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.

[Lasers in plastic surgery--vascular lasers]. / Zastosowanie laserów w chirurgii plastycznej--lasery naczyniowe.

Laser treatment of the cutaneous vascular lesions gained approbation and well-established position among plastic surgery techniques. Rapidly evolving laser market delivers us modem and safer devices. In the paper we discuss the most common vascular lesions and available lasers used to treat them. Described indications and safety rules might be useful for many specialists for their patient therapy choice.

[Own clinical experience in treatment of port-wine stain with KTP 532 nm laser]. / Wlasne doswiadczenia w leczeniu pacjentów z malformacjami naczyniowymi typu port-wine stain przy uzyciu lasera KTP 532 nm.

UNLABELLED: Lesions of port-wine stain (PWS) type are the most commonly occurring vascular malformations of the skin which concerns about 0.3% of the population. These important from aesthetic and psychological points of view capillaries malformations have always been difficult for treatment. Previously applied methods consisting in cryosurgery, dermabrasion, radiation therapy or surgery and skin grafting produced unsatisfactory results. It was only when highly selective lasers were introduced that PWS could be treated effectively and safely. A lot of available lasers and lack of experience of the health care providers result in not always proper qualification of the lesions to the given laser type. The aim of the study was to present a prospective analysis of the efficacy of treatment of PWS vascular malformations by means of KTP 532 nm laser. From January 2003 to May 2005, 155 patients (115 women, 40 men) aged from 2 to 62 years (mean age 18.23) were treated by means of laser at the Plastic Surgery Hospital in Polanica Zdrój, Poland. In the investigated population, the vascular malformation was a component of Sturge-Weber syndrome in 7 patients, Klippel-Trenaunay syndrome--in 2 patients, while in one case it accompanied Recklinghausen disease. The vascular lesions had not been treated before in majority of cases, while in 37 patients the laser therapy was the continuation of other previously attempted treatment, which included excision and skin grafting, argon laser therapy, radiation therapy and pulsed dye laser treatment. The procedures were performed with at least 4-week intervals without, or under local and in children general anaesthesia. Therapeutic efficacy was evaluated independently by 3 surgeons and a photographer on the basis of Subjective Scoring System (SSS) comparing simultaneously shown pictures of the patients taken prior to and after the last procedure. The outcomes of treatment were classified according to a 4-degree scale: excellent outcome--75-100% improvement, with 100% perceived as eradication of the lesion; good--50-74% improvement; fair--25-49% improvement and poor--less than 25% improvement, including no observable improvement. In 81% of the lesions (126 patients) treatment with KTP 532 nm laser produced significant improvement which was found satisfactory by the patient. excellent outcome of treatment was obtained in 49 patients (31%), good in 42 (27%), fair in 35 (23%). However, despite many laser treatments using various energy and pulse duration, there was almost not observable improvement in 19% of the study population (29 patients). The PWS which failed to treatment were most commonly located on the limbs. The results of treatment was poor in 74% of malformations which were located beyond the face and neck (all of them were on the limbs). There was no episodes of scarring or persistent pigmentary changes in any of the patients. CONCLUSIONS: 1. KTP (532 nm) laser is an effective and safe tool in the management of capillary malformations of PWS type. 2. The treatment is especially effective in adults and in lesions localized to the face and neck area. 3. Port-wine stain localized on the trunk and extremities often appears to be KTP laser resistant.