Versatility of perforator-based V-Y advancement flaps in reconstruction of complex mid back wounds.

Reconstruction of complex mid back wounds is challenging due to the patient comorbidities and scarcity of reliable regional flap alternatives. Four consecutive cases treated with perforator based V-Y advancement flaps are reported. An effective repair was achieved in all the patients and the mean follow up period was 28 months. Our results indicate the efficacy of adipocutaneous flaps in complex spinal soft tissue repair and may help to refine the relevant algorhythm.

Pretreatment with octreotide modulates iNOS gene expression, mimics surgical delay, and improves flap survival.

We aimed to evaluate the role of a synthetic somatostatin analogue in delay procedure of experimental skin flaps. Thirty-six rats were randomly divided into 2 groups of 18 each to compare the possible local ischemic effect of octreotide with that of surgical delay in the dorsal random pattern skin flap model. The inducible nitric oxide synthase gene expression was assessed in the flap territory at intervals of immediate, 24 and 48 hours after preconditioning. Histologic analysis was performed in rats at 48th hour and 3 additional rats were used for microangiography. A gradual increase of daily transcript levels was detected in both groups (P < 0.05). The differences of molecular and histologic findings between the groups were not distinctive. Pharmacologically preconditioned rat displayed relevant microvascular features. Forty rats were further grouped randomly into 4 groups of 10 each. In group 1 rats, flaps were raised and reinserted without any prior intervention. Group 2 rats underwent surgical delay procedure, whereas flap territories of the others received either saline solution or octreotide 1 week before the ultimate flap harvest. After another 7-day period, both delay procedures were found effective in improving flap viability (P < 0.01). Ischemia induced by octreotide favored to investigate its utility in delay phenomenon. Although it was not as effective as the surgical delay procedure, it may be a safe pharmacologic alternative to improve the flap survival.

Airway management in neonates with Pierre Robin sequence.

Neonates with Pierre Robin sequence (PRs) suffer from varying degrees of airway obstruction and feeding difficulties, the courses of which differ from patient to patient, due to mandibular deficiency. We aimed to evaluate the course and prognosis of upper airway obstruction in 20 newborns with PRs. Among 15 isolated and 5 syndromic cases, 7 patients fell into Group I, 5 into Group II and 8 into Group III, respectively, according to the clinical classification system proposed by Caouette-Laberge. The 12 patients in Groups I and II were treated with positioning and gavage feeding, whereas the 6 patients in Group III underwent bilateral mandibular distraction. Decannulation or avoidance of tracheostomy was achieved in all of them. A patient who had a significant comorbidity was managed with tracheostomy and one patient expired due to pulmonary problems. When conservative measures fail, mandibular distraction osteogenesis should be considered to obviate tracheostomy in newborns with micrognathia.

Vascular anomalies of the upper extremity in children.

Vascular malformations in the pediatric upper extremity remain a diagnostic and therapeutic challenge. Recent knowledge about diagnosis and treatment is provided including specific markers, imaging techniques, and management.

L-myc polymorphism in head and neck nonmelanoma skin and lower lip cancers.

OBJECTIVE: To evaluate the presence of L-myc gene variations as a genetic predisposition to head and neck nonmelanoma skin cancer (HNNMSC) and lower lip cancer (LLC). DESIGN: A case-control study. SETTING: An academic institute laboratory. PARTICIPANTS: Twenty-four patients with HNNMSC and 27 with LLC were compared with 51 age- and sex-matched control subjects. MAIN OUTCOME MEASURES: Polymerase chain reaction restriction fragment length polymorphism and agarose gel electrophoresis were used to determine the L-myc oncogene genotypes. RESULTS: The presence of the LS genotype was found to be significantly increased in the study group, whereas the LL genotype was not detected. The S allele was also more frequent in the study group. The SS genotype was found to correlate with aggressive tumor behavior in patients with HNNMSC and a family history of cancer. Patients with LLC displayed significantly less of the SS genotype. CONCLUSIONS: The L-myc gene polymorphism may help detect and prevent HNNMSC and LLC in susceptible individuals. It may also contribute to estimation of tumor behavior in patients with HNNMSC.

Amazia with midface anomaly: case report.

Amazia, the absence of the mammary gland, is a very rare congenital anomaly of the breasts. Bilateral absence of the breasts may occur as an isolated anomaly or may be associated with a syndrome or a cluster of other anomalies. Although the literature examining pediatric breast abnormalities is replete with case reports and series, bilateral amazia together with skeletal anomalies has not yet been described. An unusual case of amazia associated with face, limb, and vertebrae anomalies is presented.

Rhinoplasty and hemophilia A.

Major surgical procedures can be performed safely for hemophiliacs provided the clotting factors are adequate. However, rhinoplasty, an elective facial procedure, has not yet been evaluated in this group of patients. The authors present a hemophilia A patient who underwent rhinoplasty for cosmetic reasons.

Use of distally pedicled sural fasciocutaneous cross-leg flap in severe foot and ankle trauma: a safe alternative to microsurgery in very young children.

Advances in reconstructive microsurgery have enabled us to make use of many flap alternatives in severe lower-extremity trauma, and traditional cross-leg flaps for wound coverage have been replaced in most centers by free-tissue transfers. But free-flap surgery is still a challenging area in very young pediatric populations because of technical difficulties with considerable drawbacks. Six children with severe foot and ankle trauma were presented. Distally based sural fasciocutaneous cross-leg flaps were carried out to cover the defects, with no complications. Because of its easy dissection and reliable pedicle without compromising the major vessels, this procedure may be a safe choice among the other cross-leg flap alternatives when microsurgery is not considered.

Two-plane injection of botulinum exotoxin A in glabellar frown lines.

Botulinum exotoxin A has been used for the treatment of glabellar frown lines. Despite this fact, the effect of the toxin is sometimes either partial or lost in a short time. The muscles responsible for frowning, the corrugator supercilii and depressor supercilii muscles, are attached to the periosteum in the glabellar region under the frontalis muscle deep in the medial aspect. The muscles then course laterally and superficially to insert in the skin superior to the eyebrows. Thus, to get a long-lasting and full effect, the exotoxin has been applied deeply in the medial aspect and superficially in the lateral aspect of the glabellar region. It is concluded that botulinum exotoxin is more effective when it is applied in two planes superficially and deep so that the anatomic course of the corrugator supercilii and the depressor supercilii muscles are followed.