RESUMO
Rhinoplasty is a complex operation that requires precise preoperative diagnosis to select the appropriate surgical technique. In reduction rhinoplasty, I generally use the external rhinoplasty approach. Most dorsal humps are comprised primarily of cartilage, and overreduction of the bony dorsum must be avoided. The decision concerning the extent of hump removal should be determined preoperatively. Following hump removal and to close the open roof, osteotomies are considered for repositioning and reshaping the nose. A medial osteotomy is defined as the separation of the nasal bones and the bony septum. This can be further subclassified as medial oblique and paramedian osteotomies. I prefer to use a fading medial osteotomy(medial oblique). The fading medial osteotomy avoids those deformities created by extending osteotomies into the thick frontal bone. A lateral osteotomy may be used to narrow a wide nasal base, or to close open roof deformity. "Low-high", "low-low" and double osteotomies have been described. After dorsal hump removal and osteotomies, I frequently use spreader grafts to reconstruct middle nasal vault.
Assuntos
Cartilagem , Anormalidades Congênitas , Diagnóstico , Divórcio , Osso Frontal , Osso Nasal , Nariz , Osteotomia , Rinoplastia , TransplantesRESUMO
This study includes 19 cases of complicated low extremity injury to whom underwent microvascular free-tissue transfer in cases of open comminuted fracture, osteomyelitis, and vascular compromise or extensive soft tissue defect from Nov. 1994 to July 1997. The average time after injury to coverage was 25 days. The nineteen patients underwent a total of nineteen free tissue transfers primarily, and eighteen (94.7 per cent) of the transfers survived. Major complications were encountered recurrent failure of the free tissue transfer in one patient and partial necrosis in the other flap, which were successfully treated by flow-through radial forearm free flap and distally based superficial sural artery flap respectively. Two patients were sustained below knee amputation, one above knee amputation, despite of survival of flaps. This reveals limb salvage in 84 percent. The microvascular reconstruction is a versatile and reliable methods in complicated cases after severe trauma. Free tissue transplantation should be considered as a primary treatment in such complicated cases.
Assuntos
Humanos , Amputação Cirúrgica , Artérias , Extremidades , Antebraço , Fraturas Cominutivas , Retalhos de Tecido Biológico , Joelho , Salvamento de Membro , Extremidade Inferior , Necrose , Osteomielite , Transplante de Tecidos , TransplantesRESUMO
The optimal reconstruction of soft tissue defects with exposure of blood vessel, nerve, tendon muscle, and bone requires muscle flap that provides a durable surface, appropriate bulk and stability. The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. In our department, reconstructive operations were performed for 18 patients who had soft tissue defect of upper or lower extremities or head from March 1995 to February 1996. We performed free flap of serratus anterior muscle in 13 patients, free flap of adipofascial tissue overlying serratus anterior muscle in 3 patients, free flap of both serratus anterior muscle and adipofascial tissue in 1 patient, free flap of serratus anterior muscle and rib in 1 patient. Their ages were 5 to 56 years, the ratio of male to female was 14 : 4. The defects involved the upper extremity in 6 patients, lower extremity in 10 patients, and scalp in 2 patients. Free flap using adipofascia overlying serratus anterior muscle was performed when gliding surface was required due to the exposure of some structure such as tendon. The average duration from operation to follow-up examination was 4 months(from 1 to 12 months). One total necrosis was observed in the patient who had crushing injury of forearm, and one partial necrosis was observed in other patient. In the rest 16 cases, results of operation were satisfactory. This kind of flap was very useful in reconstruction of soft tissue defect and gliding surface due to easy dissection, capability of getting long vascular pedicle, and no serious functional and cosmetic deficit on donor site.
Assuntos
Feminino , Humanos , Masculino , Vasos Sanguíneos , Extremidades , Seguimentos , Antebraço , Retalhos de Tecido Biológico , Cabeça , Extremidade Inferior , Pescoço , Necrose , Costelas , Couro Cabeludo , Tendões , Doadores de Tecidos , Extremidade SuperiorRESUMO
The optimal reconstruction of soft tissue defects with exposure of blood vessel, nerve, tendon muscle, and bone requires muscle flap that provides a durable surface, appropriate bulk and stability. The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. In our department, reconstructive operations were performed for 18 patients who had soft tissue defect of upper or lower extremities or head from March 1995 to February 1996. We performed free flap of serratus anterior muscle in 13 patients, free flap of adipofascial tissue overlying serratus anterior muscle in 3 patients, free flap of both serratus anterior muscle and adipofascial tissue in 1 patient, free flap of serratus anterior muscle and rib in 1 patient. Their ages were 5 to 56 years, the ratio of male to female was 14 : 4. The defects involved the upper extremity in 6 patients, lower extremity in 10 patients, and scalp in 2 patients. Free flap using adipofascia overlying serratus anterior muscle was performed when gliding surface was required due to the exposure of some structure such as tendon. The average duration from operation to follow-up examination was 4 months(from 1 to 12 months). One total necrosis was observed in the patient who had crushing injury of forearm, and one partial necrosis was observed in other patient. In the rest 16 cases, results of operation were satisfactory. This kind of flap was very useful in reconstruction of soft tissue defect and gliding surface due to easy dissection, capability of getting long vascular pedicle, and no serious functional and cosmetic deficit on donor site.