necrosis occurred in 4 dogs. Wound margins apposed with butyl-cyanoacrylate had thinner and more esthetic scars than sutured margins. Conclusion-Random flaps based on the subdermal plexus proved to be versatile for covering limb wounds after excision of cutaneous or subcutaneous tumors. Mean survival rate was comparable to that reported for axial pattern flaps. Butyl-cyanoacrylate adhesive was easy to apply, allowed accurate margin apposition with good cosmetic outcome and reduced sutures needed. Clinical Relevance-Cyanoacrylate adhesive should be considered in lieu of suture closure to secure random skin flaps based on the subdermal plexus in dogs. r

Objective-To describe a novel technique for blepharoplasty to cover a tissue defect involving ! 50% of the lower eyelid. Study Design-Prospective clinical study. Animals-Five cats with lower eyelid squamous cell carcinoma (SCC). Methods-En bloc resection of SCC by removing ! 50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. Results-Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. Conclusions-After en bloc resection of SCC involving ! 50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. Clinical Relevance-Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with ! 50% tissue loss of the lid margin. r

abstract Double DIEP flap for lower extremities reconstruction introduction: A soft tissue defect considering the extent, location, depth and involved structures can be a complex task, leading to search for unusual reconstructive alternatives. case report: Puerperal woman, 21 years, previously healthy, admitted for septic shock and skin necrosis of both extremities secondary to purpura fulminans. Escharectomy was performed and the final defect was 27% of total body surface, corresponding to necrotic areas of both superior and lower extremities. Is remarkable the presence of musculocutaneous perforating vessels thrombosis and segmental muscular necrosis in legs and interosseous muscles necrosis in hands. In upper extremity coverage was performed with dermoepidermal grafts. To cover peroneal malleolus and feet dorsum, whereas there were no regional or local alternatives, we realize a double DIEP flap. Flap elevation of bilateral DIEP flap was performed simultaneously for two surgical teams. The patient had no complications and was discharged with complete soft tissue coverage. key words: Double DIEP flap, lower limb reconstruction, microsurgery.

Background: An adequate reconstruction of foot soft tissue, specially in the sole, is crucial to restore functional capacity. Aim: To report the experience with reconstruction of sole soft tissues. Material and Methods: Retrospective analysis of 12 patients aged 19 to 72 years (seven males), subjected to reconstruction of soft tissue defects in the sole. Results: The lesions were secondary to excisions of malignant melanomas in seven patients, old traumatisms in two patients, a burn lesion in one patient and a diabetic ulcer in one patient. The reconstruction techniques used were skin grafts in one patient, local fl aps in eight and free fl aps in three patients. Five patients experienced complications and one of these required a new reconstructive surgery. Functional recovery was adequate in 11 patients. Conclusions: Reconstructive surgery of the sole can achieve an adequate functional recovery in most operated patients.

Resumen Actualmente, la cirugía conservadora es el estándar quirúrgico en el tratamiento del cáncer de mama, pero en un 15-35% de los casos, debe ofrecerse la mastectomía. Hasta no hace mucho tiempo, si estas pacientes necesitaban radioterapia, la opción de la reconstrucción se retrasaba o incluso se rechazaba. Actualmente, los avances técnicos permiten poder ofrecer reconstrucción e irradiación. En el presente artículo se revisan los diferentes tipos de cirugía reconstructiva y su relación con la irradiación, de forma que se incluyen: reconstrucción inmediata con técnica heteróloga, prótesis definitivas, expansores tisulares, reconstrucción diferida con técnica heteróloga y/o autóloga, reconstrucción del complejo aréola-pezón y lipoinfiltración. Se revisan las complicaciones de la combinación de cirugía reconstructiva y radioterapia, y se establecen unas recomendaciones prácticas.

