Evaluation of early active mobilization protocol of extensor tendon repair at zone V, VI and VII

Extensor tendon injuries are relatively common. The thin overlying skin makes the tendons vulnerable to sharp injuries. Yet tendon adhesions during the healing phase is a frequent outcome, it might limit the full recovery of the patient. This prospective clinical study was done to evaluate the postoperative protocol of early active mobilization using simple, easy to made static splint. It provides the surgeon with guidelines to treat patients with extensor tendons injuries. It helps the patients to attain best results and least complications. In this prospective study 27 cases of fresh injury of extensor tendon at zone V to VII were treated with primary repair [within 24 hour] or delayed primary in the Medical City teaching complex between March 2009 to March 2011. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Twenty seven patients included in this study, with age ranging between 20 - 60 years. All were assessed according to the Dargon criteria at the sixth postoperative week. The most common injury was caused by glass 74%.Patients were followed up to one year, and 63% of the patients had excellent The most common complication was tendon rupture in 4 cases, 14.7%. The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tend-on repair in the hand at zone V, VI, and VII in cooperative patient .It will give fairly acceptable results

Primary repair of unilateral cleft lip nasal deformity

There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome. A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008. Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were perfonned primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages. The average follow up periods were 3 years [ranging from 1-5 years]. The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good resu1ts, 16 patients had acceptable results, and 6 patients had poor results. Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Whether it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question

Nasal layer lengthening in cleft palate repair outcome of two techniques

Cleft palate repair aims at producing closure of the cleft with reasonably lengthy palate in order to have competent velopharyngeal closure. Various procedures have been described and used for this purpose Primary lengthening of the nasal layer is one of these procedures. The aim of this study is to evaluate two procedures of primary nasal layer lengthening, with or without a turned in buccal flap. The total number of our patients is 36. Twelve patients of our study did not undergo nasal layer lengthening technique and considered as control [group A]. Twenty four patients underwent lengthening of nasal layer technique. In 12 of them [group B] the raw area of nasal layer was covered only by oral layer flaps and 12 cases of them [group C] the raw area of nasal layer was covered by unilateral buccal flap. All patients who had this technique [group B and C] obtained an acceptable lengthening of the palate and it approached the posterior pharyngeal wall. Three patients to whom we used nasal layer lengthening technique without buccal flap developed complications; two fistulas and one case of infection, while patients with nasal layer lengthening with buccal flap and patient without nasal layer lengthening technique showed lower level of complications. Nasal layer lengthening technique is a favorable technique for palatal lengthening in cleft palate repair if accompanied by buccal flap

distally based radial forearm flap in reconstruction of complex defects of the hand

The hand is exposed to various types of trauma, the majority of which involve multiple tissues which needs to be repaired in the most perfect way. The distally based radial forearm flap is one of the commonly used flaps for reconstruction of hand defects. The aim is to test the applicability and the versatility of the distally based radial forearm flap in complex soft tissue reconstruction of the hand. Nine patients were treated using distally-based radial forearm flaps. There were seven males and two females, mean age was 21 year. Reconstructed sites involved the thumb, the first web, the palm and dorsum of the hand. Neurofasciocutaneous flap was transferred in one case, adipofascial flap in one case, all the remaining flaps were fasciocutaneous island flaps. All the flaps survived completely. There were two donor sites complications, but no major functional disturbances. No patient had symptoms of cold intolerance or other ischemic changes. Distally based radial forearm flap is very useful in hand reconstruction especially when no suitable local flaps can solve the problem and it can permit further surgical procedures to be done underneath when indicated

Closure of A large complicated pharyngocutaneous fistula

Pectoralis major muscle or myocutaneous flap is usually used for closure of big pharyngocutaneous fistula. In case of partial or complete failure, the plastic surgeon should be well prepared to use a second option for closure weather using myocutaneous or fasciocutaneous flaps, alone or with combination. Deepithelialized Deltopectoral flap found to be a reliable option

Cleft palate repair without fracture of the pterygoid hamulus

Cleft palate repair should be done with minimal tension across the suture line in order to avoid the development of palatal fistula. Fracture of the pterygoid hamulus is routinely done by many surgeons during cleft palate surgery to facilitate soft tissue approximation. To demonstrate the actual need for fracturing the pterygoid hamulus in palatoplasty. Seventy-one cleft palate patients were studied, their ages ranged between 16 months and 14 years .In all of them surgical repair was done by Veau-Wardill- Kilner operation without fracturing of the pterygoid hamulus. Dissection of the mucoperiosteal flaps from the underlying muscles was done to overcome the tension and the clefts were closed in layers. The patients were observed for the ease of the closure during surgery and the development of fistulas postoperatively. Closure can be obtained with minimal tension without fracturing the pterygoid hamulus even in wide clefts if the flaps are properly released from the underlying muscular attachment. Postoperatively three cases developed postoperative bleeding and 2 cases had palatal fistulas. Fracturing of the pterygoid hamulus is not indicated in repair of narrow to moderate clefts. In wide clefts successful closure can be obtained without fracturing if adequate release of the flaps from the muscles is done, otherwise fracturing might be justifiable to reduce the tension across the suture line