Reconstruction of middle third defects of the face with the temporal flap.

The temporal flap is of great interest in head and neck reconstruction when a skin graft or a local flap cannot be used. It has shown important results on the facial reanimation and in oncological surgery. We describe our experience with the pedicled flap in reconstruction of the middle third face defects in 8 oncologic patients. This flap allows the covering of bone and noble structures such as the periorbital, auricular, frontal, or parotid gland areas. Few major or minor complications were seen and good aesthetic results were achieved. It also can be done with or without adjuvant radiotherapy. The patient prognosis however, depends on the stage of the tumor.

Fournier's gangrene: a review of 43 reconstructive cases.

BACKGROUND: Fournier's gangrene is a rare and potentially fatal infectious disease characterized by necrotic fasciitis of the perineum and abdominal wall, along with the scrotum and penis in men and the vulva in women. Fournier's gangrene is a true surgical emergency. Skin loss can be very incapacitating and difficult to repair. METHODS: The authors reviewed retrospectively the clinical records of a series of 43 patients with Fournier's gangrene between the years 1985 and 2003 who, after initial treatment by the Departments of Urology and Surgery, were referred to the Department of Plastic Surgery for reconstruction. The following parameters were evaluated: age, gender, interval between onset of symptoms and diagnosis, clinical symptoms, lesion site, results of bacteriologic cultures, cause and predisposing factors, treatment and reconstructive procedures, length of hospital stay, and outcome. RESULTS: The mean patient age was 56.6 years. Fifteen patients (34.9 percent) had diabetes mellitus. The cause of Fournier's gangrene was found in 32 patients (74.4 percent). The most common presentation was scrotal swelling, and scrotal involvement was found in 40 cases (93.0 percent). All of the patients underwent surgical debridement, and several reconstruction techniques were used. The mean length of hospital stay was 73.6 days. Two patients died. CONCLUSIONS: Management of this infectious entity should be aggressive. Several techniques that are used to reconstruct the lost tissue have shown good results. The superomedial thigh skin flap has proven to be a reliable method of resurfacing large scrotal defects. Reconstructive surgery makes the return to a normal social life possible in many cases.

Retrospective study of 1251 maxillofacial fractures in children and adolescents.

BACKGROUND: Fractures of the facial skeleton are relatively uncommon in children and adolescents, and only a few reports review a significant number of patients. The authors performed a retrospective study to analyze the different characteristics of such fractures in the pediatric population of Portugal. METHODS: The authors reviewed the clinical records of a series of 912 patients 18 years of age or younger with facial fractures treated by the Departments of Plastic, Reconstructive, and Aesthetic Surgery and of Maxillofacial Surgery, São João Hospital, in Porto, Portugal, between the years 1993 and 2002. The following parameters were evaluated: age; sex; cause of accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. RESULTS: A total of 1251 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (47.8 percent). Motor vehicle accident was the most common cause of injury (53.3 percent of patients). Mandibular fracture was the most common type of fracture (48.8 percent). Associated injuries occurred in 558 patients (64.5 percent). CONCLUSIONS: Pediatric facial fractures are usually associated with severe trauma. The number of fractures caused by automobile accidents has decreased (p < 0.05). The incidence of this type of fracture is high in Portugal.

Parotid surgery: review of 107 tumors (1990-2002).

Tumors of the parotid gland are uncommon. We performed a retrospective study to analyze the clinical, diagnostic, and therapeutic features of a group of patients. We reviewed the clinical and the surgical records of a series of 109 patients who were recommended for surgery because of parotid tumors by the Plastic and Reconstructive Service of São João Hospital, Portugal, between 1990 and 2002. The following parameters were evaluated: age, sex, gland afflicted, symptoms, and duration of symptoms, diagnostic procedures, treatment methods, follow-up, and recurrences. Pleomorphic adenoma was the most common tumor (63.5%). In the majority of cases, fine-needle aspiration cytology was used. Swelling was the most frequent clinical finding. In 68.2%, superficial parotidectomy was performed. There were five cases of permanent facial palsy, and 10 patients developed Frey's syndrome. Recurrent disease was seen in six patients. For the majority of tumors, superficial parotidectomy is an effective treatment with acceptable morbidity.

Cervical impalement injury.

Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.