Bilateral mandibular distraction osteogenesis in the neonate with pierre robin sequence and airway obstruction: a primary option.

Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early intervention with bilateral mandibular osteogenesis avoids the need for tracheostomy, along with its complications, and it targets the primary etiologic factor of the problem-the anomalous anatomy of the mandible. We report two neonates with severe Pierre Robin sequence managed with bilateral mandibular distraction osteogenesis on day 9 and day 11 of life. The surgical techniques and distraction and consolidation periods were similar apart from the distraction devices used. The procedures were successful with early extubation (day 5 and day 7), oral feeding tolerance (day 11 and day 13) and hospital discharge (day 19 and day 18). Total mandibular distraction was 19 mm and 23.45 mm, respectively. No major complications were reported. Medium to long-term results were good. Bilateral mandibular distraction osteogenesis in the neonate is a safe and accurate procedure and is the primary option in cases of selected severe Pierre Robin sequence.

The posterior interosseous flap - a prime technique in hand reconstruction. The experience of 100 anatomical dissections and 102 clinical cases.

Based on our experience of 102 clinical cases and 100 anatomical dissections, we have assessed the indications for the posterior interosseous flap in reconstruction of the hand. Large fasciocutaneous island flaps can be harvested, even when the radial or ulnar pedicles are damaged. One real advantage is that the posterior interosseous artery is a vessel of secondary importance for hand vascularisation. Fasciocutaneous and osteofasciocutaneous island distally based flaps can be tailored. The major indications are reconstruction of the first web space up to the interphalangeal joint of the thumb, dorsal hand defects up to the metacarpal joints and large defects on the palm-ulnar border of the hand. It is, therefore, a primary weapon amongst hand reconstruction techniques.

Tuberous breast: a surgical challenge.

Since the presentation of the tuberous breast deformity by Rees and Aston in 1976, many surgical procedures have been developed, but the correction of such a deformity still remains a surgical challenge. The authors report the last cases treated in the Department of Plastic and Reconstructive Surgery of São João Hospital-Porto and discuss about the ideal procedure which should be used according to the type of deformity. They emphasize the periareolar approach and the good results obtained by the Liacyr Ribeiro technique.