The use of nail enfolded flaps for reconstruction of full-thickness ala nasi defects: an early report of experience.

The most common etiology of nasal defects that require reconstruction is basal cell carcinoma, as well as squamous cell carcinoma and melanoma. In reconstructing full-thickness ala nasi defects following excision of basal cell carcinomas, we present our technique of the nail enfolded local flaps which involves the harvesting of the nail plate and placing it to serve as a supporting component. In four patients, the nail plate grafts are inserted into various local flaps, and used for reconstruction of full-thickness ala nasi defects. Lining deficiencies of the alar lobule were resurfaced with skin grafts. None of the cases experienced skin graft loss or nail plate exposure. The nail graft prevented alar collapse by supporting the nasal airway. This technique discards the need for a second operation.

Gold weight with single hole versus multiple holes--experimental study in rabbits.

Lagophtalmia can be a serious complication of facial paralysis. Gold weight application to the upper eyelid is one of the most popular and practical conventional techniques. However, displacement or extrusion are commonly encountered complications. In order to minimize these complications, we modified the original design of the gold weight. Our hypothesis is that gold weight with multiple holes resists displacement and resultant extrusion via extensive fibrous tissue formation through the holes. Twelve New Zealand rabbits were used for this experiment. 2 x 1 cm and 1.8 g ellipsoid golden weights with single and multiple holes were compared. They were placed subcutaneously, to the dorsal surface of the rabbit ears and no suturing was performed. Golden weights with single holes were introduced to the left ear while the golden weights with multiple holes were placed to the right ear. The rates and degree of extrusion and displacement were evaluated in the second and third weeks macroscopically and microscopically. Results were compared by Chi-square and Mann-Whitney U tests. Statistically better outcomes were achieved by golden weights with multiple holes versus single hole (p<0.0034).

Silastic sheet integrated polymethylmetacrylate splint in addition to surgery for commissure contractures complicated with hypertrophic scar.

Numerous appliances or methods have been used to manage perioral deep burns and resultant contractures, however, until now, no particular technique is considered to be the "ideal technique". In this article, a new modified design of an extraoral appliance, composed of polymethylmetacrylate and silicon sheet is introduced. Two female and one male patient of a mean age of 33 were included in the study. They had a common history of facial thermal injury and hypertrophic scar formation. All three had a history of failed preceding operations to release commissure contractures. The appliance was placed within 14 days following the operation and stretched continuously for 6 months. During 14 months of follow-up period, no recurrence was encountered and a relatively symmetrical and satisfactory mouth opening was obtained. Owing to the effect of the silicon sheet, a more smooth, flattened scar surface and pliable commissure was achieved. No ulcerations, or tissue breakdown was observed. Extraoral appliances composed of polymethylmetacrylate silicon sheet were considered to be practical, convenient and efficient for the postsurgical treatment of the oral commissure contractures complicated with hypertrophic scar formation.

Surgical correction of unusual double-outlet right ventricle.

This paper presents the case history of an 8-year-old girl who had total situs inversus and double-outlet right ventricle with pulmonary stenosis and severe tricuspid insufficiency in the presence of dextrocardia with ventricular discordance. A successful repair was performed using the Rastelli technique in conjunction with replacement of the tricuspid valve with a Bjork-Shiley prosthesis. The postoperative course was uneventful, and follow-up catheterization revealed a good operative result. However, the patient died suddenly during an emotionally upsetting period about two months after the operation. Postmortem examination revealed only signs of moderately severe cardiac decompensation. Some anatomical and embryological comments are made.