Archives of Plastic Surgery-APS最新文献

An artificial sphincter implanted in the bulbous urethra to treat severe postprostatectomy urinary incontinence is effective, but embedding-associated complications can occur. We assessed the feasibility, efficacy, and safety of urethral graciloplasty cross-innervated by the pudendal nerve. A simulation surgery on three male fresh cadavers was performed. Both ends of the gracilis muscle were isolated only on its vascular pedicle with proximal end of the obturator nerve severed and transferred to the perineum. We examined whether the gracilis muscle could be wrapped around the bulbous urethra and whether the obturator nerve was long enough to suture with the pudendal nerve. In addition, surgery was performed on a 71-year-old male patient with severe urinary incontinence. The postoperative 12-month outcomes were assessed using a 24-hour pad test and urodynamic study. In all cadaveric simulations, the gracilis muscles could be wrapped around the bulbous urethra in a γ-loop configuration. The length of the obturator nerve was sufficient for neurorrhaphy with the pudendal nerve. In the clinical case, the postoperative course was uneventful. The mean maximum urethral closure pressure and functional profile length increased from 40.7 to 70 cm H ₂ O and from 40.1 to 45.3 mm, respectively. Although urinary incontinence was not completely cured, the patient was able to maintain urinary continence at night. Urethral graciloplasty cross-innervated by the pudendal nerve is effective in raising the urethral pressure and reducing urinary incontinence.

Background  Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg. Methods  This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg. Results  The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm ² . Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia. Conclusion  Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

Background  This article describes the development of the Myanmar Articulation, Resonation, Nasal Emission, and Nasal Turbulence test for children with cleft lip and palate (CLP), and evaluation of its validity and reliability. Methods  It was created by three Thai researchers and a Burmese research assistant based on Burmese phonology. The content validity was evaluated by six Burmese language experts. All test items were divided into three groups: high-pressure oral consonants, low-pressure oral consonants, and nasal consonants. Results  All items (58-word and 32-phrase/sentence) gave an excellent level of the expert agreement (item-level content validity indexes = 1.00). The target items were illustrated as color pictures. Each picture was clearly drawn and easy to identify. As a pilot study of face validity, all pictures were administered to 10 typical-developing children. The actual testing was assessed by 10 CLP children, and the developed test was analyzed through consultation of the Burmese teachers and interpreters from a speech camp. Testing scores for a total including three groups of target items were shown acceptable for internal consistency reliability (ranged from 0.4 to 0.88). Conclusion  The constructed test is valid in terms of its content.