ABSTRACT
Skull-base surgery is associated with a high risk of cerebrospinal fluid (CSF) leak, infection, and functional and aesthetic deformity. Appropriate reconstruction of cranial-base defects following surgery helps to prevent these complications. Between March 1998 and May 2000, 28 patients (age: 1-68 years) underwent reconstruction of the anterior and middle cranial fossae. The indications for surgery were tumours, trauma involving the anterior cranial fossa, midline dermoid cysts with intracranial extension, late post-traumatic CSF leak, craniofacial deformity and recurrent frontal mucocoele. We used local anteriorly based pericranial flaps (23 flaps, alone or in combination with other flaps), bipedicled galeal flaps (seven patients) and free flaps (nine patients; radial forearm fascial/fasciocutaneous flaps, rectus abdominis muscle flap and latissimus dorsi muscle flap). Follow-up has been 4-24 months. We had no deaths, no flap failure and no incidence of infection. Complications included two CSF leaks, three intracranial haematomas and one pulsatile enophthalmos. All patients had a very good aesthetic result. We present an algorithm for skull-base reconstruction and comment on the design and vascularity of the bipedicled galeal flap. The monitoring of intracranial flaps and the difficulties of perioperative management of free flaps in neurosurgical patients are also discussed.
Subject(s)
Algorithms , Bacterial Infections/prevention & control , Postoperative Complications/prevention & control , Skull Base/surgery , Subdural Effusion/prevention & control , Surgical Flaps , Adolescent , Adult , Aged , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Middle Aged , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Treatment OutcomeABSTRACT
Arborising telangiectasia is a rare but distinct progressive condition of unknown aetiology. The vessels are subepidermal and measure less than 0.2 mm in diameter. Twenty-three patients with this condition, involving the lower limbs and in extensive cases the upper limbs and trunk, have been treated with the flash lamp pulsed tunable dye laser (SPTL-1b, Candela Laser Corp.). Retrospective review of 17 of these patients, who have finished their treatment (average five sessions of therapy per patient, given at 3-4 monthly intervals), shows complete clearance of the telangiectasia in all cases. The mean follow-up time after the last session of treatment was 7 months. Temporary hyperpigmentation was seen in eight patients. Persistent pigmentary changes (one hyper- and one hypopigmentation) were noted in two patients. No evidence of scarring or change in skin texture was encountered. No progression or recurrence of telangiectasia was noted during the period of follow-up.
Subject(s)
Laser Therapy , Leg Dermatoses/radiotherapy , Skin Diseases, Vascular/radiotherapy , Telangiectasis/radiotherapy , Adolescent , Adult , Female , Follow-Up Studies , Humans , Hyperpigmentation/etiology , Lasers/adverse effects , Leg Dermatoses/pathology , Middle Aged , Radiation Injuries/etiology , Retrospective Studies , Skin Diseases, Vascular/pathology , Telangiectasis/pathologyABSTRACT
The aim of this study was to assess the mobility of the soft palate following sphincter pharyngoplasty in patients with velopharyngeal incompetence of variable aetiology. Pre- and postoperative videotape recordings of lateral view videofluoroscopy of 24 patients were retrospectively studied and compared with regard to the range of velar movement. Tracings of the velopharyngeal port were made on acetate paper directly from the television monitor and absolute angle measurements were taken. Analysis of the results showed a highly significant increase in the range of palatal movement postoperatively. There was no evidence of correlation between the magnitude of the increase and the postoperative improvement in speech. The findings and their implications are discussed.
Subject(s)
Movement , Palate, Soft/physiopathology , Pharynx/surgery , Velopharyngeal Insufficiency/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Fluoroscopy , Humans , Male , Postoperative Period , Retrospective Studies , Speech/physiology , Treatment Outcome , Videotape RecordingABSTRACT
The Bangour Burn Unit was opened in 1968 having been built using existing buildings modified in a relatively inexpensive way. The buildings were unsophisticated because the Unit was designed to be temporary before an eventual move into a new regional plastic surgery unit elsewhere. An analysis of some salient observations over the 22-year period of its lifetime is discussed.
