Salvage of cartilage framework exposure in microtia reconstruction using a mastoid fascial flap.

One of the common complications of microtia reconstruction with cartilage grafting is exposure of the framework. Recently, we used a mastoid fascial flap for salvage operations in two microtia patients, who had partial skin necrosis with resultant exposure of the cartilage framework. Following the excision of the necrotic skin, the anteriorly based mastoid fascial flap was elevated and transferred as a hinge flap on to the portion of the exposed framework. Split-thickness skin grafts were applied over the mastoid fascial flap. Each skin graft took well and the relief of the reconstructed ear was preserved in both cases. This salvage method has a large advantage of not leaving any visible scars on the temporal region and the reliability of its rich blood supply.

Modification of thoracoscopy in pectus excavatum: insertion of both thoracoscope and introducer through a single incision to maximise visualisation.

Our modification of the Nuss procedure includes insertion of both the introducer and the thoracoscope through the same skin incision, which enables continuous visualisation of the tip of the introducer during blunt dissection across the mediastinum. From January 2001 to January 2005 we studied 32 consecutive patients whose ages ranged from 3 to 30 years. They had all undergone the modified procedure. The mean operating time was 1 hour 44 minutes (range 43 minutes-4 hours 20 minutes). Blood loss was less than 10 ml. There were no intraoperative bleed complications. The modification that we devised may minimise the risk of cardiothoracic and vascular injuries and the procedure is safe.

New grading system for patients with treacher Collins syndrome.

Treacher Collins syndrome (TCS) is a congenital, craniofacial disorder affecting the development of structures derived from the first and second branchial arches. The associated clinical features and their severity are variable. Therefore, we reasoned that objective assessment of the clinical features and their severity in TCS is necessary to plan the treatment and to evaluate the outcome. We hereby propose a new grading system for Treacher Collins syndrome (TCS). Since 1978, 16 patients have been diagnosed with TCS. Eleven out of the 16 TCS patients, for whom we were able to estimate the severity of the clinical features in each region, and to make an objective assessment of the therapeutic outcomes, were selected. By allocating points according to the degree of severity of the clinical features in each region, then summing them up and categorizing them, we classified the overall clinical features into 3 grades. The severity increases from grades I to III. In summary, there were 3 patients of grade I, 4 patients of grade II and 4 patients of grade III. Distinctive differences regarding the degree of severity of the clinical features were clearly observed between each grade. We propose a new TCS grading system and applied it to 11 patients. We believe that this system may be useful for planning treatment and to evaluate the outcome in TCS patients.