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Secondary repair of unilateral cleft lip nose deformity with bilateral reverse-U access incisions
J Oral Maxillofac Surg 57:877-881, 1999
Abstracts rhinoplasty between 10 and 16 years of age. Septal, ilial, and auricular cartilage grafts cannot be used as donor sources in younger patients because of possible growth disturbances as well as inherent lack of sturdiness in the young septum and ear. The eyes and nose are the focal point of appearance, and any aesthetic change in the eyes makes a large change in appearance. Lower lid herniated fat bags may be corrected under 1 year of age, eyelid deformities at 3 to 4 years (younger if amblyopia is a potential problem), and epicanthal folds at 10 to 12 years. Absent, abnormally shaped, or large protruding ears adversely affect the sclfimage of children and, fortunately, can and should be addressed relatively early in a child’s development. Protruding ears may be taped at 0 to 6 months, and then surgically corrected at 5 to 6 years along with microtia and cryptotic ears. Microgenia may be addressed in select cases between 5 and 6 years. Macroglossia is commonly seen in congenital anomalies such as Down Syndrome and Beckwith-Wiedemann Syndrome. A large tongue causes severe functional as well as aesthetic problems leading to excessive drooling, speech problems, and an open mouth appearance that is perceived as an indication of mental retardation. Tongue reduction can be performed in the first year of life.-R.H.
Wound Contraction in an Experimental Porcine Model Hinrichsen N, BirkSorenson L, Gottrup F, et al. Stand J Plast Reconstr Hand Surg 32:243,1998 Previous studies have noted differences in contractility of healing wounds based on the type and site of the wound. This study compared healing time and contraction at different sites on pigs in secondarily healing wounds and wounds treated with split-thickness skin grafts (STSG). Two pairs of round skin excisions, down to muscle on eight minipigs (4 cm in diameter), were performed bilaterally on either side of the animal. Tattooing marked the edges for measurements after healing. The wounds were either repaired with STSG or left to heal secondarily. After 5 months, the final determination of contraction and shape of the wounds was made. Wound closure time was, on average, 12 days in the grafted group and 30 days in the secondarily healed group. Median wound contraction was found to be 33% in grafted sites and 64% in secondarily healing groups. The shape of the wound was also determined by height/width ratios. The grafted wounds were found to have healed with a shape more near “round” than “cigar-shaped.” Closure time, contracture, and shape were individually characterized based on exact location of the original excision (lateral vs medial and cranial vs caudal). Different sites on the body possess specific characteristics as shown by Langer but it is not known whether the differences are species differences or the result of special characteristics in the different sites on the body. The authors state that factors such as degree of adherence of the skin to the underlying body wall, skin tension, depth of fatty tissue, the underlying muscle mass, frequent motion of the wound area, and the chosen wound treatment are all factors to consider to control wound contracture with as rapid of healing as possible.-T. BARTHOLOMEW
HAUG Reprint
rquests
to Dr Std: 1102 Bates 3330, MC 3-2314,
Houston,
TX 77030. Secondary Repair of Unilateral Cleft Lip Nose Deformity with Bilateral Reverse-U Access Incisions. Nakajima T, Yoshimura Y. Br J Plas Surg 51:176, 1998 Cleft lip nose deformity is often seen bilaterally even with unilateral cleft. There have been many reports on the bilateral repair of cleft lip nose; however, they describe transection of the columella. In this method, the anatomic point of the nasolabial angle is not lost and the scar of the incision is completely hidden within the nostrils. Through bilateral reverse-U incisions, the alar and lateral cartilages are undermined subcutaneously. The areolar tissue between the alar cartilages is elevated with the dorsal skin and used as augmentation material after suturing of the cartilages. To enhance the alar groove and nasal bridge, an inverted trapezoid suture is placed from the alar cartilage to the alar groove. The knot of the suture is buried through a stab incision. To prevent postoperative recurrence of the deformity, the alar cartilage of the cleft side is elevated slightly more than the noncleft side. At the end of the operation, a long retainer is inserted into the nostrils and kept in place for 1 or 2 months after surgery to prevent recurrence of the deformity. The authors have found the surgical results to be adequately maintained in limited follow-up with no need for implants to augment the nasal dorsum.-M.K. ROLLERT
Reprint requests to Dr Hinrichsen: Institute of Experimental Clinical Research, University of Aarhus, Aarhus and Copenhagen Wound Healing Center, Copenhagen IJniversity, Denmark. Aesthetic Considerations and the Pediatric Population. Stal S, Peterson R, Spira M. Clin Plast Surg 25:631, 1998 Aesthetic surgery is the natural evolution of rcconstructive surgery done to improve a patients’ form in addition to function. This becomes especially critical in the pediatric age group in which patients are constantly evolving and their concepts of self-esteem and body image are so fragile. At birth, there are no cosmetic problems in normal babies. Normal toddlers (1 to 5 years) are also cute. True physical deformities that are outside the norms of development are quickly noted by children (5 to 10 years) and become the focus of derision and of negative body image in the child who is unfortunate enough to have this abnormality. Between 10 and 15 years, the major aesthetic issues are breast development, facial development, and a change in the proportion of the limbs and rest of the body. According to a recent American Society of Plastic and Reconstructive Surgeons survey, 27% of the people who have had rhinoplasties are 21 years old or younger. Septoplasty may be performed whenever airway obstruction is severe, and
Reprint requests to Dr Nalrajima: Department of Plastic and Reconstructive
Surgery,
School
of Medicine,
Fujita Health
University,
Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
877
l-98
Abstracts rhinoplasty between 10 and 16 years of age. Septal, ilial, and auricular cartilage grafts cannot be used as donor sources in younger patients because of possible growth disturbances as well as inherent lack of sturdiness in the young septum and ear. The eyes and nose are the focal point of appearance, and any aesthetic change in the eyes makes a large change in appearance. Lower lid herniated fat bags may be corrected under 1 year of age, eyelid deformities at 3 to 4 years (younger if amblyopia is a potential problem), and epicanthal folds at 10 to 12 years. Absent, abnormally shaped, or large protruding ears adversely affect the sclfimage of children and, fortunately, can and should be addressed relatively early in a child’s development. Protruding ears may be taped at 0 to 6 months, and then surgically corrected at 5 to 6 years along with microtia and cryptotic ears. Microgenia may be addressed in select cases between 5 and 6 years. Macroglossia is commonly seen in congenital anomalies such as Down Syndrome and Beckwith-Wiedemann Syndrome. A large tongue causes severe functional as well as aesthetic problems leading to excessive drooling, speech problems, and an open mouth appearance that is perceived as an indication of mental retardation. Tongue reduction can be performed in the first year of life.-R.H.
