Correction of tethered upper lip deformity following bilateral cleft lip repair.

BACKGROUND: Shallow upper buccal sulcus, vertical shortness (whistling deformity), and limited mobility of the median part of the upper lip are among the most common secondary deformities following surgical repair of wide bilateral cleft lip. They are often encountered together as a triad of postoperative deformities with a common etiology. To date, there has been no surgical procedure to correct these 3 associated deformities in 1 stage. PURPOSE: In this article, we describe the triad above-mentioned 3 associated postoperative deformities as a single clinical entity, namely the tethered upper lip (TUL) deformity. Moreover, a new procedure for simultaneous correction of these 3 postoperative deformities in 1 stage is presented. MATERIAL AND METHOD: Over 4 years, this new technique was used in 9 patients, 7 males and 2 females, with the TUL deformity following bilateral cleft lip repair. The patients were aged from 1 to 3 years. RESULTS: All patients healed uneventfully. A mean follow-up of 18 months revealed a well-contoured upper lip with a sufficient depth of the upper buccal sulcus, an adequate oral sphincter function, and mobility in all patients. The scars placed on the mucosal surface were almost invisible. CONCLUSIONS: Our technique seems to be useful for 1-stage correction of all 3 components of the TUL deformity including shallow upper buccal sulcus, vertical shortness of the median part of vermilion, and limited upper lip mobility following surgical repair of the bilateral cleft lips.

Polydactyly and hypertension.

A case diagnosed as Bardet-Biedl syndrome with polydactyly and hypertension has been presented here. Bardet-Biedl syndrome is an autosomal recessive disorder, which includes renal dystrophy, dystrophic extremities (often polydactyly), obesity, hypogenitalism, renal disease, and mental retardation. It was first described by John Z. Laurence and Robert Moon. The basic components of the syndrome were established by George Bardet in 1920 and Arthur Biedl in 1922. Although it is still referred to as Laurence-Moon-Bardet-Biedl in some reports, it has recently acquired the name Bardet-Biedl syndrome. Patients were generally lost due to renal insufficiency at young ages.

The "reading man" procedure: a new technique for the closure of circular skin defects.

BACKGROUND: As most of the skin lesions tend to grow in a circular pattern, the resultant defects after surgical removal of these lesions are often circular. Although a number of local flap procedures have been described, alternative techniques are still needed for the closure of circular defects. PURPOSE: Here, a new surgical technique for the closure of circular skin defects is presented. This technique basically uses the extra skin relaxation gained with an unequal Z-plasty maneuver in favor of the defect closure. The procedure is named as "the reading man" because its surgical design resembles the silhouette of a man who is reading a book held in his hand. MATERIAL AND METHODS: In this technique, 2 flaps designed in an unequal Z-plasty manner are used. The first flap is transposed to the defect area whereas the second flap is used for closure of the first flap's donor site. For 3 years, this technique has been used for closure of the circular skin defects in 27 patients (19 men and 8 women) aged from 2 months to 68 years. The defect size was ranging between 1.5 and 14 cm in diameter. RESULTS: A tension-free defect closure was obtained in all patients. All flaps healed with no complications. There was no patient with dog ear formation. A mean follow-up of 15 months (6 months-3 years) revealed an esthetically acceptable scar formation in all patients. CONCLUSION: The reading man procedure was found to be a useful and an easy going technique for the closure of circular skin defects located on various anatomic regions. It enables surgeon to obtain a tension-free closure of considerably large skin defects with minimal scarring and additional healthy skin excision.

Bilateral musculocutaneous unequal-Z procedure: a new technique for reconstruction of total lower-lip defects.

BACKGROUND: Although several techniques have been described for total lower-lip reconstruction, it is still a major reconstructive challenge, which often requires lengthy and risky microsurgical procedures. PURPOSE: Here, we present a new local procedure, namely, bilateral musculocutaneous unequal-Z procedure for functional reconstruction of total lower-lip defects. MATERIAL AND METHODS: In this technique, 2 musculocutaneous flaps including the depressor anguli oris and platysma muscles, respectively, are used in an unequal Z-plasty manner on each side of the defect. The lip defect is closed by the means of extra tissue relaxation provided with bilateral Z-plasty maneuver. The oral sphincter is reconstructed by suturing the depressor anguli oris muscles to each other at the midline. The mucosal coverage is provided with mucosal flaps obtained from the buccal areas bilaterally. Over 2 1/2 years, this new technique was used in 8 patients, aged between 47 and 83 years, with total lower-lip defects resulted from excision of squamous cell carcinomas. RESULTS: All patients healed uneventfully. At 6 months, physical and electromyography (EMG) examinations revealed an intact oral sphincter with a normal sensitivity. One patient died because of lung metastasis at 8 months after surgery. A mean follow-up of 2 years revealed a functionally and cosmetically acceptable lower-lip reconstruction in all surviving patients. CONCLUSIONS: As a nonmicrosurgical local procedure providing an esthetically acceptable, sensitive, and functional lower lip, this new technique seems to be a useful alternative to the microsurgical procedures in total lower-lip reconstruction.

A new surgical technique for the correction of pincer nail deformity.

BACKGROUND: Pincer nail is a rare deformity characterized by transverse overcurvature of the nail that increases distally. Many conservative and surgical treatment modalities have been recommended, but there is not a worldwide accepted technique for long lasting treatment of this deformity yet. PURPOSE: A new surgical technique for the treatment of pincer nail deformity is described. MATERIAL AND METHOD: In this procedure, after the osteophyte located on the dorsal surface of the distal phalanx is removed to provide a flat surface for the nail bed, the distal part of the nail bed is enlarged in a transverse direction by using a modified 5-flap z-plasty technique. Over 2 years, this technique has been performed on 15 toes in 8 patients. RESULTS: In all patients, the deformity was eliminated successfully with no recurrence in 2 years of follow up. The growing nail turned back into its natural form and all clinical signs and symptoms of the pincer nail deformity were relieved. CONCLUSIONS: Widening and flattening the nail bed provide a longlasting effective treatment of the pincer nail deformity with an excellent esthetic result. Pain and episodes of infection is relieved perfectly with this new technique.

A new technique for correction of congenital constriction rings.

BACKGROUND: Congenital constriction ring (CCR) is among the most common congenital anomaly of the extremities. However, few techniques have been described for correction of this anomaly, and none of these techniques could provide a complete elimination of the deformity. Therefore, new surgical techniques are needed for correction of this challenging deformity. PURPOSE: Here, a new technique, namely, Mutaf procedure, for the correction of congenital constriction rings is described. MATERIAL AND METHOD: In this technique, following excision of the fibrotic constriction ring, the groove is filled with the turnover dermofat flaps elevated from both sides of the ring in an alternating pattern. Then skin closure is done with rectangular-plasty technique. Over 8 years, this new technique was used for correction of severe CCRs of the lower extremities in 7 patients aged 1-7 years. RESULTS: In all patients, a normal extremity contour was obtained, with complete elimination of the sandglass deformity caused by the constriction ring. A mean follow-up of 3 years revealed a normal growth of the operated extremity in all patients. The scars were found to be esthetically acceptable. No further surgery was required. CONCLUSIONS: Filling the circular groove caused by the constriction ring with dermofat flaps, this new technique eliminates the soft tissue deficiency and provides a normal extremity contour. Moreover, since rectangular-plasty allows replacing the major limbs of the incisional scars within the relaxed skin tension lines, it provides a better scar in comparison with old Z-plasty techniques.