Binder syndrome: Clinical findings and surgical treatment of 18 patients at the Department of Plastic Surgery in Polanica Zdrój.

BACKGROUND: Binder syndrome (BS) is an uncommon congenital underdevelopment of the maxilla and nasal skeleton. Other clinical features include a hypoplastic or absent anterior nasal spine; a short, flat nose with short columella; an acute nasolabial angle; a convex upper lip and class III malocclusion. OBJECTIVES: The aim of the study was to outline the major characteristics of BS and to present a variety of surgical treatment methods. MATERIAL AND METHODS: The study included 18 patients treated in the authors' department from 1989 to 2013. RESULTS: The patients were predominantly women, aged 6 months to 34 years. Nine patients did not present any co-morbidities, but in the other 9 the most common co-morbidities were a unilateral cleft lip and palate, followed by a cleft palate, a bilateral cleft lip and palate, a cleft lip, GERD, gluten intolerance, oligophrenia, goiter and foot malformation. Most of the patients had not been operated on previously. The most common procedure carried out was an iliac crest bone graft. In 4 patients, no procedures other than cleft lip and palate repair were undertaken. In 3 cases a Le Fort I osteotomy was performed to correct the patients' orthognathic status. No major or life-threating complications were noted. In 2 cases, due to a high degree of resorption of bone grafts, multiple secondary grafting of bone, cartilage and deepithelialized skin was necessary to obtain satisfactory results. CONCLUSIONS: In BS surgical treatment is the treatment of choice. It results in adequate correction of facial retrusion. However, due to various degrees of bone resorption, the results are not lifelong. No unequivocally superior surgical strategy in BS has been presented so far. Most disagreement among authors is related to the need for and timing of maxillary osteotomy, the choice between bone and cartilage grafting in nose reconstruction and columella lengthening. Although alloplastic materials offer the tempting advantage of fast and simultaneous augmentation of deficient tissues, their use may risk prolonged infections and extrusion, resulting in exacerbations of deformities.

Surgical management of ichtyosis-related ectropion. Description of four cases and a literature review.

Ichtyosis is an heterogeneous group of diseases characterized by formation of hyperkeratotic, squamous, tile-like scales virtually on the whole body. Depending on the severity and localization of the symptoms, the disease may lead to serious complications including ectropion of the eyelids, which may further lead to ocular disorders, including blindness. The aim of the work was to outline major characteristics of the entity and to focus on surgical methods of ichtyosis-related eyelid ectropion management. Four cases of ichtyosis-related eyelid ectropion, which occurred in patients presenting severe symptoms of the disease treated surgically in the clinic between 2003-2011, were described. In all patients the eyelid contractures were successfully released and relief of conjunctival inflammation was obtained. No postoperative complications occurred. In two patients, a secondary operation was necessary due to skin graft contracture and ectropion recurrence. In some cases, ichtyosis may lead to serious ocular complications. Surgical management of eyelid ectropion is challenging due to the shortage of available lesion-free skin for grafting and due to possible skin graft contracture leading to recurrence.

Anatomical variability of the anterolateral thigh flap perforators between sexes: a cadaveric study.

BACKGROUND: Anterolateral thigh flap (ALTF) has gain popularity as a workhorse flap in the management of simple as well as complex tissue defects. The purpose of this study was to investigate the differences in ALTF's perforators' location in male and female human cadavers. METHODS: The study involved 30 fresh human cadavers of both sexes. A total of 60 flaps were examined. The flaps were raised as originally designed. After location of vessels, the distance from the anterior superior iliac spine (ASIS) to subsequent perforators was measured. Also, the kind of the perforator, its diameter and origin were marked. Perforators were designated according to Yu's classification (A, B, and C). The perforators were divided into thin (<0.5 mm), medium (0.5-1 mm), and thick (>1 mm). Ratio of the ASIS-patella distance to the distance of a given perforator from the ASIS (AP rate) was calculated. RESULTS: The mean AP rate (perforator location) was different in both sexes. Mean AP rate in men was calculated as 0.498 ± 0.117, and in women, 0.559 ± 0.114. Differences in AP rate between female and male were statistically significant (t = -3.144; p < 0.002). Mean flap thickness was 3.65 cm in women and 1.17 cm in men (t = -14.444; p < 0.00001). In men, 63 perforators originated from descending branch, and seven perforators originated from oblique branch. In women, there were 67 and one, respectively. CONCLUSIONS: In men, perforators are located closer to the ASIS in comparison to women. Clinically significant perforators (Φ > 0.5 mm), in majority of cases, occur in A and B positions. Thickness of the flap was higher in women. The oblique branch was more common in men.

