Radiodermatitis (x-ray burns) cases complications and treatment

Five representative cases of radiodermatitis are presentedWhile the usefulness of X-Rays both for diagnosis and therapy cannot be overemphasized, one must be fully aware of the hazard of unneccessary exposure and over-exposure to them. For like a double-edged sword, it can hurt while it can cure. (Summary)

Cleft lip in adults and infants

Cheiloplasty done in infancy has its advantages and disadvantages. It moulds better the defective structures; and in the absence of a cleft palate, nasal twang is avoided. If, however, nasal twang is unavoidable due to the presence of a cleft lip and palate, we still have the psycho-somatic factor to consider. The inferiority complex which invariably accompanies these structural defects disappears more easilyOn the other hand, cheiloplasty done in adults offers the surgeon the advantage of dealing with bigger structures. (Summary)

Injection and surgical operation in treatment of hemangiomas of the lip

As a rule, hemangiomas are classified into capillary or cavernous type. In the capillary type, there are the portwine stain or strawberry birthmark, and the hemangioma simplex. Portwine stain usually does not regress, but it remains for life without increasing in size. Hence a cover mark is enough to mask its color. It can be left untouched for lifeHemangioma simplex may be observed for 2 years. It may regress within this period. However, injection treatment may be tried even before 2 years have passed because if it does not regress after 2 years, the mass becomes so big that the organ involved becomes distorted so that reconstruction becomes complicated. Hence in hemangioma simplex, it is better to begin injection treatment as early as possible as shown in case 1. It is seen at an older age it may be exercised and the remaining tissue approximated. If the remaining tissue for covering the gap is too small, then combined partial excision of hemangioma followed by injection method may be doneInjections consist of either sylnasol, sodium morrhuate 5% dextrose 50% or supersaturated salt solution. These injections are done every two weeks until the mass subsidesWith cavernous hemangiomas, the injection treatment cannot be used because they are too extensive and the mass even if it regresses will not return to normal size. Instead the whole mass is excised and the gap produced is replaced by a triangular flap from the opposite lip made by rotating it to bridge the gap and suturing to the sides as done in cross lip flap, only connected from the opposite lip by vermillon. After two weeks, the connecting vermillon is cut to separate upper lip from lower lip. (Summary)

The selection of technique in primary cleft palate repair

The choice of technique in uranoplasty should depend on the individual case. However, in each instance it is better to adopt a technique where 2 layers of flaps are apprerimated to ensure that at least one of the layers will take. Again, it is a good principle not to force suturing and to liberate the flaps and approximate them without tension. Multiple operations should be discouraged. Each operation produces fibrosis and the more operations there are the harder they become. Cleft palate should be done ideally at 1 1/2 to 2 years because here (1) speech recovery is satisfactory, (2) structures are still soft and can be approximated and sutured without tension, (3) whatever deficiency there is, nature will try to compensate for it because the child is still young, and (4) bad speech habits are obviatedThe technique that is preferred is one that will be finished in one sitting, one that will make the uvula long and make the soft palate and uvula mobilePre-alveolar fistulas can be closed by triangular mucosa of the lip being slid to cover the opening.(Summary)

Le Mesurier technique in repair of unilateral cleft lip

Herewith is presented the different techniques of repair for unilateral harelip. It mentions the evolution of the different methods of harelip repair up to the LeMesurier technique of unilateral harelip repair. Each methods has its corresponding advantage. However, whichever method is employed we cannot overemphasize the fact that mastery of the technique counts the most for the success of the result. (Summary)

Importance of dermal grafts for depressions or deformities of the face and neck

Herewith are presented cases with deformities of the face where depressions had been corrected with grafts. Advantages over bone and cartilage as autografts are the availability and ease in the method of procuring; over plastic inert materials, the less chance of foreign body reactionThe possibility that cysts or sinus may develop due to retained sebaceous gland or other appendages of the skin has not been observed. One striking thing that has been noticed is that the line of incision in the face never leaves scar. (Summary)

The surgical management of elephantiasis of the lower extremeties

The etiological factors and historical data on surgical treatment of elephantiasis are briefly discussedIndications of operation by clinical criteria are the following: a. Progressive increase in the size of the extremity especially despite conservative management for 6-12 monthsb. Marked skin changes such as in duration, thickening, hyperkeratosis, and dermatitisc. Repeated episodes of lymphangitis and chronic fungus infectiond. The unsightly appearance, the functional disability, and the severe reaction of the patient to the disease are obviouse. Tremendous increase in the size of the extremity affected so that the patient can hardly carry itDiagnosis of the lesion is often easily made; however, it is the etiological factor that is sometimes difficult to determine or prove. Not all cases that develop elephantiasis are due to filariasis. Most of them can be traced to lymphangitisSome of the improvements in the current surgical management of elephantoid extremities are briefly discussed. The use of full-thickness skin grafts and the avoidance of scar in kinetic areas is emphasizedThe operative procedure in one stage, the pre-operative preparation and postoperative care are discussedThe surgical treatment of choice at present in the Philippine General Hospital for elephantiasis of the lower extremities is the total excision of the edematous tissue (dermo-fibrolipectomy) and followed by skin grafting from the specimen and from the sound skin of the bodySix cases of elephantiasis of the lower extremity treated in the P.G.H. are presentedComplications and early results of the cases are discussedThe shorter the duration of the elephantiasis, the better is the result. (Summary)

Face lifting for premature wrinkles and wrinkles due to age

Cases are presented here with wrinkles due to old age and some with premature wrinkles. Operative technique is described. Patients who submit to this operation show signs of contentment, confidence and upliftment from the depressed stage of age obsession. As a rule, a face lifting should make a person grow younger by 20 years, otherwise it means that it is not a thorough job. For one who is young at heart, still with strong muscles and other organs, one has every hope in undergoing such an operation to enjoy again the looks that he or she had 20 years ago. A woman who is single may attract a prospective husband and one who is already married can hold her husband. Economically, one can get a job easier, and if he has already one he can keep it or transfer to a better one. Socially, one can assert ones self in gatherings and psychologically, ones inferiority complex is eliminated. (Summary)

Secondary repair in defective harelip operations

In defective cheiloplasties where there is only slight whistling deformity, a V to Y maneuver in the inner surface of the vermillion is done even under block anesthesiaFor cases where the vermillion is interspersed with a triangular white skin this can be repaired by interpolating the triangular inserted skin with the adjacent vermillion triangle in a Z-plasty thus making the vermillion in a continuous line as in the normal lip. Where the defective cheiloplasties consist of marked scarring, whistling deformity and deficiency in nasal floor, then the triangular flap marking of the James Barrett Brown technique can be utilized but including as much of the scars of the tissue to be discarded. For the deficiency of the floor of the nose, the rectangular flap can be rotated upward and thus fill up the nasal floorFor bilateral harelip operations where there is too much deficiency of tissues, a W-shaped flap from the lower lip can be rotated to be inserted in a V-shaped cut of the upper following the method of Abbe-Estlander in their crosslip flap. (Summary)