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
Lipoma is a quite common type of soft-tissue tumor, but it is rarely found in the hand. Hand lipomas are generally asymptomatic; however, when they become too large or when they are present in some specific location, they can cause symptoms due to compression of the median nerve. These tumors must be correctly characterized preoperatively with imaging exams and the proper management is the complete removal of the tumor and release of the median nerve. The authors present the case of a female patient with carpal tunnel syndrome due to compression of the median nerve by a giant palmar lipoma, successfully treated with tumor excision and nerve release.
O lipoma é um tumor frequente dos tecidos moles, mas a sua localização na mão é rara. Os lipomas da mão geralmente são assintomáticos; contudo, quando apresentam um grande crescimento ou em determinadas localizações, podem causar sintomas devido à compressão do nervo mediano. Esses tumores devem ser devidamente caracterizados pré-operatoriamente com um exame de imagem e seu correto tratamento baseia-se na sua excisão completa e liberação do nervo mediano. Apresentamos o caso clínico de uma paciente com o diagnóstico de síndrome do túnel carpal resultante de compressão do nervo mediano por um lipoma palmar gigante, tratada com sucesso com lipectomia e descompressão nervosa.
ABSTRACT
ABSTRACT Lipoma is a quite common type of soft-tissue tumor, but it is rarely found in the hand. Hand lipomas are generally asymptomatic; however, when they become too large or when they are present in some specific location, they can cause symptoms due to compression of the median nerve. These tumors must be correctly characterized preoperatively with imaging exams and the proper management is the complete removal of the tumor and release of the median nerve. The authors present the case of a female patient with , carpal tunnel syndrome due to compression of the median nerve by a giant palmar lipoma, successfully treated with tumor excision and nerve release.,
RESUMO O lipoma é um tumor frequente dos tecidos moles, mas a sua localização na mão é rara. Os lipomas da mão geralmente são assintomáticos; contudo, quando apresentam um grande crescimento ou em determinadas localizações, podem causar sintomas devido à compressão do nervo mediano. Esses tumores devem ser devidamente caracterizados pré-operatoriamente com um exame de imagem e seu correto tratamento baseia-se na sua excisão completa e liberação do nervo mediano. Apresentamos o caso clínico de uma paciente com o diagnóstico de síndrome do túnel carpal resultante de compressão do nervo mediano por um lipoma palmar gigante, tratada com sucesso com lipectomia e descompressão nervosa.
