Transconjunctival upper blepharoplasty.

Transconjunctival lower lid blepharoplasty now has an established role as an option in rejuvenation of the lower eyelid. Transconjunctival upper lid blepharoplasty, or transconjunctival removal of medial upper eyelid fat, also has a role in rejuvenation of the upper eyelid. However, this is a rather limited role. We have found this approach safe and efficacious as a primary as well as a secondary procedure for removal of excess medial upper eyelid fat. We report on 20 patients who have undergone this operation: 5 as a primary procedure and 15 as secondary. There were no complications, no revisions, and the patients have been uniformly happy with their results.

Calcaneal fillet flap: a new osteocutaneous free tissue transfer for emergency salvage of traumatic below-knee amputation stumps.

Traumatic below-knee amputations do not always leave enough soft tissue of bone with which to fashion a stump of sufficient length and durability to support a prosthesis. Composite free flaps can often be harvested from the amputated limb to provide immediate one-stage stump salvage and to preserve knee function. We report a new technique to increase stump length by incorporating the calcaneus into a foot fillet flap as a vascularized bone transfer. The calcaneal fillet flap is a useful addition to the inventory of available composite flaps. It is recommended for knee joint salvage when there is less than 11 cm of tibial remnant length.

The effect of muscle repair on postoperative facial skeletal growth in children with bilateral cleft lip and palate.

The effect of orbicularis muscle repair on postoperative facial skeletal growth in bilateral cleft lip and palate patients was studied by analysis of cephalometric radiographs and dental casts. Sixty-two patients operated on between 1961-1989 were selected for the study. They were divided into three groups, group 1a (muscle repair; n = 12), group 1b (failed attempt at muscle repair; n = 5), and group 2 (no attempt at muscle repair; n = 45). Comparison of the morphological measurements among these three groups showed that there was a trend towards crossbite in the muscle repair group, but this difference was not significant. Mechanisms by which muscle repair might influence maxillofacial skeletal growth include the possibility that the area around the nasal septum might be the growth centre. The choice of operative technique in bilateral cleft lip and palate should be important.

Age-related outcomes of sleep apnea surgery in infants and children.

This study was designed to determine whether age at the time of surgery is an important influencing factor on outcomes following surgical correction of severe refractory obstructive sleep apnea (OSA) in infants and children. Data were collected prospectively on 55 children, all with severe OSA refractory to conservative medical and surgical measures, who underwent combinations of soft-tissue and skeletal procedures aimed at relieving their airway obstruction. The study population was subdivided for analysis into three groups based on age at the time of surgery (> 36 months, > 12 to < 36 months, and < or = 12 months). Each child was assessed for clinical outcomes, polysomnography results, and complications. Children in the > 36 months group demonstrated a significant improvement in respiratory disturbance index (RDI), apnea index, and lowest overnight oxygen saturation postoperatively. Only RDI improved significantly in the > 12 to < 36 months group. Although there was a trend toward improvement in the respiratory indices for the children < or = 12 months of age, they had a significantly longer intensive care and hospital stay, a greater mean number of extubation attempts, and the highest surgical failure rate (29%). Other complications such as infection, atelectasis, or temporary postoperative nasopharyngeal tube dependence occurred most frequently in the > 36 months group. Surgical management of severe refractory OSA in children age < or = 12 months is more difficult and less likely to succeed. The reasons for this are discussed and recommendations for management are given.

The submental island flap.

The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.