RESULTS OF SURGICAL TREATMENT OF A CHILD WITH SEVERE DEFECT IN SCALP SOFT TISSUES USING TISSUE EXPANDER

Deep wounds of the scalp of various origins (mechanical trauma, animal bites, burns) are quite common in pediatric practice. Defects of soft tissues, the bottom of which has open bones, are a particular difficulty. This clinical observation describes a method of surgical treatment of a deep wound of the scalp using the tissue expansion, which leads at one time to the complete closure of the soft tissue defect in combination with an excellent cosmetic result. The relative simplicity and safety of the technique can cause its widespread use in pediatric reconstructive surgery and burn surgery.

Zygomatic Implants for Restoration of Complex Nasal Defects – A Case Report and Outcome

Total rhinectomy defects pose a challenge for the reconstructive surgeon, but since the introduction of osseointegrated implants, maxillofacial implant–retained prosthetic rehabilitation has provided the patient with an alternative option that has an excellent cosmetic result. Traditionally, zygomatic implants are used for prosthodontic restoration in patients with severely atrophic maxilla or to retain an obturator after tumor ablative surgery. More recently, the nonconventional use of zygomatic implants for retention of a nasal prosthesis has been reported in cases involving rhinectomy defects where the length of conventional dental implants is a limiting factor. In this article, we describe the use and value of transversely-oriented zygomatic implants in combination with an acrylic keeper and maxillary denture to optimize retention of a complex, multi-unit prosthesis in an edentulous patient with a total rhinectomy and upper lip defect.

Closure of sino-orbital fistula using glabellar rotation flap: A case report

Background: Sino-orbital fistulas (SOF) are a well-reported complication of orbitalexenteration and sinonasal carcinoma resection. Despite repair, however, complete fistula closure may be difficult. Case: A 79 –years-old man had undergone total exenteration of right orbit for spreading sqamous cell carcinoma of conjunctiva. Subsequently he developed two large sinoorbitalfistulae medially to the ethmoid sinus wall of the orbit. Post- operatively good socket hygiene was maintained but the fistulae increased in size. At 3 month follow-up, closure of the fistulae using glabellar rotation advancement flap was done. The defects have remained closed at follow-up with excellent cosmetic results. There is no recurrence of fistula or malignancy till date. Patient was cosmetically rehabilitated with spectacle prosthesis. Conclusion: Glabellar rotation flap for closure of medially situated sino- orbital fistulae is a good option with excellent cosmetic result.

Miniinvasive video-assisted interventions on the thyroid and parathyroid glands

Objective. To study the efficacy of miniinvasive video-assisted interventions on the thyroid and parathyroid glands. Materials and methods. In a frame of the investigation accomplished in 2012-2018 yrs 50 patients were operated for nodular goiter (40) and primary hyperparathyrosis with solitary adenoma of a parathyroid gland (10). In all the patients miniinvasive video-assisted interventions were performed in accordance to procedure, proposed by P. Miccoli. Results. A pain syndrome was minimal in all the patients. Stable paresis of nn. Recurrens and parathyrosis were not observed. Transitory paresis of n. Recurrens have occurred in 2 patients. The wound infection was absent. In all the patients with primary hyperparathyrosis the calcium content have lowered down to normal or subnormal value. Stationary stay after miniinvasive operations have been reduced down to (2.2 ± 0.3) bed-days, while after open operations they constituted (5/7 ± 1.2) bed-days. While further follow-up of the patients during one year the disease recurrence was not registered. Excellent cosmetic result was obtained in majority of the patients. In 3 of them only keloid cicatrices have formatted, causing a cosmetic effect lowering. Conclusion. The procedure for miniinvasive video-assisted interventions on thyroid gland was proposed by P. Miccoli, and is still actual. It may be applied also in patients with primary parathyrosis and solitary adenoma of parathyroidal gland. But the patients must be thoroughly selected for this operative interventions.

A clinical study of external ear reconstruction: a study of 20 cases

Background: Auricular defects pose one of the most difficult challenges in reconstructive surgery of the head and neck. The reason is the unique three-dimensional anatomical architecture of the auricle, with its multiple concavities and convolutions of the cartilage and the thin, delicate skin cover. Acquired auricular deformities commonly result from traumatic injuries, burn trauma or tumour extirpation. These vary in severity from simple lacerations to complete auricular avulsions. Congenital ear deformity (microtia) occurs in every 1 out of 6000 live births. The goal of reconstruction is the precise duplication of the missing anatomical part with regard to size, orientation and anatomical landmarks.Methods: Range from healing by secondary intention to complete replacement with autologous rib cartilage and/or auricular prosthesis. Total auricular reconstruction was done by two methods: (1) Nagata and (2) Brent’s method. Nagata’s technique is commonly performed in this study. The present study aimed to evaluate the reconstruction of auricular defects using autologous rib cartilage graft with or without temperoparietal fascia flap covered by split-thickness skin graft.Results: Excellent cosmetic result can be obtained with adequate skills and training in carving the cartilage for auricular framework. This improves confidence and gives psychological support to microtia patients.Conclusions: With training and method, results in ear reconstruction using autologous rib cartilage are excellent and reproducible.

