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OBJECTIVES@#This study aimed to compare the postoperative outcome of the new and classical muscular reconstruction technique combined with nasal internal-fixation method for secondary deformity post unilateral cleft lip repair. A rationale is provided for the further surgical improvement of secondary deformities.@*METHODS@#Sixty patients aged 4-18 years with secondary unilateral cleft lip-nose deformity were involved in this research. The deformities of 28 patients were repaired using the muscular force balance technique through nasal internal fixation method, and 32 were repaired using classical muscular reconstruction technique. Two-dimensional analysis was used to evaluate the nose-lip morphology of pre- and post-operative patients through standardized photographs seven days after surgery.@*RESULTS@#Compared with preoperative nasal morphology in the muscular force balance technique group, the 7-days postoperative results of this group showed the significantly improved short-term outcomes in the correction of columellar deflection, alar rim angle, nasal shape, and the symmetry of alar base width, nostril width, nostril height, alar rim angle (@*CONCLUSIONS@#The new muscular reconstruction technique with nasal internal-fixation method has a significant effect on nasal repair.
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Humans , Cleft Lip/surgery , Nose/surgery , Postoperative Period , Rhinoplasty , Treatment OutcomeABSTRACT
@#The postoperative evaluation of cleft lip is an important means to improve the operation method and the effect of the restoration. In recent years, the methods of cleft lip repair, such as Chinese western rotary propulsion, reconstruction of labial and nasal muscle tension band+trefoil flap, etc., have been developed. However, at present, there are still many secondary deformities, such as obvious scars and alar collapse. In this paper, in a review of the previous literature, the existing methods, advantages and disadvantages, and the application of the evaluation of the postoperative effect of cleft lip were reviewed. To date, there are many methods that can be used to evaluate the effect of cleft lip surgery. These research methods can be divided into subjective evaluation and objective evaluation, such as subjective evaluation, direct measurement, photo measurement, and three-dimensional scanning measurement. Among them, the subjective evaluation is simple, but the reliability is poor, and this method is suitable for all patients with cleft lip. The direct measurement has a low cost and is only suitable for one-dimensional information measurement, but the accuracy is poor, so it is difficult to determine the endpoints. The time of the photo measurement method is short, which can avoid tissue deformation, but it is easy to produce errors; this method is suitable for patients with cleft lip who can cooperate. The three-dimensional scanning measurement has a high accuracy, is time consuming and is a simple method but has a high cost and is suitable for areas with appropriate equipment conditions. Overall, the evaluation of the postoperative effect of cleft lip surgery should combine subjective evaluation with objective evaluation, dynamic evaluation with static evaluation, and utilize long-term follow-up to obtain comprehensive and accurate information and provide a reference for clinicians to carry out cleft lip surgery.
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Objective@#This study is to repair nostril sill deformity in the cleft lip patients by reconstructing the first auxiliary muscle tension line group and to assess the therapeutic outcome.@*Methods@#437 cleft lip patients with nostril sill deformity underwent the surgery from January 1, 2012 to November 1, 2016.They were treated using the technique of first auxiliary muscle tension line group reconstruction to repair the deformity. Aesthetic correction evaluations were rated by the GAIS. Random digit was used to randomly select 24 patients during the follow-up for three-dimensional measurement and analysis. The preoperative and postoperative symmetry of the nostril sills were evaluated by paired t test.@*Results@#Mucosal ischemia or wound infection occurred in 11 cases, left obvious scar on the nostril floor. Surgical incisions of the other patients were primary healing. After 6 months to 3 years follow up, GAIS questionnaires of 378 patients demonstrated that 84% patients reported great or moderate improvement of nostril sills. Three-dimensional measurements of 24 patients suggested that there were no significant differences of the nostril sill and the nasal ala between the cleft side and the normal side.@*Conclusions@#First auxiliary tension line group reconstruction, which is to restore biomechanical balance rather than merely increase muscle volume, is an effective method of nostril sill repair in the cleft lip patients. Post-operatively, the patients achieved a stable and natural nostril sill, a middle columella, as well as a narrowed nasal ala.
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Objective@#To sum up the clinical manifestations and the method for repairing of secondary deformities of postoperation of hypospadias.@*Methods@#Applying balanus tissue flaps and urethral meatus plastic could correct the flat balanus and prevent urethral meatus from falling back. Resecting scar completely in penis and rebuilding urethral tissues could treat secondary curved penis. Applying modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis) could correct shorter and much smaller penis.@*Results@#Among January 1st 2007 to December 31st 2016, 62 cases were treated.All of them were male. Their ages were from 14 to 34 years old.55 cases were followed up from 6 months to 9 years after operations, but 7 cases could not be followed up because of the change of addresses and phone numbers.All patients achieved excellent cosmetic result. None of them had complications like urethral fistula.@*Conclusions@#After operations of hypospadias, the secondary deformities may happen when the children grow up.And these deformities always need to be corrected with operations. Balanoplasty, correction of penis and the penile augmentation are good methods for secondary deformities.Consequently, a good penis appearance and function can be acquired.
