Reconstructive Surgery

Oral and Maxillofacial Surgeons have increasing opportunities to train in head and neck oncologic and reconstructive surgery. The development of a fellowship training programs within our speciality has had a transformative effect on the speciality. This survey by the commitee on Maxillofacial Oncology and Reconstructive is aimed to evaluate the impact of fellowship training on the careers of the fellows and speciality from 2005-2015.

Microtia is a congenital abnormality with low incidence but considerable morbidities. Reconstruction of the microtia deformity is a complex and difficult process that requires a proper planning. The primary technique of reconstruction employs patient's own rib cartilage. Irradiated homograft cartilages previously have been used in facial reconstruction but its application in microtia surgery has not been reported yet. This study is designed to compare the results of autograft versus homograft auriculoplasty. Between 1992 - 2002, 23 patients underwent auricular reconstructive surgery by the senior author in our department. Autograft implantation was performed in one stage but homograft auriculoplasty was done in two stages. Auricular deformity was right-sided in 13, left-sided in 8, and bilateral in 2 cases. Implanted graft was autograft in 9 patients and homograft in 14 patients. During mean follow-up of 4 years, cartilage graft resorption was detected in two cases, one in autog...

The diabetic triad of neuropathy, vasculopathy, and foot deformity can be surgically challenging to the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. It is critical to have adequate blood flow and to debride the wound to clean healthy tissue before considering reconstruction. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail perioperatively due to postoperative shear forces created by premature joint motion and/or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing in the Charcot foot by providing temporary but reliable offloading and/or immobilization of joints. Using a team approach is critical to ...

To document the experience at a tertiary referral hospital in India with managing complex and complicated vesicovaginal fistulae (VVF) by the transvaginal route, and to document the complications and the long-term outcome of the patients.The medical records of 102 patients with complex or complicated VVF who underwent transvaginal surgical repair during 2000–2009 were reviewed retrospectively.The mean age of the patients was 24 years and the mean duration of urinary incontinence was 3 years (range 6 months to 12 years). The patients were followed up for a median of 48 months. In total, 78 patients had obstetric fistulae, 20 patients had surgical (gynecologic) fistulae, and 4 patients had postradiation fistulae. The overall success rate for the transvaginal approach was 86.3%. Fourteen patients remained incontinent despite the surgical repair. Early failure of the repair was observed in 11.8% of the patients and delayed failure in 2.0%. Postoperative complications included stress urinary incontinence (9.8%), urge urinary incontinence (7.8%), dyspareunia (5.9%), and chronic labial pain (2.0%).The transvaginal approach to the repair of complex and complicated VVF gives good long-term results with low complication rates.

Complex posttraumatic forearm deformities, have a significant impact on the integrity of the upper extremity leading to pain, instability in both the proximal and/ or distal radioulnar articulation and reduced range of forearm motion. Corrective osteotomy or more advanced procedures for malunited fractures or other posttraumatic deformities of the upper extremity, especially in the forearm are challenging procedures. In this review we will discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the pathway from preoperative planning to the actual deformity correction surgery, either with one- stage correction or using gradual lengthening with external fixation ("callotasis techniques") and finally the functional outcome we can expect for our patients. In addition we will analyse the modern computer- assisted techniques available to date.

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.
Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.
Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.
Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco- regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.

PURPOSE To define the order and frequency of elongation in tendon junctions in extensor carpi radialis longus (ECRL) to flexor digitorum profundus tendon transfer and its correlation to grip strength and lack of finger flexion. METHODS Forty-seven tetraplegic patients had surgery involving the reconstruction of finger flexion with the transfer of the ECRL in a total of 62 arms. During surgery metal markers were placed on both sides of the tendon-to-tendon attachment site. After surgery the distance between the markers was measured on radiographs. Any increase in the distance between the markers was judged as elongation. The grip strength and mean pulp-to-palm distance were evaluated a minimum of 6 months after surgery. Three arms had a second surgery because of insufficient functional results. RESULTS The average final elongation was 9 +/- 10 mm (mean +/- SD). The mean grip strength was 16 +/- 12 kPa (range, 0-50). The lack of flexion (mean value of pulp-to-distal palmar crease of 3...

abstract Double DIEP flap for lower extremities reconstruction introduction: A soft tissue defect considering the extent, location, depth and involved structures can be a complex task, leading to search for unusual reconstructive alternatives. case report: Puerperal woman, 21 years, previously healthy, admitted for septic shock and skin necrosis of both extremities secondary to purpura fulminans. Escharectomy was performed and the final defect was 27% of total body surface, corresponding to necrotic areas of both superior and lower extremities. Is remarkable the presence of musculocutaneous perforating vessels thrombosis and segmental muscular necrosis in legs and interosseous muscles necrosis in hands. In upper extremity coverage was performed with dermoepidermal grafts. To cover peroneal malleolus and feet dorsum, whereas there were no regional or local alternatives, we realize a double DIEP flap. Flap elevation of bilateral DIEP flap was performed simultaneously for two surgical teams. The patient had no complications and was discharged with complete soft tissue coverage. key words: Double DIEP flap, lower limb reconstruction, microsurgery.

