Deviated Nose: A Systematic Approach for Correction.

Attaining a straight dorsum in patients with deviated nose is a main task in rhinoplasty. The basis of this difficulty is the presence of multiple anatomical abnormalities; hence, many methods are used to correct such a deformity. In this study, a sequential comprehensive surgical approach is proposed for the correction of deviated nose. METHODS: Seventy-six patients who presented with developmental or posttraumatic external nasal deviation were enrolled in this study. All patients were subjected to open septorhinoplasty using a systematic approach. The outcome was assessed throughout for patient satisfaction. RESULTS: The postoperative course was uneventful. Minor complications were encountered as transient hypoesthesia in the nasal tip in 4 patients and as prolonged tip edema in 10 patients. Residual significant nasal deviation was observed in 3 patients, and only 1 of them necessitated revision. All patients reported improvement of their nasal airway, and the percentages of their aesthetic satisfaction were as follows: very satisfied (n = 57, 75%), satisfied (n = 18, 23.7%), and unsatisfied (n = 1, 1.3%). CONCLUSIONS: A simple and comprehensive approach for correction of deviated nose is presented, which resulted in a better long-term cosmetic and functional outcome. This approach could correct the deviations in various anatomic locations, and helps the surgeon to deal with nasal deviation in an effective and straightforward manner wherever the pathology of deviation.

Extended Use of Full-Thickness Skin Grafts, Employing Variable Donor Sites.

BACKGROUND: Full-thickness skin graft (FTSG) is a very versatile tool regularly used in small sizes. With the established knowledge of the graft take through the margins as well as wound bed, we extended the use of the FTSG for reconstruction of large-sized defects with satisfactory results. METHODS: We presented our experience in wound reconstruction using FTSG in 28 patients. We selected cases with graft size equal to or more than 130 cm2. Seven patients had chronic but healthy granulating wounds and 21 patients had fresh raw areas. Sizes of FTSG used varied between 130 to 452 cm2 of outstretched skin at donor sites. We used subgluteal skin crease in most of cases, though groin, upper medial thigh and medial arm aspects were also used. RESULTS: There was no difference in graft take between fresh and chronic wound sites. Almost complete graft take was the rule in all cases apart from mild epidermal skin peeling in four cases and small spots of graft necrosis in three cases. Primary wound healing at donor sites was the rule with scar hypertrophy in six cases necessitating scar conservative care for few months. CONCLUSION: Use of FTSG for reconstructing raw areas in acute and chronic wounds has to be safely reconsidered regardless of wound size. It's still a sound and reliable tool which can decrease the necessity of complex flap coverage. Subgluteal skin crease is relatively a new donor site to be considered for large grafts with primary direct closure.

Immediate single-stage reconstruction of complex frontofaciobasal injuries: Part II.

OBJECTIVES: The purpose of this prospective study was to identify selection criteria for immediate single-stage reconstruction in patients with severe complex craniofacial trauma to improve their functional outcome and reduce complications. PATIENTS AND METHODS: In this series, 24 new patients (16 men and 8 women) were added to our previous group (26 patients) with an age range from 10 to 55 years with mean of 26 years and Glasgow Coma Scale scores of 5-13; all patients had a combined single-stage repair of their complex craniofacial injuries within 6 h of their admission. We added some modifications to our standard technique using three-dimensional computed tomography, intracranial pressure monitoring, and support of dural repair/graft using dural patch and glue. The esthetic facial outcome was evaluated by an independent plastic assessor based on objective scale criteria. This series was carried out in Prince Salman Military Hospital between November 2010 and September 2013. RESULTS: Early neurosurgical outcome was considered good in 22/24 patients (92%), moderate in one patient (4%), and poor in the last one (4%). At late evaluation, 20 cases (83%) regained their consciousness without any cognitive deficit. One patient (4%) remained in neurovegetative status. Early esthetic outcome was considered to be excellent in 18/24 patients (75%), good in 3 patients (12.5%), deemed fair in 2 patients (8%), and labeled poor in only 1 patient (4%). At late evaluation, the patient labeled fair had improved to good with topical scar management and the patient deemed poor had improved to fair with two successive plastic procedures. Complications included a cerebrospinal fluid leak in 2 patients (8%), one was managed conservatively and the second was treated surgically with intra- and extradural grafting. CONCLUSION: In complex frontofaciobasal injuries, successful facial repair depends on immediate and definitive reconstruction. However, improved neurological outcomes in these patients depend on judicious selection of the appropriate candidates from severely head-injured patients.

Detection of microalbuminuria: a simple test for prognosis in severe burns.

PURPOSE: To evaluate the effectiveness of microalbuminuria monitoring in the management of patients with severe burns. METHODS: Consecutive patients admitted to the burn unit with total body surface area burn between 20% and 50% were examined for microalbuminuria during the hospitalisation. The findings were correlated to different clinical variables usually encountered in this patient category. RESULTS: Microalbuminuria was found in patients with inhalation injuries (100%), systemic inflammatory response syndrome (SIRS, 88.4%), burn sepsis (95.1%) and postoperatively (94.9%). CONCLUSION: Microalbuminuria is the only simple, non-invasive, bedside, immediate and cost-effective test to indicate for occurrence of SIRS, if the other variables were stabilised. It can be measured with every urine void or more often when a urinary catheter is inserted. This will affect our management of patients with severe burns.