Breast reconstruction using latissmus dorsi myocutaneous flap

Fifteen female patients were submitted for breast reconstruction by using latissmus dorsi myocutaneous flaps that were used to close a large postmastectomy defect for 3 patients, immediate breast reconstruction after radical, modified radical, or mastectomy for 5 patients and delayed reconstruction for 4 patients after mastectomy. Latissmus dorsi myocutaneous flap was also used for augmented mammoplasty in 3 patients who were exposed to deep thermal injury to breast and chest before puberty. The breast development at puberty was sparse because of intrinsic breast tissue injury and constricting scar over the breast which worsened the situation. An island of skin attached to muscle with its intact pedicle was used to close post mastectomy defects and augmented mammoplasty after thermal injury. The advantages of this flap as shown by this study are: its greater length, adequate vascularity, having enough bulk to fill cavities to augment contour of the breast and provide structural support in one step. Also, the donor site is quite acceptable without significant muscular weakness or disability, adequate replacement of skin immediate formation of breast mould and cereation of inframammary fold. The results were more satisfactory, indicating its greater versatility than other regional flaps used in breast reconstruction, but if this flap cannot be used due to ligation of its pedicle; the rectus abdominis myocutaneous flap can be a very effective alternative as we use it in both cases complicated with contracture and atrophy of the flap

Effect of three layers repair of cleft palate with or without middle ear aeration on eustachian tube dysfunction in children

This study was carried out on 30 patients admitted to El- Menia University Hospital with cleft palate deformity. Three layers repair was done to every patient, audiological examination proved secretory otitis media in 28 patients of them, myringotomy and grommet tubes application were done to 15 patients. In cases with hamalar fracture technique, no improvement of middle ear pressure occurred even with aeration. In cases of nonhamalar fracture technique, improvement occurred only when middle ear aeration was done. So, middle ear aeration must be done with or before cleft palate repair. Three layers repair technique gave a satisfactory result with successful rate of healing [84.3%]. Wound disruption was detected in 10% of cases and fistula formation in 2 cases in which hamalus bone fracture was not done