Use of the LigaSure™ vessel sealing system in neurofibroma excision to control postoperative bleeding.

BACKGROUND: The resection of neurofibromas in Von Recklinghausen's disease (NF-1) is frequently complicated by potentially life-threatening intraoperative and postoperative hemorrhage, due to the high tumor vascularity and tissue friability. METHODS: This report describes a novel technique for the resection of neurofibromas using the LigaSure™ (Valleylab, Tyco International Healthcare, Boulder, CO) vessel sealing system. We compared five cases of NF-1 tumor removal which used this vessel sealing system, with six cases that did not, and recorded the intraoperative and postoperative blood loss, length of hospitalization, and postoperative complications. RESULTS: In all cases employing the LigaSure™, the perioperative blood loss was less than 600 ml (30 âˆ¼ 570 ml), and no patient developed a postoperative hematoma or other bleeding complications. In contrast, the cases not using the LigaSure™ had greater blood loss as well as a higher rate of postoperative hematomas. CONCLUSIONS: The LigaSure™ provides excellent hemostasis with few complications when used for neurofibroma removal.

Treatment of giant congenital melanocytic nevi with enzymatically separated epidermal sheet grafting.

Treatment of giant congenital melanocytic nevi (GCMNs) must be considered from both a cosmetic and a medical aspect of reducing the risk of a growing malignancy. We treated five patients who had a GCMN on the trunk with an enzymatically separated epidermal sheet taken from their excised GCMN skin. All patients underwent enzymatically separated epidermal sheet grafting at the age of 2 months. With the patient under general anaesthesia, we removed the affected area with an electric dermatome until the brown colour had almost completely disappeared. The removed skin was immersed in dispase I solution (1000Uml(-1)) dissolved in Ringer's solution at 37 degrees C for 75-105min until the epidermal sheet separated from the dermis without tension. Three back lesions and two abdominal lesions were treated. In all cases, the enzymatically separated epidermis grafted well, without infection. The amount of discharge that accumulated from immediately after the operation until the first dressing change (performed at 3 days after the operation) was reduced compared with that from curettage. The skin colour was light brown at first and gradually became lighter within a few months. The grafted areas were soft and did not show significant re-pigmentation. In most cases, hard hair did not grow on the treated area. Histological samples taken 1 year after the operation showed that the dermal layer was reconstituted without pigmented nevus cells. Enzymatically separated epidermal grafting is a useful method for the treatment of GCMN, is easy to perform and leaves cosmetically satisfactory results.

Dynamic analysis of the effects of upper lip pressure on the asymmetry of the facial skeleton in patients with unilateral complete cleft lip and palate.

OBJECTIVE: Our purpose was to assess quantitatively the effect of increased upper-lip pressure on asymmetry of the facial bones in patients with unilateral complete lip-alveolar-palatal clefts. METHODS: We collected computed tomographic images from 16 patients with unilateral complete lip-alveolar-palatal clefts and classified them into two groups based on absence/presence of alveolar bone grafting. We categorized eight patients (9.6 +/- 2.0 years old) who had not been treated with alveolar bone grafting as the ABG(-) group and the other eight patients (9.3 +/- 1.6 years old) who had received alveolar bone grafting as the ABG(+) group. After producing a computer-aided design model for each patient, we applied a uniform load on the anterior aspects of the maxilla, alveolus, and teeth of the model to simulate the upper-lip pressure. Then we calculated the degree of distortion each model presented using the finite element method. We compared the distortion pattern between the ABG(-) and ABG(+) groups. RESULTS: In the ABG(-) patients, asymmetry of distortion between the cleft and noncleft sides was present in wide areas involving the orbit, nasal bone, piriform margin, and anterior wall of the maxillary sinus. In the ABG(+) patients, asymmetry of distortion was limited to rather small areas. CONCLUSIONS: In unilateral complete lip-alveolar-palatal clefts patients, the upper-lip pressure works to dislocate the cleft-side segment to a more posterior position than the noncleft-side segment. This finding implies that the increased lip pressure exacerbates facial asymmetry of these patients. The exacerbating effect on facial asymmetry is alleviated by alveolar bone grafting.

Full-thickness reconstruction of the eyelid with rotation flap based on orbicularis oculi muscle and palatal mucosal graft: long-term results in 12 cases.

BACKGROUND: Numerous techniques have been proposed for full-thickness eyelid reconstruction. Previously, we reported full-thickness eyelid reconstruction with a rotation flap based on the orbicularis oculi muscle and palatal mucosal graft. Here, we report long-term results in 12 cases. METHODS: After confirmation of defect size, the mucosal defect was covered with a split-thickness palatal mucosal graft. The rotation flap was elevated at the lateral orbital region and the skin defect was covered. Seven cases were reconstructions after tumour excision and five cases were for lagophthalmos after trauma. In cases of tumour excision, five cases had full defects of the lower eyelid and two cases had defect of the lower eyelid lateral to the punctum. In the cases of lagophthalmos, four cases had upper eyelid contracture and one had lower eyelid contracture. RESULTS: Postoperatively, one case showed severe venous congestion of the flap, which led to scleral show. In the other 11 cases, there were no complications, and cosmetic results were excellent. CONCLUSIONS: With our method, cosmetically good results can be obtained in either upper or lower eyelids. In the rotation flap based on the orbicularis oculi muscle, the undermined area is small, invasion is minimal, and the effects of scar contracture can be minimised. Minimal shrinkage of palatal mucosal grafts prevents the reconstructed eyelid from sagging. In only one case, poor design of the flap led to flap congestion. However, this complication can be avoided with the proper design.