Designing a Trifoliate Flap for Isolated Congenital Alar Rim Defect in Pediatric Patients

2021 ◽  
pp. 229255032110196
Author(s):  
Shi-Yan Li ◽  
Bao-Fu Yu ◽  
Shu-Yi Wei ◽  
Ning Yin ◽  
Zong-Jiang Yao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Standard Technique ◽  
Aesthetic Outcome ◽  
Flap Surgery ◽  
Rotation Flap ◽  
Alar Retraction ◽  
Surgical Suture ◽  
The Aesthetic ◽  
Alar Rim

Isolated congenital alar rim defects are extremely rare, and there has been no standard technique for the reconstruction of remarkable aesthetic deformity. Herein, we introduce a trifoliate flap for the correction of isolated congenital alar rim defects in pediatric patients. Fifteen cases undergoing nasal alar sulcus rotation flap surgery were analyzed retrospectively. This rotation flap including 3 triangles was a modified flap based on prior studies. Clinical medical notes and photographs were reviewed. Patients’ (or their parents) reported satisfactions with aesthetic outcome were also evaluated during the post-operative follow-up period. In all patients, the isolated congenital alar rim defects were successfully reconstructed. The rotation flap survived and the wound healed primarily. The follow-up period ranged from 6 to 22 months (average 11 months). There were no incidents of flap loss, step-off deformities, nasal obstruction, or alar retraction. At follow-up of post-operative 3 months, pale red scars were observed in the operative area in few patients (2/15). However, these scars gradually became invisible at post-operative 6 months. All patients (or their parents) were satisfied with the aesthetic outcome of this operation. This newly designed trifoliate flap can be an alternative method for the reconstruction of isolated congenital alar rim defects in pediatric patients. The scars of this procedure can be unobvious with fine surgical suture.

scholarly journals 57 The Use of a Hemi Glabella Flap for Reconstruction of Medial Canthus Defects

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Tan ◽  
J Agilinko ◽  
A Khalil
Keyword(s):  
Donor Site ◽  
Advancement Flap ◽  
Senior Author ◽  
Lateral Nasal Wall ◽  
Oral Antibiotics ◽  
Aesthetic Outcome ◽  
Medial Canthus ◽  
Complex Anatomy ◽  
The Aesthetic

Abstract Background Medial canthal reconstruction is a challenging task due to the complex anatomy. The glabellar flap is a common viable technique; however, this results in narrowing of the eyebrows, bulky nasal dorsum and horizontal scarring which is aesthetically displeasing. The senior author in this paper has developed an intuitive modification to the technique. Method A rotational advancement flap involving the upper lateral nasal wall with the hemi glabella was formed and transferred to the medial canthal defect. The donor site was closed in a V-Y manner. Complete closure of defect was achieved in all patients. Results Reconstruction using the Hemi-Glabellar technique was performed on 12 patients following resection of BCC in or near the medial canthus area. Superficial cellulitis was noted in 2 patients, they were managed oral antibiotics. There was bruising in 7 patient which resolve spontaneously in 4-7 days. All patients had a good outcome at 2 months and 6 months follow up. There was no flap loss and all patients were satisfied with the aesthetic outcome. Conclusions The technique highlighted can be performed easily and is applicable to reconstruction to defects of the medial canthus with excellent aesthetic outcomes with an inconspicuous scar and supple skin with matching colour

Closed Flap Osseous Crown Lengthening Procedure

2020 ◽  
Author(s):  
Aditi Chaudhary
Keyword(s):  
Postoperative Complications ◽  
Healing Process ◽  
Aesthetic Outcome ◽  
Flap Surgery ◽  
Erbium Laser ◽  
Tooth Structure ◽  
Present Technique ◽  
The Aesthetic ◽  
Biologic Width ◽  
Crown Lengthening