A New Coracoclavicular Guider for Minimally Invasive Anatomic Coracoclavicular Reconstruction with Two TightRope Systems in Acute Acromioclavicular Joint Dislocation

High-grade injuries of complete acromioclavicular (AC) joint disruption (types IV - VI) are typically treated surgically. Since the coracoclavicular (CC) ligament is most often used for stabilizing the AC joint, most reconstruction techniques to treat dislocation of this joint rely upon CC interval fixation. A TightRope system is usually used to augment the CC ligament to treat acute AC dislocations with arthroscopic assistance. The conventional arthroscopic technique employing one TightRope system is associated with some complications, including anterior subluxation of the clavicle and clavicular bony avulsion as a consequence of rotational movements. As an alternative, two TightRope systems can be used to anatomically reconstruct the CC ligament to avoid these complications. We present a new CC guider with which the surgeon can replicate the native CC ligament complex orientation using two TightRope systems via two minimally invasive incisions without arthroscopic assistance. This procedure relies upon the accommodation and stable placement of the clavicle and coracoid bone tunnels for the two TightRope systems in place of the trapezoid and conoid of the CC ligament. We retrospectively reviewed the outcomes for 16 patients with acute dislocation of the AC joint that had been treated by a single surgeon using a double-button fixation system. An independent reviewer conducted functional testing of these patients, including the use of Disability of Arm, Shoulder and Hand (DASH), Constant and visual analog scale (VAS) scores. Standard radiographs were used for assessing the CC distance for the impacted shoulder relative to that of the unaffected contralateral shoulderThe new CC guider leads to an excellent cosmetic result. Our clinical results show that this technique can be easily performed and is similarly invasive to other current arthroscopic techniques.

CLINICAL AND ECONOMIC EFFICIENCY OF LAPAROSCOPIC OPERATIONS IN EMERGENCY ABDOMINAL SURGERY IN CHILDREN

The data of the analysis of the efficacy of the use of laparoscopic operations in comparison with open surgical interventions for ten years in 8462 children with the acute surgical pathology of the abdominal cavity on the basis of an emergency surgical hospital are presented. Laparoscopic operations were performed in 4984 (59%) patients, and open surgical operations were performed in 3478 (41%) patients. In the treatment of acute surgical pathology in children, laparoscopic operations have been established to provide: low traumatic operative access and manipulation; visual control of all stages of the operation; relief of pain syndrome and intestinal paresis; early recovery of impaired functions and the patient activity; decline in the number of postoperative complications, the prevalence of adhesions; significant reduction in the length of stay in the hospital; excellent cosmetic result. The authors showed the execution of laparoscopic surgical interventions to be economically more profitable if compared with open operations in children.

Successful Brace Treatment of Pectus Carinatum in Osteogenesis Imperfecta Using the Dynamic Compression System

Osteogenesis imperfecta (OI) is a genetic disorder of collagen resulting in a “fragile” skeleton with increased fracture risk and other complications, dependent on the specific variant. Pectus deformities of the chest wall, while not common, can be associated with OI. The use of a pectus carinatum brace in a patient with OI poses unknown risks for fractures and adverse treatment outcomes. We successfully applied external compression bracing using the dynamic compression system to one such patient. This case illustrates the ability to treat an OI patient with pectus carinatum using a nonsurgical brace, without complications, resulting in an excellent cosmetic result.

PS01.117: TOTAL LAPAROSCOPIC MIDCOLON RETROSTERNAL ESOPHAGEAL BYPASS FOR CORROSIVE STRICTURE ESOPHAGUS

Description Colonic bypass for corrosive stricture of the esophagus is traditionally performed using the conventional open approach. A laparoscopic mid colon retrosternal bypass has not been reported in the literature. Total laparoscopic left colic artery based mid colon retrosternal esophageal bypass is described in this report. Method: A 25-year-old female presented with acid-induced long esophageal stricture starting at 18cm from incisors refractory to endoscopic dilatation. The laparoscopic mid colon esophageal bypass was performed using 5 abdominal ports. The essential steps are colonic mobilization and assessment of the adequacy of the mesocolic vascular arcade by clamping middle colic, right colic, and ileocolic vessels proximal to their branching, creation of the retrosternal tunnel, preparation of left colic artery based colon conduit by dividing terminal ileum proximal to ileocecal junction, neck dissection to expose cervical esophagus and delivering the colonic conduit retrosternally into the neck. Reconstruction was performed by side to side esophagocoloplasty, side to side cologastric and ileocolic anastomosis. Results: The duration of surgery was 410 minutes and blood loss was 150 mL. The patient had an uneventful postoperative course. She was started on oral semisolids on postoperative day 7 and discharged on the tenth postoperative day. At 9 months follow up the patient is euphagic to solid diet with an excellent cosmetic result. Conclusion: Total laparoscopic mid colon esophageal bypass is a feasible procedure for the management of corrosive stricture of the esophagus Disclosure All authors have declared no conflicts of interest.