Cranioplasty: successful use of rib grafts

Background: numerous materials are available for use in Cranioplasty including bone, ceramics and metals. Rib graft as a construct for cranial reconstruction offers several advantages including autologous bone source, a formable platform, low infection rate, regeneration at the donor site and high fusion rates

Aim of the work: the present series aims to clinical evaluation of the use of rib grafts in Cranioplasty

Patients and methods: rib autograft Cranioplasty was performed in 15 patients. 12of them were males and 3 were females. The mean age was 18 years. When single rib needed, it has been harvested from the 5th rib and when two ribs needed, they were f harvested from the 4th and 6th ribs. 20 ribs were totally harvested

Results: the reasons for cranial reconstruction were: post traumatic calvarial defects [73.6%]. Previous craniotomy [13.2%], congenital defect [6.6%] and fibrous dysplasia resection [6.6%]. The size of the defects ranged between 15 and 84cm2. The mean follow up period was 16 months post-operatively. Normal cranial contour was achieved in all patients. One patient developed CSF leak that resolved spontaneously No donor site complications were noted [Pneumothorax, haemothorax post-operative pain no post-operative infections were encountered and graft resorption was not noticed in all patients

Conclusion: the use of autologous rib graft for cranioplasty,particularly in young age group was found to have low cost effectiveness, easily harvested, easily moulded to the skull shape, osteointegrated adequately with the surrounding bone thus offers good brain protection and is associated with low complication rate

Open rhinoplasty: versatility of the technique

Aim: to study the advantages of application of external technique in the different rhinoplasty procedures

Methods: 200 Patients were subjected to open rhinoplasty technique. The indications were; combined nasal and septal deformity, broad nasal tip, low nasal tip, saddle nose deformity, bifid nasal tip and cleft lip nose deformity. The different procedures performed in this study were; sept rhinoplasty, narrowing of the nasal tip, augmentation rhinoplasty, lengthening of the columella and insertion of columellar strut

Results: the good exposure allowed in open approach made the surgical procedures performed under direct vision. None of the patients developed wound dehiscence or tip necrosis. No patient developed hypertrophic scar or need scar revision. There were no considerable reported complications related to this external approach and the results were satisfactory

Conclusion: the open rhinoplasty technique is a versatile approach for variety of rhino plastic procedures as: severely deformed nasal bones, severe septal deviation saddle nose deformity, deformed nasal tip and congenital nasal tip deformity. Also, it is a simple, reliable and rapid technique for gaining access to both nasal architecture and soft tissue of the nose without significate cosmetic or surgical risk

Palliative stenting versus surgery for obstructing left sided colorectal cancer

Aim: this study aimed to compare the results of palliative stenting with the results of emergency surgery for patients with obstructing left-sided colorectal cancer

Methods: patients with inoperable obstructing left-sided colorectal cancer with self-expanding metallic stent [SEMS] placement [group A] or emergency surgery [group B] from June 2003 to June 2005 were included. Data on the mortality, morbidity, necessity of intensive care and hospital stay for the two groups were compared

Results: insertion of metallic stent was successful in 14 of 16 patients [87.5%]. Hospital death occurred in two patients in group A and in 6 patients in group B. The mean hospital stay was significantly shorter in [Group A]/3.3 +/- .3days versus [Group B] [15.7 +/- 0.7, p=0.0001 Table 1. The incidence of colostomy was significantly lower in [Group A] [4 patients] versus [13 patients] in [Group B], p=0.003. Twelve patients [70%] required intensive care admission after surgery, compared with only two patients [12.5%] following SEMS insertion [p=0.0001]

Conclusion: SEMS are effective in the palliation of obstructing left-sided colorectal cancer. SEMS is associated with a shorter hospital stay, less likelihood of intensive care admission and lower incidence of stoma creation, when compared with emergency surgery

Effect of dermal excision off inferiorly based flap in reduction mammaplasty

Aim: to study the effect of full thickness excision off the inferiorly based flap

Methods: reduction mammaplasty by the inferior pedicle technique used in two equal groups of 30 patients, 1st. group the flap based on dermoglandular tissue, 2nd. Group the flap based on glandular tissue only with excision of full thickness skin off the flap

Results: concerning the aesthetic results and complications there is no significant differences between the two groups. A comparative study between the two groups revealed that the retained dermis does not improve the vascularity of the nipple and areola but the operative time showed marked difference, in the first group [dermoglandular pedicle], the mean operative time was 207 minutes while in the second group [glandular pedicle] the mean operative time was 130 minutes

Conclusion: reduction mammaplasty by the inferior pedicle technique is versatile, safe and easy. Full thickness excision of the skin from the inferior pedicle save the time, avoid possibility of post-operative inclusion dermoid cyst formation and reduced anesthesia time without any effect on the breast projection and viability of the nipple areola complex

Laparoscopis cholecystectomy: Evaluation with Ultrasonography

To determine the postoperative appearance of the gallbladder bed and the significance of fluid collections after surgery, a routine postoperative scanning with ultrasound of the right upper quadrant was performed for 40 patients 24 hours after laparoscopic cholecystectomy [LC]. The location, volume and appearances of fluid collection were recorded. The maximum diameter of the common bile duct was measured in all patients and compared with the preoperative measurements. The minimal fluid collections were identified in the gallbladder fossa and/or peritoneal cavity in 30 patients. Fluid collections were not associated with fever or elevated white blood cell count. In six patients, the diameter of the common bile duct increased on the postoperative scan. This was not associated with an elevation in alkaline phosphatase or bilirubin levels. Thirty-six patients were discharged in the first postoperative day. So, routine postoperative ultrasound is important in the evaluation of patients who had had laparoscopic cholecystectomy