O carcinoma de células escamosas é um tumor maligno dos queratinócitos, o diagnostico definitivo desta doença se baseia no exame histopatológico das lesões. As narinas dos gatos é uma das regiões comumente afetadas por esta neoplasia. A resposta aos agentes quimioterapêuticos, criocirurgia e radioterapia não é muito promissora, por este motivo a ressecção cirúrgica é instituída a fim de remover a maior quantidade de tecido comprometido e proporcionar margens cirúrgicas livres, nos casos de envolvimento nasal, realiza-se nosectomia, muitas vezes precisando utilizar técnicas reconstrutivas como os flapes de avanço para a síntese das feridas cirúrgicas. Devido a grande incidência de pacientes felinos com esta entidade, o presente estudo objetiva relatar e discutir a eficácia da nosectomia em sete felinos acometidos pela doença. Conclui-se que a nosectomia é uma técnica com fim terapêutica, eficaz em cinco dos setes pacientes felinos, resseccionando a massa tumoral com margem e proporcionando tempo e qualidade de vida aceitável.

Objective: To document the experience at a tertiary referral hospital in India with managing complex and complicated vesicovaginal fistulae (VVF) by the transvaginal route, and to document the complications and the long-term outcome of the patients. Methods: The medical records of 102 patients with complex or complicated VVF who underwent transvaginal surgical repair during 2000-2009 were reviewed retrospectively. Results: The mean age of the patients was 24 years and the mean duration of urinary incontinence was 3 years (range 6 months to 12 years). The patients were followed up for a median of 48 months. In total, 78 patients had obstetric fistulae, 20 patients had surgical (gynecologic) fistulae, and 4 patients had postradiation fistulae. The overall success rate for the transvaginal approach was 86.3%. Fourteen patients remained incontinent despite the surgical repair. Early failure of the repair was observed in 11.8% of the patients and delayed failure in 2.0%. Postoperative complications included stress urinary incontinence (9.8%), urge urinary incontinence (7.8%), dyspareunia (5.9%), and chronic labial pain (2.0%). Conclusion: The transvaginal approach to the repair of complex and complicated VVF gives good long-term results with low complication rates.

Objective: The purpose of this anatomical study was to explore the morphological, parameters, topography and diameter of neurovascular pedicles of the semitendinosus muscle. Materials and Methods: The study was conducted on 46 formalin fixed adult human cadaveric lower limbs (20 right and 26 left), at the Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, MakkahSaudi Arabia. The semitendinosus muscle was dissected and studied regarding its origin, insertion, parameters and the number and points of entry of the supplying nerves and diameters of arteries just before entery to the semitendinosus muscle. Results: The mean width of ST fleshy part near origin, at middle and before overlap part were 2.07±0.41, 3.01±0.48, 2.46±0.44 cm respectively. ST muscle thickness mean of fleshy and tendentious parts were 1.45±0.28, 0.39±0.53 cm respectively.1-3neurovascular pedicles entering into the ST muscle. The distance of the entry of neurovascular pedicle to the ST muscle f...

Purpose: Traumatic rupture of the corpus cavernosum of the penis is rare and has been reported infrequently. We demonstrated the moderate frequency and most common etiologies of this condition. Materials and Methods: Between February 1990 and June 1993, 68 patients underwent a n emergency operation 3 hours to 4 days after penile fracture. Results: Among 32 patients who completed a questionnaire functional results were excellent except for 3 with penile curvature and pain during coitus who underwent surgery more than 48 hours after injury. Conclusions: Fracture of the penis is a common urological problem. In our series the most common cause was manipulation. To avoid serious complications immediate surgical intervention is recommended.

Semitendinosus muscle arteries, the main two are femoral artery and th innervation by the tibial d Several surgical strategi anterior cruciate ligament Semitendinosus and Gra articular reconstruction acromioclavicular recon calcaneus[6] and reconst

Bone morphogenetic proteins (BMPs) accelerate bone repair in experimental and clinical conditions. Impacted Morsellized Cancellous Bone grafts (MCB) are successfully used to reconstruct bone defects after failed hip implants. The main question in this study was if BMP-7 (OP-1) mixed with MCB could accelerate the incorporation of MCB and prevents the formation of a soft tissue interface after remodeling of the MCB. A large loaded defect in the acetabulum of goats was reconstructed with a wire mesh and with MCB or MCB mixed with OP-1. After 6 weeks, no differences were found in the revascularization process, in the number of osteoclasts resorbing the MCB, and in the thickness and appearance of the fibrous interface between MCB with or without OP-1. After 6 weeks, enchondral bone had formed in the bone graft layer and on the periosteal anterior and superior rim in the OP-1 group only. More periosteal bone and more bone in the holes of the mesh had been formed in most OP-1 goats. Most MCB was replaced by new lamellar bone after 15 weeks in both groups. We speculate that during or directly after impaction most of the OP-1 is released from the carrier inducing an early effect outside the reconstructive layer at the periosteal side of the acetabulum. Probably most OP-1 has left the reconstruction by the time new vessels and progenitors reached the bone graft. These results do not support the use of OP-1 in impaction bone grafting in patients. '

