Use of linked mucosal flap for lower lip reconstruction after human bite injury.

AIM: An alternative method of reconstruction of a lower lip defect is presented, using a mucosal flap taken from the upper lip. This approach leaves the skin intact and therefore avoids skin scarring, with its associated unpredictable healing. The upper lip mucosal flap applied to reconstruct the lower lip injury was identical to the injured tissue type. RESULT: The results were functionally and aesthetically excellent (as illustrated). CONCLUSION: This technique represents an excellent alternative to reconstruction of a damaged lip, with the benefits of minimal scar tissue formation and excellent aesthetic result.

Ultrasound-guided percutaneous dilatational tracheostomy: a safe method to avoid cranial misplacement of the tracheostomy tube.

The aim of this investigation was to evaluate the role of ultrasonography in avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died were removed en bloc at autopsy. The tracheas were opened along the membranous portion and the condition of tracheal rings and the site of tracheostomy macroscopically evaluated. The patients were divided in two groups: group A with 15 patients who underwent "blind" PDT and group B with 11 patients who underwent ultrasound-guided PDT. In five (33%) patients from group A, autopsy revealed that the tracheostomy tube was placed between the cricoid cartilage and the first tracheal ring (cranial misplacement) and in six (43%) patients a fracture of one tracheal ring was found. Cranial misplacement of the tracheostomy tube in patients from group B was not found (P < 0.05) and four (36%) patients had a broken tracheal ring (P = NS). The authors maintain that by using ultrasound-guided PDT cranial misplacement of the tracheostomy tube may be entirely avoided.

[Personal experience in the treatment of war injuries of the jaw and face at the Clinical Hospital Center in Rijeka]. / Nasa iskustva u lijecenju ratnih ozljeda celjusti i lica u klinickom bolnickom centru Rijeka.

In this paper we have presented 38 cases of wounded persons who had sustained war injuries in maxillo-facial and neck region. All of them were injured in Croatia during the war period of 1991 and 1992, and treated at the Maxillo-Facial Surgery Department of the Clinical Hospital of Rijeka. The wounded persons were observed and monitored from the moment of their injury through the first aid on the spot, up to the surgical treatment of the wounds, subsequent primary and secondary reconstruction, and the final medical treatment. This paper describes for wounded persons with injuries of bones and soft tissue of the face. In two thirds of the wounded persons with the primary medical treatment and reconstruction, the cure terminated, while in one third it was necessary to provide for a secondary reconstructive operation. At the end of the treatment, all the wounded persons were successfully cured, functionally and aesthetically restored, so they were able to leave the Clinic to return to their everyday life and work. Such result has been particularly gratifying because they were mostly young men.