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Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip.We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap.Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities.The central defects usually occurred in these patients.The defects were reconstructed partially or completely according to the severities of the defects.The operative procedures were as follows: The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided.Then the partial-thickness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect.Results All 98 musculomucosal pedicle flaps were viable.The upper lips were reconstructed according to the severities.Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity.It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities.
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Objective To investigate the surgical methods and effect of double-cut nasolabial muscle directional three-dimensional reconstruction on the secondary deformity of unilateral cleft lip repair.Methods We first increased a contralateral vermilion secondary incision based on the nasolabial muscle directional three-dimensional reconstruction, without damaging the contralateral white lip skin, via suturing both sides of nose wings bundle of nose outside corner under the columella muscle, and overlapping suturing both sides of the orbicularis muscle flap, and then rebuilt and took shape of the nest and the crest.Results All incisions healed well in 18 patients, all nasal deformities were corrected better than the traditional methods, with the nasal base plump, the nasal sill formed close to the contralateral side, and rebuild the philtrumdimple and philtrum crest, with clear appearance and symmetrical form.A good appearance was obtained on the both sides of nostril, nasal base and the nasal sill, and the effect of preoperative design achieved.Conclusions Both sides of the nostrils size, nasal sill and shape are almost perfectly symmetrical, and the double-cut nasolabial muscle directional three-dimensional reconstruction is suitable for repairing the secondary deformity after unilateral cleft lip repair.
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Objective To explore the causes of secondary breast deformity after breast conservative therapy and its preventive methods.Methods 30 cases were selected from the patients with secondary breast deformity of more than 1 year after breast conservative therapy,and more than half a year after radiotherapy and chemotherapy,and no local recurrence and distant metastasis occurred.After cicatrectomy and contracture loose solution,different methods were used according to varying degrees of the secondary breast deformity to reconstruct and repair the deformity.Results Three reconstructive methods were conducted.Local mammary flaps were used in 7 patients,latissimus dorsi myocutaneous flap in 21 patients,and transverse rectus abdominal musculocutaneous flaps in 2 patients.The shape and feeling were satisfactory in 30 patients with reconstructive breasts,in which 23were excellent (76.7 ％),and 7 were good (23.3 ％).All the patients were followed-up for average 2.5 years,and they were survived without tumor recurrence.Conclusions The secondary breast deformity after breast conservative therapy could be effectively prevented,and successfully reconstructed and repaired with different procedure according to varying degrees of the secondary breast deformity.As a result,the shape and feeling of reconstructive breasts are satisfactory.
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The nose is the most prominent and chracteristic feature of the human face, and nasal bone fracture is the most common facial bone fracture, resulted from less force others fractures. Although nasal fracture is often discussed as minor injury, the incidence of posttraumatic nasal deformity remains high. We reviewed the data from 380 consecutive patients with nasal bone fracture treated in Dong-A University Hospital from Jannuary 1995 to December 2001 to analysis. We classified the nasal bone fracture according to the severity of fracture. Type I is simple and unilateral nasal bone fracture, Type II is simple and bilateral, Type III is communited, Type IV is complex (nasal & septal disruption), Type V is associated with NEO fracture and midface fracture. and then we did follow up after correction and estimate the incidence of secondary deformity in classification of nasal bone fracture. The follow-up period of patients ranged from 3 months to 5 years with a mean of 2.7 years. The results were as follow. First, in Type I, II, IV, the rate of incidence of depression and hump formation after operation was lower than in Type III, V. Second, in Type III, the rate of incidence of depression and hump formation was higher than in type IV, because we had corrected nasal bone fracture with more aggressive approach in Type IV. Third, in Type IV, the rate of incidence of deviation was highest due to septal disruption. Forth, in Type V, the rate of incidence of depression and hump formation was the highest, but the rate of incidence of deviation was lower than that in Type IV. Fifth, it was highest rate of incidence of deviation of C-shape nasal bone fracture preoperatively and C-shape deformity postoperatively in type IV. Sixth, a deviated shape of nasal bone fracture was tend to be the same deviated shape of secondary deformity and It's tendency was higher in S-shape nasal bone fracture in Type IV. Seventh, it was considered that the more accurate reduction of nasal bone fracture by open approach was advisable in severe cases to reduce the incidence of postoperative secondary deformity.
Subject(s)
Humans , Classification , Congenital Abnormalities , Depression , Facial Bones , Follow-Up Studies , Incidence , Nasal Bone , NoseABSTRACT
objective: To improve the repair technique of secondary nasal deformity following surgical treatment in the patients with bilateral cleft lip. Methods: 12 cases were treated with the operation technique: bilateral vermilion flaps were inserted into prolabial for the enlongation of upper lip and "V Y incision suture" principle was employed to repaire the nasal deformity. Results: Satisfactory results were achieved in all the 12 cases. Conclusion: The technique is feasible in the reconstruction of Cupid's bow, philtrum and correction of nasal and labia deformities.