Osseous crown-lengthening is often needed to enhance the appearance of a patient’s smile, prevent the violation of biologic width, and/or provide sufficient tooth structure for the placement of final restorations. The present technique for osseous crown lengthening typically involves flap surgery, a procedure that frequently is associated with postoperative complications that can interfere with the aesthetic outcome, such as infection, bleeding, and change in tissue position during the healing process. The erbium laser enables the clinician to offer the patient a minimally invasive alternative to osseous crown lengthening negating the adverse effects associated with conventional treatment. Other advantages of using the laser for osseous crown lengthening includes: hemostasis, improved visualization, fewer postoperative complications and recession.

scholarly journals Multi-stages Aesthetic Refinement Following Anterolateral Thigh Free Flap for Head and Neck Reconstruction

2020 ◽  
Vol 7 (1) ◽  
pp. 38-42
Author(s):  
Parintosa Atmodiwirjo ◽  
Mohamad Rachadian Ramadan ◽  
Sara Ester Triatmoko ◽  
Maryam Nur Arina
Keyword(s):  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Aesthetic Outcome ◽  
Neck Reconstruction ◽  
Anterolateral Thigh ◽  
History Of ◽  
The Aesthetic ◽  
Fibrous Tumor ◽  
Challenging Situation

Introduction: Multi-stages refinement of a bulky flap after composite defects reconstruction of multiple facial units has been a challenging situation. Goals including restoration of periorbital and malar area and redefining the aesthetic aspects of the units as well as the surrounding nasolabial area with multiple refinements and microfat graft. Methods: A 50-year-old male patient with a history of solitary fibrous tumor underwent wide excision of left periorbital, infraorbital, lateral nasal sidewall, and malar area. The defect is enclosed with Anterolateral Thigh Free Flap (ALT). Bulkiness of the flap, sunken left nasolabial, and asymmetric alar nasal unit were found during outpatient follow-up. These problems lead to the necessity of refinement procedure to reduce the bulkiness to improve the aesthetic outcome of the patient. Microfat graft was the method chosen to volumized the sunken nasolabial and asymmetric alar nasal unit. Results: Patient is satisfied with the result due to improvement of alar nasal units symmetricity and reduced bulkiness of the flap area. No complication was observed. Conclusion: Meticulous planning and staging of the surgical refinement procedures in conjunction with microfat graft results in good aesthetic outcome and satisfies the patient and reduces the possibility of complications.

Do standard surgical techniques lead to satisfying aesthetic results in nonsyndromic sagittal suture synostosis?

2021 ◽  
pp. 1-6
Author(s):  
Matthias Millesi ◽  
Markus Preischer ◽  
Andrea Reinprecht
Keyword(s):  
Surgical Outcome ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Surgical Correction ◽  
Sagittal Suture ◽  
Aesthetic Outcome ◽  
Head Shape ◽  
The Aesthetic ◽  
Normal Head

OBJECTIVE Surgical correction of synostotic cranial sutures is typically performed early in an affected child’s life. Depending on the severity of the cranial synostoses, different aspects of the surgical treatment may have varying degrees of importance. In this sense, the aesthetic appearance in children with normal neurological development in single-suture synostosis plays an important role in self-perception and social acceptance for both the patients themselves and their caregivers. Therefore, in this study, the authors aimed to evaluate the aesthetic outcome after surgical correction in a cohort of patients with nonsyndromic sagittal suture synostosis. METHODS Between December 2002 and December 2019, a total of 99 patients underwent surgical correction of a synostotic sagittal suture at the Medical University of Vienna. Depending on their age, patients underwent either an extended midline strip craniectomy (EMSC) (< 4 months) or a modified pi procedure (MPP) (≥ 4 months). After the surgical procedure, the outcome was evaluated by the treating neurosurgeon at 1- and 12-month follow-up visits, and after approximately 5 years, before the patient entered elementary school. In addition to that, the patients’ caregivers were asked to evaluate the aesthetic outcome of the surgical procedure after 12 months. These results were then compared to evaluate potential differences in the perception of the surgical outcome. RESULTS After 12 months, the majority of the included patients were evaluated as having a good aesthetic outcome by the treating neurosurgeon (97%) and by their caregivers (89%). These differences did not show statistical significance (p = 0.11). Similarly, no differences in the aesthetic outcome depending on the surgical procedure performed could be found (p = 0.55). At the last follow-up visit, before entering elementary school, all available patients had an excellent or good surgical outcome. Moreover, the majority of caregivers (73%) reported that their child had a normal head shape appearance after surgical correction. CONCLUSIONS The results of this study have suggested that surgical correction of sagittal suture synostosis by simple operative techniques leads to a good aesthetic outcome and a normal head shape appearance in the majority of patients. An analysis of the evaluation of the surgical outcome by either the treating neurosurgeon or the patient caregivers showed comparable results and, thus, early intervention with simple surgical techniques can be recommended.

