ABSTRACT
Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.
Subject(s)
Dermatologic Surgical Procedures/methods , Head and Neck Neoplasms/surgery , Perforator Flap/blood supply , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Dermatologic Surgical Procedures/adverse effects , Female , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection. METHODS: Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity. RESULTS: In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05). CONCLUSIONS: Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.
Subject(s)
Acetylcholine Release Inhibitors/adverse effects , Anesthetics, Local/therapeutic use , Botulinum Toxins, Type A/adverse effects , Cosmetic Techniques/adverse effects , Ethyl Chloride/therapeutic use , Lidocaine/therapeutic use , Pain/drug therapy , Prilocaine/therapeutic use , Acetylcholine Release Inhibitors/administration & dosage , Adult , Aerosols , Botulinum Toxins, Type A/administration & dosage , Cross-Over Studies , Female , Forehead , Humans , Injections, Subcutaneous , Lidocaine, Prilocaine Drug Combination , Middle Aged , Pain/chemically induced , Pain/diagnosis , Pain Measurement , Prospective Studies , Skin Cream , Treatment OutcomeABSTRACT
Congenital midline nasal masses are rare anomalies that occur in about 1 in 20,000 to 40,000 live births. Nasal gliomas are thought to be collections of heterotopic tissue of neurogenic origin, which have lost their intracranial connection. It rarely cause ocular distortion and deformity in the medial orbital wall. We describe here a case of a 12-month-old baby girl diagnosed as extranasal glioma at the lateral nasal wall and medial orbital wall presenting with strabismus and subsequently treated in our service and perform a literature review.
Subject(s)
Glioma/diagnosis , Nose Neoplasms/diagnosis , Strabismus/diagnosis , Biopsy , Female , Glioma/congenital , Glioma/surgery , Humans , Infant , Magnetic Resonance Imaging , Nose Neoplasms/congenital , Nose Neoplasms/surgeryABSTRACT
BACKGROUND: Pilonidal sinus is frequently managed with surgical incision. If the wound is left open to heal by secondary intention, negative pressure wound therapy (NPWT) is often used to promote healing. CASE: We describe the case of a 60-year-old patient referred after excision of a pilonidal sinus, which was managed postoperatively with NPWT. Unfortunately, the patient developed squamous cell carcinoma, which was undetected postoperatively, as the dressing was left in place for 5 days. CONCLUSION: Guidelines for the use of NPWT should be followed, with dressing intervals at 2 to 3 days. Wounds managed by NPWT should be monitored carefully for malignancy at the time of dressing changes.