Surgical treatment of patients with Parry-Romberg syndrome.

INTRODUCTION: Parry-Romberg syndrome is an extremely rare disease characterized by the slow atrophy of the face involving the skin, subcutaneous tissue, fatty tissue, muscles, and even bones. The cause of the disease is unknown. The onset is slow and it begins usually during the first 2 decades of life, more often between the ages of 5 and 15. The purpose of the study was to present the principles of management and treatment outcomes in patients with Parry-Romberg syndrome. MATERIAL AND METHOD: A total of 14 patients (12 females and 2 males) aged between 14 and 36 years (mean, 21.5 years), were treated at the Hospital of Plastic Surgery in Polanica Zdrój between 1970 and 2005. Hemifacial atrophy affected the left side in 7 patients, and the right side in the remaining 7. Altogether 45 operations were performed. Less severe changes were reconstructed by means of dermal grafts, galeal flaps; patients with more severe facial deformities were treated with free tissue transfer: parascapular and latissimus dorsi flaps (6 cases). The treatment was completed with facial modeling, dermal regrafting, and scars correction. RESULTS: The appearance was improved in all the patients. There was only 1 free flap loss reported during postoperative management. CONCLUSIONS: Dermal grafts are used in the treatment of milder forms of Romberg disease to improve facial symmetry. In severe cases of facial atrophy, the surgical management is based on free-tissue transfer.

Surgical treatment of eyelid tumors.

UNLABELLED: Eyelid tumors constitute about 40% of all cancers located in the orbital region. Most commonly, they are basal cell carcinomas, in 90% of cases located in the lower eyelid and medial canthus. The purpose of our study was to present the management and to overview the results of surgical treatment of eyelid tumors. MATERIALS AND METHODS: One hundred ninety-three patients, 89 men and 104 women, aged 16 to 87 years (mean, 63.5 years) with eyelid tumors were treated in Plastic Surgery Hospital in Polanica-Zdrój in the years 1985 to 2008. The patients were divided into 2 groups: group 1 (n = 148) was composed of patients operated on primarily in our hospital, and group 2 (n = 45) was composed of patients operated on in other hospitals, admitted for recurrence. All the patients underwent surgery involving resection of the tumor and simultaneous eyelid reconstruction. The preparations were evaluated histopathologically. Various surgical modalities were used, depending on the extent and location of the tumor. RESULTS: Recurrence developed in 13 patients in group 1 (8.7%; 5 women and 8 men) and in 9 patients in group 2 (20%; 5 women and 4 men). CONCLUSIONS: Tumors, usually basal cell carcinoma, originate mainly in the lower eyelid and medial canthus. Surgery should be performed as soon as possible after onset of the primary tumors and should include resection and reconstructive therapy. The highest risk of recurrence is in case of squamous cell and basospinocellular tumors, and especially in melanoma. The aim of reconstructive therapy is to reconstruct aesthetically and functionally effective eyelid.

[Active and passive exposure to tobacco smoke of pregnant women: two-center study]. / Czynne i bierne narazenie kobiet ciezarnych na dym tytoniowy--badanie dwuosrodkowe.

According to the current data over 12 million Polish citizens smoke tobacco, 40% of them are women. Maternal smoking in pregnancy significantly increases the rate of having a low-birthweight baby, the rate of perinatal mortality and several other adverse pregnancy outcomes. The aim of the study was to estimate the rate of smoking women during pregnancy and those who are exposed to secondhand smoke. 219 women hospitalized at Gynecology and Obstetrics Department of Wroclaw Medical University and Gynecology and Obstetrics Department in Opole have undergone the examination. The pregnant women have been interviewed and the results of questionnaire have been checked by the exhaled carbon monoxide (ExhCO) measurement. CO expresses the percentage of carboxyhemoglobin (HbCO) and is used for objective monitoring tobacco smoking. The results of the study suggest that regular exposure to secondhand smoke becomes a serious problem. 25.5% patients from Wroclaw and 16.4% patients from Opole have declared passive smoking. The mean value of ExhCO in this group of women obtained the level of 3.3 ppm vs 1.95 ppm in the group of patients who have denied both active and passive exposure.