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

2021 ◽  
Vol 53 (04) ◽  
pp. 349-355
Author(s):  
Jin Li ◽  
Hewei Xiong ◽  
Gongchi Li ◽  
Pan Zhou ◽  
Fangxin Ai ◽  
...  
Keyword(s):  
Success Rate ◽  
Free Flap ◽  
Pediatric Patients ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Functional Improvement ◽  
Flap Surgery ◽  
Global Functioning ◽  
Free Flap Surgery

Abstract Background Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients. Methods From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI). Results A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100). Conclusion The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

Follow-up of pediatric patients evaluated for liver transplantation

1997 ◽  
Vol 73 (2) ◽  
pp. 75-79
Author(s):  
Sandra Maria Gonçalves Vieira ◽  
Carlos Kieling ◽  
Elza D. Mello ◽  
Carmen M. Santos ◽  
Carla Silveira ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Pediatric Patients

TRATAMENTO CIRÚRGICO DE CANINO INCLUSO EM REGIÃO MENTUAL: RELATO DE CASO

2019 ◽  
Author(s):  
Rodrigo Figueiredo de Brito Resende
Keyword(s):  
Surgical Treatment ◽  
Key Words ◽  
Oral Surgery ◽  
Tooth Eruption ◽  
Points Of View ◽  
The Aesthetic ◽  
Relationship Of ◽  
Transverse Position

RESUMOO dente denominado incluso nada mais é que um dente retido ou impactado dentro do alvéolo dentário de maneira parcial ou completa que não conseguiu erupcionar por motivos patológicos ou simplesmente anatômicos após o período de rizogênese. O canino, em especial, é de suma importância sob os pontos de vista estético e funcional. O deslocamento do canino incluso ultrapassando, ou se aproximando da linha média antes da erupção dentária do mesmo, é mais frequente na mandíbula do que na maxila.  Este trabalho tem por objetivo descrever o caso de um paciente de 21 anos que apresentava um canino incluso na região mentual, em posição transversal, inicialmente visualizado em uma radiografia periapical e posteriormente submetido a radiografia com a técnica de Donavan. Através de uma radiografia oclusal, foi possível observar o posicionamento do dente para a vestibular mentoniana e íntima relação do dente retido com as raízes dos incisivos centrais decíduos do paciente. Foi realizada a extração do dente retido no mento, removendo o mesmo por completo sendo feitas osteotomias e odontossecções. O paciente está em acompanhamento clínico à 1 ano após o tratamento cirúrgico.Palavras – chave: Dente incluso; Cirurgia Oral; Imaginologia. ABSTRACTThe tooth inserted  is nothing more than a tooth retained or impacted within the dental socket partially or completely that failed to erupt for pathological or simply anatomical reasons after the period of rhizogenesis. The canine, in particular, is of the utmost importance from the aesthetic and functional points of view. The displacement of the canine, even surpassing or approaching the midline before tooth eruption, is more frequent in the mandible than in the maxilla. This work aims to describe the case of a 21 - year - old patient who had a canine included in the mental region, in a transverse position, which was initially visualized on a periapical radiograph and later submitted to radiography with the Donavan technique. An occlusal radiograph showed the positioning of the tooth for the mental vestibular and the intima relationship of the retained tooth with the roots of the patient's central deciduous incisors. Removal of the tooth retained in the denture was performed, removing the tooth completely and osteotomies and odontosections were performed. The patient is in clinical follow-up at 1 year after the surgical treatment. key words: Tooth included; Oral surgery; Imaginology.  

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