Endoscopically assisted pectus excavatum repair.

We present an endoscopic approach for the reconstruction of pectus excavatum with a custom silicone implant. The procedure incorporates endoscopic techniques to facilitate dissection of an extensive subcutaneous pocket through a 6-cm Chevron skin incision 8 cm below the level of the xiphoid. The incision is designed based on the size, shape, and flexibility of the custom implant and the configuration of the chest wall deformity. A superiorly based rectus abdominis anterior fascial sheath flap then is elevated up to the caudal-most margin of the implant, creating a sling below the implant, thus stabilizing its position and preventing direct communication with the overlying skin incision. In our patient, the endoscope permitted insertion of the custom implant while minimizing the length of incision. The cosmetic result using a minimally invasive approach to assist with the dissection was acceptable, and the morbidity and scarring were minimized.

Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest.

Pneumothorax (PTX) in patients with penetrating thoracic trauma is routinely ruled out with serial chest radiographs (CXRs). This study examined the efficacy of a shortened time period between initial and follow-up radiographs. Patients with penetrating torso injuries treated at a Level-1 trauma center received a CXR during their initial evaluation. If no pneumothorax or hemothorax was noted, and the patient did not require immediate admission to the Intensive Care Unit or operating room, a repeat chest film was taken at 3 and 6 h. Findings were treated as clinically indicated, and patients were discharged home if the last radiograph revealed no evidence of pathology. Over a 15-month period, 116 patients were evaluated for penetrating thoracic injuries (93 stabbings, 23 gunshot wounds) and had no pneumothorax detected on initial CXR. Two patients had pneumothorax detectable only by computed tomography. One patient had a normal initial CXR, but developed a PTX on the 3-h film, requiring tube thoracostomy. No patients developed a PTX on the 6-h study that was not present on the initial or 3-h CXR. In conclusion, extending the time between initial and final CXRs to 6 h in patients with penetrating thoracic trauma provided no additional information that was not available on the 3-h film.

Approaches to cleft lip and palate repair.

Facial clefts remain one of the most common congenital anomalies encountered by plastic surgeons. Over the last few decades, surgical results have continued to improve due to the interdisciplinary approach to this complex clinical problem.