British journal of plastic surgery最新文献

Embryogenic eyelid defects can be isolated or associated with malformative diseases, such as Tessier craniofacial clefts.

We describe the exceptional coexistence of upper eyelid coloboma and lower eyelid dermolipoma in a 45-day-old infant with a Tessier no. 0–1 cleft.

The surgical intervention carried out on this patient, which used a flap of subconjunctival choristoma and grafting of reshaped cutaneous and tarsal portions of a preauricular anlage, is presented as a technique for correcting congenital palpebral coloboma.

Adoption of this technique allowed virtually complete repair of the defect and gave an acceptable functional and cosmetic result.

Extension of a burn wound over the first 24 h following injury is recognised clinically, and leads to diagnostic and therapeutic dilemmas. In the central nervous system, a similar spread of damage, beyond the initial injury, can occur via the spread of death signals from injured cells to their healthy neighbours via Connexin43 (Cx43) gap junction channels. In the skin, Cx43 is expressed in the basal epidermis and in fibroblasts and dermal appendages. We have used Cx43 specific antisense oligodeoxynucleotide approach to transiently down-regulate Cx43 protein in the early stages of partial thickness cutaneous burn wound healing. Antisense ODNs reduce the spread of tissue damage and neutrophil infiltration around the wound following injury. Epithelial cell proliferation is increased and the rate of wound closure is accelerated, compared to controls. Resultant scarring is smaller with less granulation tissue and more dermal appendages than controls. These findings suggest that Cx43 antisense treatment speeds partial thickness burn wound healing and reduces scarring. We suggest that this approach may provide an effective adjunct to managing partial thickness burn wounds.

After the surgical correction of aponeurotic blepharoptosis or blepharoplasty, the positions of the eyebrow and hairline change as if the frontal belly is independent from the occipital belly of the occipitofrontalis muscle. Therefore, the occipitofrontalis muscle was studied physiologically with electromyographic evaluation in healthy subjects and anatomically with cadaver dissections. Along with contraction of the levator muscle to maintain an adequate visual field, at a less upward gaze position, contraction of only the frontal belly was induced, and at a more upward gaze position, contraction of both the frontal and the occipital bellies was always induced to lift the eyebrow with the upper eyelid skin. The superficial fascia overlying the occipital belly becomes the temporoparietal fascia and ends at the superior end of the frontal belly, thus creating a superficial musculoaponeurotic system that lifts the eyebrow and pulls the scalp forwards. Beneath the superficial musculoaponeurotic system, the occipital belly of the occipitofrontalis muscle becomes the galea aponeurotica and inserts into the underside of the frontal belly, thus creating a deep musculoaponeurotic system that pulls the superficial musculoaponeurotic system with the scalp backwards. Thus, the occipitofrontalis muscle appears to be composed of two physiologically and anatomically different muscles.

In the advanced stage of hypopharyngeal cancer, extensive resection may sometimes leave both the cervical soft tissue and pharyngoesophageal defects that must be reconstructed at the same time. In this study, a new reconstructive method using the rectus abdominis musculoperitoneal flap is described. Three patients underwent pharyngoesophageal reconstruction by this method. Complete survival of the flaps was seen in all patients, but one patient developed a fistula due to rapid local recurrence of the tumour. We believe that the rectus abdominis musculoperitoneal flap can be an alternative choice for reconstruction of pharyngoesophageal defect, especially when there is a large area of cervical soft tissue defect at the same time.

The joint British Association of Plastic Surgeons and British Orthopaedic Association (BAPS/BOA) guidelines for the management of patients with open tibia fractures were published in 1991 and 1997 and provided a synopsis of injury epidemiology and best care. We present a retrospective review of 66 patients treated over a 2-year period (January 2001–February 2003) at a regional plastic surgery unit.

There were 33 direct admissions and 33 transfers from other hospitals in which the average delay in transfer was 7.8 days (1–28) and in whom 26 (79%) patients had already undergone surgery. Plastic surgeons were involved in 46 (62%) of the 66 patient cohort and 27 (82%) transferred patients. The delay after admission until soft tissue cover was 3.8 days (0–15). Twenty-nine (44%) complications were recorded, 20 (69%) of these were in the transferred group and additional orthopaedic intervention was needed in 11 (42%) of patients who had been operated on in other hospitals.

Despite widespread dissemination and teaching of the BAPS/BOA guidelines, complex extremity trauma is often not managed well in our region. There are unacceptable delays in admission, late communication, poor note keeping and follow up. The initial surgery/fixation is often sub-optimal and soft tissue reconstruction has to be considered at the least advantageous time period for the patient, leading to an increased hospital stay and complications.

Syndromic craniosynostoses are commonly treated conditions in craniofacial units. The features of the common syndromes (Apert, Pfeiffer and Crouzon) all include craniosynostosis, mid-face hypoplasia and ocular proptosis. The craniofacial management of a child with these syndromes through to adulthood may require a number of surgical interventions to allow brain development, to provide an adequate airway, to prevent corneal ulceration and to provide a functional dental occlusion. The management of these different priorities into timed interventions in our unit is determined by established protocols.

We report two cases that underwent simultaneous mid-face (Le Fort III) and fronto-orbital osteotomies followed by distraction but using different vectors to advance the upper and mid-face regions (to achieve all treatment goals) in a 12-year-old boy and a 16-year-old girl.