Objective: The purpose of this anatomical study was to explore the morphological, parameters, topography and diameter of neurovascular pedicles of the semitendinosus muscle. Materials and Methods: The study was conducted on 46 formalin fixed adult human cadaveric lower limbs (20 right and 26 left), at the Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, MakkahSaudi Arabia. The semitendinosus muscle was dissected and studied regarding its origin, insertion, parameters and the number and points of entry of the supplying nerves and diameters of arteries just before entery to the semitendinosus muscle. Results: The mean width of ST fleshy part near origin, at middle and before overlap part were 2.07±0.41, 3.01±0.48, 2.46±0.44 cm respectively. ST muscle thickness mean of fleshy and tendentious parts were 1.45±0.28, 0.39±0.53 cm respectively.1-3neurovascular pedicles entering into the ST muscle. The distance of the entry of neurovascular pedicle to the ST muscle f...

Purpose: Traumatic rupture of the corpus cavernosum of the penis is rare and has been reported infrequently. We demonstrated the moderate frequency and most common etiologies of this condition. Materials and Methods: Between February 1990 and June 1993, 68 patients underwent a n emergency operation 3 hours to 4 days after penile fracture. Results: Among 32 patients who completed a questionnaire functional results were excellent except for 3 with penile curvature and pain during coitus who underwent surgery more than 48 hours after injury. Conclusions: Fracture of the penis is a common urological problem. In our series the most common cause was manipulation. To avoid serious complications immediate surgical intervention is recommended.

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We present two cases of finger ring impaction. Both patients tried to remove it in rural hospitals before presenting to the burns and plastic unit of the University of Calabar Teaching Hospital. The male had the ring on the left index finger while the female had it on the left ring finger. The rings were removed by the use of circumferential cutaneous tissue infiltration (ring block) with plain lignocaine, strip of esmarch bandage exanguination of the finger, lubrication with K-Y jelly and then extraction.

A computational model is presented for the simulation of procedures of reconstructive surgery characterized by the excision of a cutaneous defect and the closure and suture of the wound edges. The skin is modeled as a plane membrane with zero flexural stiffness. The membrane undergoes large deformations and is characterized by a Fung type constitutive response in biaxial tension. Skin wrinkling, which is a typical outcome of the surgery in the form of extrusion of the wound edges and dog-ears, is considered through a modification of the elastic potential as originally proposed by Pipkin's Relaxed Energy Density theory [A.C. Pipkin, The relaxed energy density for isotropic elastic membranes, IMA J. Appl. Math. 36 (1986) 85–99; A.C. Pipkin, Relaxed energy density for large deformations of membranes, IMA J. Appl. Math. 52 (1994) 197–308]. The post-buckling analysis of a stretched annular membrane performed by Geminard et al. [Wrinkle formations in axi-symmetrically stretched membranes, Eur. Phys. J. E 15 (2004) 117–126] is used to validate the model under conditions similar to those of the surgery and to discuss the influence of a pre-existing tension in the membrane on the extension of the wrinkled regions. The model is applied to simulate different surgical procedures and investigate the effects of the natural state of the skin and the shape and size of the excisions. The results explain and validate current practice.

The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based...

Object Orbital tumors can be divided schematically into primary lesions, originating from the orbit itself, and secondary lesions, extending to the orbit from neighboring structures. These tumors are variable in their biological nature and in their location. The authors evaluate 41 cases of benign and malignant tumors involving the orbit and discuss the surgical challenge, which involves tumor removal, preserving visual function and cosmetic reconstruction. Methods The authors performed a retrospective analysis of a series of all cases involving patients who underwent surgery for treatment of orbital tumors in their hospital between December 2003 and December 2006. Data were collected from the patients' files in the hospital's outpatient clinic, operative notes, and pre- and postoperative imaging studies. Results The authors identified 41 patients who met the inclusion criteria (age range 14–82 years, mean 42.2 years, standard deviation 22.4 years). The most common presentin...