Neonates with Pierre Robin sequence (PRs) suffer from varying degrees of airway obstruction and feeding difficulties, the courses of which differ from patient to patient, due to mandibular ...deficiency. We aimed to evaluate the course and prognosis of upper airway obstruction in 20 newborns with PRs. Among 15 isolated and 5 syndromic cases, 7 patients fell into Group I, 5 into Group II and 8 into Group III, respectively, according to the clinical classification system proposed by Caouette-Laberge. The 12 patients in Groups I and II were treated with positioning and gavage feeding, whereas the 6 patients in Group III underwent bilateral mandibular distraction. Decannulation or avoidance of tracheostomy was achieved in all of them. A patient who had a significant comorbidity was managed with tracheostomy and one patient expired due to pulmonary problems. When conservative measures fail, mandibular distraction osteogenesis should be considered to obviate tracheostomy in newborns with micrognathia.
We aimed to evaluate the role of a synthetic somatostatin analogue in delay procedure of experimental skin flaps. Thirty-six rats were randomly divided into 2 groups of 18 each to compare the ...possible local ischemic effect of octreotide with that of surgical delay in the dorsal random pattern skin flap model. The inducible nitric oxide synthase gene expression was assessed in the flap territory at intervals of immediate, 24 and 48 hours after preconditioning. Histologic analysis was performed in rats at 48th hour and 3 additional rats were used for microangiography. A gradual increase of daily transcript levels was detected in both groups (P < 0.05). The differences of molecular and histologic findings between the groups were not distinctive. Pharmacologically preconditioned rat displayed relevant microvascular features. Forty rats were further grouped randomly into 4 groups of 10 each. In group 1 rats, flaps were raised and reinserted without any prior intervention. Group 2 rats underwent surgical delay procedure, whereas flap territories of the others received either saline solution or octreotide 1 week before the ultimate flap harvest. After another 7-day period, both delay procedures were found effective in improving flap viability (P < 0.01). Ischemia induced by octreotide favored to investigate its utility in delay phenomenon. Although it was not as effective as the surgical delay procedure, it may be a safe pharmacologic alternative to improve the flap survival.
Advances in reconstructive microsurgery have enabled us to make use of many flap alternatives in severe lower-extremity trauma, and traditional cross-leg flaps for wound coverage have been replaced ...in most centers by free-tissue transfers. But free-flap surgery is still a challenging area in very young pediatric populations because of technical difficulties with considerable drawbacks. Six children with severe foot and ankle trauma were presented. Distally based sural fasciocutaneous cross-leg flaps were carried out to cover the defects, with no complications. Because of its easy dissection and reliable pedicle without compromising the major vessels, this procedure may be a safe choice among the other cross-leg flap alternatives when microsurgery is not considered.
Major surgical procedures can be performed safely for hemophiliacs provided the clotting factors are adequate. However, rhinoplasty, an elective facial procedure, has not yet been evaluated in this ...group of patients. The authors present a hemophilia A patient who underwent rhinoplasty for cosmetic reasons.
A random-pattern cutaneous flap with its base at the highly vascularized dorsal web space has been designed to decrease donor site deformity and to increase securely flap mobilization in contractures ...involving more than 1 adjacent proximal phalanx base. Rectangular flaps facing each other on the lateral sides of adjacent fingers have been raised on a single pedicle in the second, third, or fourth web space. The anatomic integrity of the web space was maintained and exposure of the metacarpophalangeal joints was avoided. Flap donor sites were reconstructed with full-thickness skin grafts. Since September 2000, 22 flaps were raised during a single-stage operation in 13 patients with an average age of 11 years at the time of surgery, and a total of 38 fingers have been reconstructed. The follow-up period averaged 24 months. The postoperative course was uneventful for all patients; all the flaps survived and the donor sites healed without complications. This flap, with its wide arc of rotation and minimal donor site morbidity, is easy to perform and is a good alternative in the reconstruction of multiple proximal phalanx base region flexion contractures of adjacent second, third, fourth, or fifth fingers.
