A case of popliteal pterygium treated along with nerve expansion.

The presence of a short sciatic nerve in the free edge of a popliteal pterygium makes this syndrome a surgical challenge. We present a case of popliteal pterygium that was treated by nerve expansion. The range of motion of the patient's knee joint was between 30 and 120 degrees. A 75-cc tissue expander was placed under the sciatic nerve and filled with 5 cc of saline solution weekly. When a total of 60 cc was reached, wound dehiscence was observed, and the procedure had to be stopped. The maximum extension obtained was 160 degrees. Since the expansion process had to be stopped early, the elongation attained by expansion was less than expected. We conclude that the nerve expansion method can be used as a good alternative treatment modality for patients with popliteal pterygium.

Malignant melanoma in xeroderma pigmentosum patients: report of five cases.

Xeroderma pigmentosum is a rare genetic disease transmitted via a recessive gene with an altered reaction of the epidermis to light. Fifty per cent of patients develop a skin tumour by 8 years of age. The majority of patients may have multiple tumours, but metastasis is rare. In the last 25 years we have treated 24 xeroderma pigmentosum patients in our clinic. Only five patients had developed cutaneous malignant melanoma during their follow-up. Three of the patients were from the same family, melanoma occurring in three of five affected individuals. All xeroderma pigmentosum patients with malignant melanoma had received classical treatment modalities. Except one case of fulminant pattern, all four patients had long disease-free survival. Although early detection and treatment of these cutaneous malignancies will reduce morbidity and mortality, genetic counselling remains the most important protective measure for xeroderma pigmentosum.

A technique for the repair of simple congenital earlobe clefts.

Congenital cleft of the earlobes is rarely seen among congenital ear anomalies. These clefts show a wide range of severity and localization, from simple notching to extensive tissue deficiencies. We developed a new technique that can be used in simple cases of earlobe cleft. For this technique, we use the anterior and posterior parts of the cleft as Y-V advancement flaps and achieve a three-dimensional construction of the lobe that is symmetrical with the opposite lobe.

The effect of cleft lip repair on maxillary morphology in patients with unilateral complete cleft lip and palate.

This study was performed to investigate the isolated effects of cleft lip repair on maxillary morphology in patients with complete unilateral cleft lip and palate. We compared 10 adult patients with unilateral cleft lip and palate who had only lip repair in childhood and no palatal repair (group 1) with 30 adult patients with unilateral cleft lip and palate who had both their lip and palate repaired in childhood (group 2). Both groups of patients also were compared with 24 adult individuals who had normal occlusion and no cleft anomalies. Evaluation of lateral cephalograms showed that both group 1 and group 2 had significant degrees of maxillary retrusion compared with normal individuals. The magnitude of maxillary retrusion was not increased by cleft palate repair, and none of the cephalometric measurements were significantly different between groups 1 and 2.

Upper lip flap for reconstruction of a full-thickness ala nasi defect.

Aesthetic reconstruction of full-thickness ala nasi defects has always been a challenge to the surgeon. Although several techniques are available, none has proved to be ideal. In this paper we describe a flap from the upper lip for reconstruction of defects involving the alar base and full-thickness defects of ala nasi. A flap based on the columella-labial junction is rotated upward for reconstruction of the alar base or ala nasi. The donor site of the flap can be closed primarily. When ala reconstruction is indicated, an upper lip flap forms the inner lining of the nostril, and a skin graft is applied over it for skin coverage. With this flap, an appropriately positioned ala with natural contours may be reconstructed in one stage.

Tissue expansion in median facial cleft reconstruction: a case report.

Median cleft of the face is a rare congenital anomaly. Patients with mild deformities require only limited nasal reconstruction; however, the nasal dorsal soft tissue envelope is usually tight and insufficient, making bone grafting difficult. The tissue-expansion method was used for nasal reconstruction in a patient with a median facial cleft, an expander being improvised from an intubation tube balloon.

Dermatofibrosarcoma with lymph node involvement.

Dermatofibrosarcoma protuberans is a slow-growing, locally aggressive, fibrous tumor that, on rare occasions, metastasizes to distant sites or regional lymph nodes. We have found 28 patients with metastasis in the literature; 9 of these patients had lymph node metastasis. In this report we present a case of dermatofibrosarcoma protuberans of the lower extremity with metastasis to inguinal lymph nodes appearing 10 months after wide excision and skin grafting of the primary lesion. The clinical and pathological features of this case are presented. Although, along with our patient, 10 cases of regional lymph node metastasis are not justification for regional lymph node dissections, they do emphasize the need for regional lymph node examinations in the long-term follow-up of dermatofibrosarcoma protuberans cases.

Expansion of fascial flaps: histopathologic changes and clinical benefits.

In order to meet the requirements of large defects created by sacral and trochanteric pressure ulcers, tensor fasciae latae and lumbosacral fasciocutaneous flaps were expanded with a silicone expander in six patients (10 flaps). In 8 of the flaps the location of pressure ulcers was trochanteric, and in 2 it was sacral. In each case the period of expansion was 4 weeks. Histopathologic examination after expansion showed an increase in the vascularity and overall thickness of fascia in both types of flaps. After 4 weeks of expansion, the perifascial areolar tissue was replaced with thick granulation tissue in the tensor fasciae latae flaps. This markedly vascular layer of granulation tissue interposed between the fasciae and the subcutaneous tissue augmented the internal matrix of the flap, thereby lowering the potential for shearing during flap elevation. Conceivably, owing to the absence of an areolar tissue layer in the lumbosacral fasciocutaneous flaps, no layer of granulation tissue was observed. The average thickness of the fibrous capsule formed around the expanders was 573.2 microns, which was composed of three structurally different zones. Prior tissue expansion obviously assisted primary closure of the flap donor site. In addition, it seems that the tissue-expansion process rendered the distal portion of fascial flaps more robust because of increased vascularity. It is therefore proposed that preparatory tissue expansion of fascial flaps has several advantages. The obvious benefits include the ability to close larger defects while closing the donor site primarily. As a result of this study, the additional benefits may include a reduction in the mechanical shear potential of these flaps and an improvement in their vascularity.