Wound Contraction in an Experimental Porcine Model Hinrichsen N, BirkSorenson L, Gottrup F, et al. Stand J Plast Reconstr Hand Surg 32:243,1998 Previous studies have noted differences in contractility of healing wounds based on the type and site of the wound. This study compared healing time and contraction at different sites on pigs in secondarily healing wounds and wounds treated with split-thickness skin grafts (STSG). Two pairs of round skin excisions, down to muscle on eight minipigs (4 cm in diameter), were performed bilaterally on either side of the animal. Tattooing marked the edges for measurements after healing. The wounds were either repaired with STSG or left to heal secondarily. After 5 months, the final determination of contraction and shape of the wounds was made. Wound closure time was, on average, 12 days in the grafted group and 30 days in the secondarily healed group. Median wound contraction was found to be 33% in grafted sites and 64% in secondarily healing groups. The shape of the wound was also determined by height/width ratios. The grafted wounds were found to have healed with a shape more near “round” than “cigar-shaped.” Closure time, contracture, and shape were individually characterized based on exact location of the original excision (lateral vs medial and cranial vs caudal). Different sites on the body possess specific characteristics as shown by Langer but it is not known whether the differences are species differences or the result of special characteristics in the different sites on the body. The authors state that factors such as degree of adherence of the skin to the underlying body wall, skin tension, depth of fatty tissue, the underlying muscle mass, frequent motion of the wound area, and the chosen wound treatment are all factors to consider to control wound contracture with as rapid of healing as possible.-T. BARTHOLOMEW
HAUG Reprint
rquests
to Dr Std: 1102 Bates 3330, MC 3-2314,
Houston,
TX 77030. Secondary Repair of Unilateral Cleft Lip Nose Deformity with Bilateral Reverse-U Access Incisions. Nakajima T, Yoshimura Y. Br J Plas Surg 51:176, 1998 Cleft lip nose deformity is often seen bilaterally even with unilateral cleft. There have been many reports on the bilateral repair of cleft lip nose; however, they describe transection of the columella. In this method, the anatomic point of the nasolabial angle is not lost and the scar of the incision is completely hidden within the nostrils. Through bilateral reverse-U incisions, the alar and lateral cartilages are undermined subcutaneously. The areolar tissue between the alar cartilages is elevated with the dorsal skin and used as augmentation material after suturing of the cartilages. To enhance the alar groove and nasal bridge, an inverted trapezoid suture is placed from the alar cartilage to the alar groove. The knot of the suture is buried through a stab incision. To prevent postoperative recurrence of the deformity, the alar cartilage of the cleft side is elevated slightly more than the noncleft side. At the end of the operation, a long retainer is inserted into the nostrils and kept in place for 1 or 2 months after surgery to prevent recurrence of the deformity. The authors have found the surgical results to be adequately maintained in limited follow-up with no need for implants to augment the nasal dorsum.-M.K. ROLLERT
Reprint requests to Dr Hinrichsen: Institute of Experimental Clinical Research, University of Aarhus, Aarhus and Copenhagen Wound Healing Center, Copenhagen IJniversity, Denmark. Aesthetic Considerations and the Pediatric Population. Stal S, Peterson R, Spira M. Clin Plast Surg 25:631, 1998 Aesthetic surgery is the natural evolution of rcconstructive surgery done to improve a patients’ form in addition to function. This becomes especially critical in the pediatric age group in which patients are constantly evolving and their concepts of self-esteem and body image are so fragile. At birth, there are no cosmetic problems in normal babies. Normal toddlers (1 to 5 years) are also cute. True physical deformities that are outside the norms of development are quickly noted by children (5 to 10 years) and become the focus of derision and of negative body image in the child who is unfortunate enough to have this abnormality. Between 10 and 15 years, the major aesthetic issues are breast development, facial development, and a change in the proportion of the limbs and rest of the body. According to a recent American Society of Plastic and Reconstructive Surgeons survey, 27% of the people who have had rhinoplasties are 21 years old or younger. Septoplasty may be performed whenever airway obstruction is severe, and
Reprint requests to Dr Nalrajima: Department of Plastic and Reconstructive
Surgery,
School
of Medicine,
Fujita Health
University,
Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
877
l-98