Long Term Follow Up of Maxilla Reconstruction Following the Ablative Cancer Surgery

PURPOSE: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. METHODS: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. RESULTS: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. CONCLUSION: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

Aesthetic Surgery for a Posttraumatically Split Medial Head of the Clavicle

PURPOSE: We experienced a patient with posttraumatic duplication of the sternoclavicular joint causing a protruding deformity, whose major complaint was aesthetic. The patients history, radiologic findings, and surgical treatment are reported. METHODS: A 41-year-old bus driver complained a bony prominence at the left medial clavicle, which had developed after a fracture. The patient was annoyed by the protrusion, which was even visible, when he was wearing a pullover. A three dimensional CT scan showed that the medial head was split into two portions, of which the anterior portion was protruding. In general anesthesia the anterior portion of the medial head was excised. RESULTS: The bony prominence was corrected successfully. Follow up three dimensional CT scans showed that the anterior cortex of the clavicle had regenerated completely at the resection line one year after the operation. CONCLUSION: Surgical interventions for complications after clavicular fracture are usually carried out, only if there is a limitation of function or if it is painful. We report of a patient with posttraumatic bifurcation of the medial clavicular head, most probably caused by malunion. Upon the patient's request, the deformity causing protrusion of the medial clavicular area was successfully resected for cosmetic reasons.

Digital Sympathectomy for Treatment of Raynaud's Syndrome

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.