Rhinoplasty: the nasal bones - anatomy and analysis.

BACKGROUND: The analysis of nasal anatomy, and especially the nasal bones including the osseocartilaginous vault, is significant for functional and aesthetic reasons. OBJECTIVES: The objective was to understand the anatomy of the nasal bones by establishing new descriptions, terms, and definitions because the existing parameters were insufficient. Adequate terminology was employed to harmonize the anthropometric and clinical measurements. METHODS: A two-part harvest technique consisting of resecting the specimen and then creating a replica of the skull was performed on 44 cadavers to obtain specific measurements. RESULTS: The nasal bones have an irregular, variable shape, and three distinct angles can be found along the dorsal profile line beginning with the nasion angle (NA), the dorsal profile angulation (DPA) and the kyphion angulation (KA). In 12% of cases, the caudal portion of the nasal bones was straight and without angulation resulting in a "V-shape" configuration. In 88% of cases, the caudal portion of the bone was angulated, which resulted in an "S-shape" nasal bone configuration. The intervening cephalic bone, nasion to sellion (N-S), represents the radix while the caudal bone, sellion to r (S-R), represents the bony dorsum. CONCLUSIONS: By standardizing and measuring existing nasal landmarks and understanding the different anatomic configurations of the nasal bones, rhinoplasty surgeons can better plan their operations within the radix and bony and osseocartilaginous vaults.

Unusual localisation of pressure ulcer--the vulva.

Only a few papers have been published about unusual localisations of pressure ulcer. To date, no papers were published presenting pressure ulcer on external genitals in women. The paper presents the mechanism of origin of vulval pressure ulcer, surgical treatment (excision of lesion tissue of the pressure ulcer) and reconstruction of the vulva. The patient, aged 50, has been paraplegic for 20 years. During the last 3 years she has had a wound which was spreading in the region of the vulva. The pressure ulcer was surgically removed, external female genitals were reconstructed using advancement skin flap and the function and natural appearance of organs were re-established. The presence of all three aetiological factors for the formation of pressure ulcer - presence of prolonged pressure, swelling and infection - were proven in the described patient. For this reason, we are able to claim that this was in fact a pressure ulcer of the vulva. Reconstruction was simple without any complications and donor-site morbidity.

The use of polarized light in aesthetic surgery.

This article presents a clinical investigation of polarized light therapy after aesthetic surgery procedures. The study included patients who the authors underwent face-lifts, blepharoplasties, and various facial ancillary procedures, at center during the past 2 1/2 years. One side of the surgically treated area was managed with polarized light, whereas the other side served as a control. The results were compared using clinical examination only including signs of recovery such as resolution of swelling and bruises. The results in most cases showed a significant difference between the treated and untreated sides.

The use of pedicled tram flap for delayed breast reconstruction.

The pedicled TRAM flap based on superior epigastric artery is very safe and reliable flap which provides sufficient autologous tissue for natural breast reconstruction. Depending on quantity of abdominal tissue used for the reconstruction, the breast can be sufficiently large and ptotic to achieve symmetry in a single operative procedure. The importance of appropriate patient selection should never be underestimated, especially in risky patients like heavy smokers, those with previous vascular diseases or heavy scarring of the abdominal wall, where delayed procedure is strongly indicated. Adequate patient selection, preoperative management, monitoring of the flap and routine postoperative care with oxygenation, together with the selection of proven surgical technique is the key for the safety of the procedure and reduced patient morbidity.