We present two cases of finger ring impaction. Both patients tried to remove it in rural hospitals before presenting to the burns and plastic unit of the University of Calabar Teaching Hospital. The male had the ring on the left index finger while the female had it on the left ring finger. The rings were removed by the use of circumferential cutaneous tissue infiltration (ring block) with plain lignocaine, strip of esmarch bandage exanguination of the finger, lubrication with K-Y jelly and then extraction.

Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 13, 2021. usage and total calcium supplementation were not predictive of readmission rates or ED visits. Conclusion: Higher preoperative PTH levels were independently predictive of 30-day readmission rates, 30-day ED visits related to hypocalcemia, and HBS following surgery. We note a PTH cutoff value of 1960 pg/mL, which identifies a high-risk group that can be used to guide calcium replacement protocols postoperatively. Thyroid imaging Reporting and Data systems (Ti-RADsTM) in Community setting Easwer Raman (Presenter); Jagdish K. Dhingra, MBBS, FRCS Introduction: Ultrasound (US)-guided fine-needle aspiration (FNA) forms the basis of investigation of thyroid nodules. Various risk stratification criteria based on US features have been proposed to help decide which nodules to investigate by FNA. The 2 most widely used systems are the American Thyroid Association (ATA) 2015 recommendations and the 2017 TI-RADS of the American College of Radiology (ACR). We aim to analyze the adoption and performance of the TI-RADS system over a 3-year period in a community setting. Method: All patients referred for FNA of thyroid nodule/s to a dedicated ultrasound clinic over a 3-year period between January 2018 and December 2020 were studied. Prior to performing the FNA, nodules were prospectively assigned to 1 of 5 ATA risk categories by the senior author (J.K.D.), who was blinded to the TI-RADS score. Radiology reports were retrospectively reviewed for the TI-RADS scores. The percentage of patients that had TI-RADS scores assigned was calculated for each of the 3 years. Using cytology as the gold standard, performance of the ATA risk stratification system and the ACR TI-RADS score was compared. Results: A total of 943 nodules were studied. Adoption of the ACR TI-RADS increased from 6.72% through 21.76% to 42.91% over 3 years. A total of 216 nodules had both the ATA risk category and TI-RADSTM score data. Some 38 of 216 nodules (17.59%) yielded positive FNA results-defined as either Bethesda category 5/6 or Bethesda category 3/4 with suspicious Afirma® Gene sequencing classifier. ATA system yielded sensitivity, specificity, and negative and positive predicted values of 62.5%, 95.1%, 96.3%, and 55.6%, respectively, compared with 50.0%, 28.6%, 72.3%, and 13.1%, respectively, with the TI-RADSTM scores. Conclusion: In our community, there has been a gradual but slow adoption of the TI-RADSTM by radiologists, with less than 50% adoption, more than 3 years after its implementation. In our experience, ATA stratification is associated with a higher degree of sensitivity and specificity compared with the TI-RADSTM system.

A computational model is presented for the simulation of procedures of reconstructive surgery characterized by the excision of a cutaneous defect and the closure and suture of the wound edges. The skin is modeled as a plane membrane with zero flexural stiffness. The membrane undergoes large deformations and is characterized by a Fung type constitutive response in biaxial tension. Skin wrinkling, which is a typical outcome of the surgery in the form of extrusion of the wound edges and dog-ears, is considered through a modification of the elastic potential as originally proposed by Pipkin's Relaxed Energy Density theory [A.C. Pipkin, The relaxed energy density for isotropic elastic membranes, IMA J. Appl. Math. 36 (1986) 85–99; A.C. Pipkin, Relaxed energy density for large deformations of membranes, IMA J. Appl. Math. 52 (1994) 197–308]. The post-buckling analysis of a stretched annular membrane performed by Geminard et al. [Wrinkle formations in axi-symmetrically stretched membranes, Eur. Phys. J. E 15 (2004) 117–126] is used to validate the model under conditions similar to those of the surgery and to discuss the influence of a pre-existing tension in the membrane on the extension of the wrinkled regions. The model is applied to simulate different surgical procedures and investigate the effects of the natural state of the skin and the shape and size of the excisions. The results explain and validate current practice.

