ABSTRACT
The aim of this study is to present a sequential strategy of soft-tissue, non-osteogenic distraction with a novel device, followed by microvascular bony reconstruction for severe cases of mandibular hypoplasia. The case of a 21-year-old woman with Goldenhar syndrome is presented, whose mandible remained severely hypoplastic despite previous attempts at distraction and was not suitable for further osteogenic distraction. Soft tissue deficiency and pin track scarring prevented free fibular transfers. A personalized distractor, anchored to the cranium and the mandibular symphysis, was designed to expand the soft tissues while allowing for physiological temporomandibular joint (TMJ) movement without compression forces. Internal distractors were placed along the osteotomies to prevent condylar luxation. After completion of the soft tissue distraction, the native mandible was resected except for the condyles and reconstructed with two free fibula flaps. This report represents the proof of concept of a sequential approach to severe lower face soft-tissue and bone deficiency, which preserves TMJ function and avoids the transfer of poorly matched skin to the face.
Subject(s)
Goldenhar Syndrome , Micrognathism , Osteogenesis, Distraction , Plastic Surgery Procedures , Female , Humans , Young Adult , Adult , Goldenhar Syndrome/diagnostic imaging , Goldenhar Syndrome/surgery , Mandible/diagnostic imaging , Mandible/surgery , Mandible/abnormalities , Micrognathism/surgery , Skull/surgeryABSTRACT
An 18-year-old boy presented with a giant midline mass with 9 years of evolution. The tumor was excised, and reconstruction made with a customized sternum implant and a free latissimus dorsi muscle flap with skin graft. Histological analysis was compatible with low-grade fibromyxoid sarcoma (LGFMS).
ABSTRACT
The most used vessels for free flap breast reconstruction are the internal mammary, the thoracodorsal and the circumflex scapular. We present a case where those were inadequate. DIEP vessels were passed through a created sternal groove and anastomosed to the contralateral IM vessels, accessed by the breast symmetrisation incisions.
ABSTRACT
INTRODUCTION: Experiences of clinical and nonclinical learning environments, as well as assessment and study environments influence student satisfaction with their medical schools. Student-tutor ratios may impact on their perception of clinical learning environments. The aim of this study was to analyze medical students' satisfaction and student-tutor ratios in relation to medical schools' number of admissions. MATERIALS AND METHODS: A questionnaire was created, regarding learning, assessment and study environments in eight medical schools. 2037 students participated in this cross-sectional study. Cronbach' alpha (internal consistency) was calculated and principal component analysis was conducted. Pearson correlations and multiple comparisons were analyzed. RESULTS: Assessment environments showed the highest satisfaction scores and clinical learning environments the lowest scores. The national student-tutor ratio in clinical rotations is 7.53; there are significant differences among schools. Institutions with higher number of admissions showed the lowest scores of overall student satisfaction (r = -0.756; p < 0.05), which decreased with progression in the medical course. High student-tutor ratios are strongly correlated with low levels of satisfaction regarding clinical learning environments (r = -0.826; p < 0.05). DISCUSSION: Clinical learning environments show the lowest satisfaction scores, which may expose the effect of high ratios in clinical rotations. Depending on the number of admissions, significant differences between medical schools were found. Quality of teaching-learning strategies and articulation with hospitals might also be important variables. CONCLUSION: Medical schools with more admissions might be more susceptible to lower scores of student satisfaction. High student-tutor ratios in clinical rotations may reduce the quality of learning experiences and inhibit the acquisition of competences.
Introdução: Os ambientes de ensino clínico e não clínico, bem como as condições de avaliação e estudo, influenciam a satisfação estudantil com as Escolas Médicas. Os rácios estudante-tutor podem ter impacto na perceção sobre o ensino em meio clínico. Este estudo tem como objetivo analisar a satisfação dos estudantes de Medicina e os rácios estudante-tutor em relação com o número de admissões das Escolas Médicas. Materiais e Métodos: Foi criado um questionário sobre os ambientes de aprendizagem, avaliação e estudo em oito Escolas Médicas, distribuído a 2037 estudantes. Calculou-se o alfa de Cronbach (consistência interna) e executou-se uma análise de componentes principais. Resultados: Condições de avaliação obtiveram os melhores resultados de satisfação, enquanto o ensino em meio clínico revelou as menores pontuações. O rácio estudante-tutor nacional em disciplinas clínicas (7,53) traduz diferenças significativas entre Escolas. Instituições com maior número de admissões evidenciam resultados inferiores de satisfação estudantil (r= -0,756; p < 0,05), com redução progressiva ao longo do curso. Elevados rácios estão correlacionados com baixa satisfação com o ensino em meio clínico (r= -0,826; p < 0,05). Discussão: O ensino em meio clínico evidencia menor satisfação estudantil, traduzindo os elevados rácios em disciplinas clínicas. Dependendo do número de admissões, existem diferenças significativas entre Escolas. A qualidade das estratégias de ensino-aprendizagem e articulação hospitalar podem igualmente ser variáveis importantes. Conclusão: As Escolas com maior número de admissões podem ser mais suscetíveis a baixos resultados de satisfação estudantil. Elevados rácios estudante-tutor em disciplinas clínicas podem reduzir a qualidade do ensino em meio clínico e inibir a aquisição de competências.
