Comparison of divided sciatic nerve growth within dermis, venous and nerve graft conduit in rat.

BACKGROUND: Considering the common origin of skin and peripheral nervous system, a tube of dermal layer of skin hypothetically can be an ideal conduit for nerve reconstruction. An experimental study performed to evaluate the nerve regeneration of efficacy into a dermal tube. METHODS: Sixty male Wistar rats were used. A 10 mm gap was produced in right sciatic nerves. In group A the autogenous nerve grafts were used to bridge the defects. In group B vein conduit were use to reconstruct the gaps. In group C dermal tube were used to bridge the defects. Morphologic studies were carried out after 3 month. RESULTS: The density of nerve fibers was significantly higher in autogenous nerve graft group. The efficacy of nerve growth into the dermal tube group was significantly poor in comparison to other groups. CONCLUSIONS: In the present study, dermis was used as the nerve conduit for the first time. This study indicates that the dermal tube is not a suitable conduit for nerve regeneration till further studies to resolve the problems before clinical application.

Closure of complicated palatal fistula with facial artery musculomucosal flap.

BACKGROUND: Palatal fistulas occur most commonly as a complication of cleft palate surgery. Treatment of these fistulas, especially when they are wide and scarred, is a challenge for both patients and plastic surgeons, with a high rate of recurrence. METHODS: The authors have operated on 22 cases of wide, scarred, recurrent palatal fistula with the use of the facial artery musculomucosal flap, first introduced by Pribaz et al. in 1992. The patients were operated on from March of 2001 to December of 2002 and ranged in age from 2 to 21 years. This flap is axial, centered over the facial artery, and can be raised inferiorly based or superiorly based. All of these patients with cleft palate had been operated on before. In one case, because of a very wide fistula, a bilateral facial artery musculomucosal flap was used. RESULTS: There were two cases of partial necrosis and one case of complete failure, probably caused by twisting of the whole pedicle. The nasal lining was made using turndown flaps of the fistula margin. Because of hanging the base of the flap (inferiorly based) and producing bite block during mastication, the pedicle had to be divided and the flap inset secondarily 1 month later. CONCLUSIONS: The facial artery musculomucosal flap is an alternative for closing the scarred, wide, recurrent fistula, and is associated with a high rate of success. The flap should be included among the techniques of any plastic surgeon who performs palatal surgery.