No abstract

The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.

Plastic surgical disease is a significant source of morbidity for patients in resource-limited regions. Dedicated programs that provide essential reconstructive surgery can produce substantial clinical and economic benefits to host countries.

A retrospective study was done to evaluate the frequency and severity of wound complications in 112 patients with breast cancer who received adjuvant chemotherapy following mastectomy with immediate breast reconstruction. Data on wound complications were available for 120 mastectomies. The rate of complications in 36 mastectomies treated with chemotherapy after mastectomy and immediate reconstruction was compared to that in 84 mastectomies not receiving adjuvant therapy. There were 25 wound complications (20.8%) in the entire group. The rate of wound complications was 27.8% (10 of 36 mastectomies) in the group treated with adjuvant chemotherapy and 17.9% (15 of 84 mastectomies) in the group that did not receive adjuvant therapy (P = 0.13). No patient had a delay in the initiation of adjuvant therapy because of wound complications secondary to immediate reconstruction. Logistic regression analysis found no correlation between age, type of operation, tumor pathology, stage, number of lymph nodes harvested, type of prosthesis or chemotherapy, and wound complications in patients undergoing immediate breast reconstruction after mastectomy. The frequency of wound complications was not increased in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction. The administration of adjuvant chemotherapy does not need to be delayed in patients who have had immediate breast reconstruction following mastectomy for breast cancer.

This novel technique permits significant anterior movements, allowing dramatic improvements in functional and facial aesthetic outcomes. Furthermore, intraoral appliances allowed greater acceptance in this age group. Disadvantages include complicated orthodontic setup and surgical procedure, as well as the cost of occasionally necessary dental implants. No postoperative relapse was seen at an average follow-up of 33 months. This approach renders comfortable yet effective patient care, yielding optimum results while circumventing shortcomings of conventional techniques.

OBJECTIVEMinimally invasive (MI) synostectomy with postoperative helmet orthosis is increasingly used in the management of sagittal craniosynostosis. Although the MI technique reduces or eliminates the need for access to the lateral skull surface, the modified prone/sphinx position remains popular. The authors present their initial experience with supine positioning for MI sagittal synostectomy.METHODSThe authors used supine positioning with the head turned laterally on a horseshoe head holder in 5 consecutive patients undergoing MI sagittal synostectomy.RESULTSResection of the sagittal suture from the anterior to posterior fontanel was accomplished in all patients. Surgical time averaged 70 minutes. No patient required transfusion. The posttreatment cephalic index averaged 83%.CONCLUSIONSInitial experience with supine positioning for MI sagittal synostectomy suggests that the technique can be used as an alternative to the modified prone position, with the potential to reduce anesthetic risk in these patients.

Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

Clinical practice can be guided en route to robust evidence as to the efficacy of various plagiocephaly management strategies, in pursuit of definitive standards.