The perineal defect in female genitalia results from multiple etiologies, including obstetric injury, sexual assaults, and perineal trauma. Untreated defects may lead to significant physical, functional, and esthetic complaints. Numerous reconstruction methods are used for a perineal defect, but various complications, such as fecal impaction, fecal incontinence, and wound disruption, are introduced. We report a case of a 40-yr-old woman with a cloaca-like perineal defect, who was treated with reconstructive surgery of the perineal defect and recovered with a good anatomical and functional outcome.

Objective-To report a technique for correction of atresia ani and rectovestibular fistula with fistula preservation, and outcome in 2 dogs. Study Design-Case report. Animals-Two intact female puppies. Methods-The fistula was approached by episiotomy. A vertical median perineal incision was made starting dorsal to the anal region and extended to surround the fistula. The rectum and vagina were separated, and the end of the fistula was sutured to the skin. Results-Early postoperative complications included constipation, fecal incontinence, and perineal soiling, but long-term outcome was good in both dogs. Conclusion-With careful dissection, the fistula and internal anal sphincter can be preserved and used in the surgical reconstruction of the anal canal and anus. Clinical Relevance-Preservation of the fistula may provide an internal sphincter that contributes to a better functional result during correction of atresia ani. A surgical approach that combines episiotomy and perineal incision for separation of the vagina and rectum, and preserves the fistula may decrease the risk of dehiscence.

This paper presents a retrospective study of the use of 346 expanders in 132 patients operated at the Ivo Pitanguy Clinic, between the period of 1985 and 2000. The expanders were used in the treatment of burn sequela. In the majority of cases, more than one expander was used at the same time. In 42 patients, repeated tissue expansion was done. The re-expanded flaps demonstrated good distension and viability. With the increase in area at each new expansion, larger volume expanders were employed, achieving an adequate advancement of the flaps to remove the injured tissue. The great advantage of using tissue re-expansion in the burned patient is the reconstruction of extensive areas with the same color and texture of neighboring tissues, without the addition of new scars.

The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based...

Object Orbital tumors can be divided schematically into primary lesions, originating from the orbit itself, and secondary lesions, extending to the orbit from neighboring structures. These tumors are variable in their biological nature and in their location. The authors evaluate 41 cases of benign and malignant tumors involving the orbit and discuss the surgical challenge, which involves tumor removal, preserving visual function and cosmetic reconstruction. Methods The authors performed a retrospective analysis of a series of all cases involving patients who underwent surgery for treatment of orbital tumors in their hospital between December 2003 and December 2006. Data were collected from the patients' files in the hospital's outpatient clinic, operative notes, and pre- and postoperative imaging studies. Results The authors identified 41 patients who met the inclusion criteria (age range 14–82 years, mean 42.2 years, standard deviation 22.4 years). The most common presentin...

Case presentation: A vascularized outer-table calvarial bone graft was used for repairing a Posnick type 2 traumatic orbito-frontal bone defect supported by the use of a calcium-based putty (Allomatrix R t) in a 7-year-old girl. Gaps between the donor and recipient sites were filled with Allomatrix R t containing demineralized bone matrix particles. Four years later there was a good cosmetic result using an artificial left eye. Discussion: Orbito-frontal defects have been repaired using iso-, allo-or xenografts as well as synthetic materials. Anatomical studies have pointed to the importance of the superficial temporal vessels for the vascular supply of a graft to the calvaria. Conclusion: The vascularized outer-table calvarial bone graft based on the superficial temporal vessels is a reliable option for repairing bony defects in the craniofacial skeleton especially in irradiated or scarred areas where there is a paucity of well-vascularized tissues. It also has the potential for bony growth in children. r 2005 European Association for Cranio-Maxillofacial Surgery