Managing a pharyngocutaneous fistula in patients who have had total laryngectomy and radiotherapy is difficult. The purpose of this study was to review our experience using anterolateral thigh flaps to repair these defects. Between May 2002 and May 2006, pharyngocutaneous fistulas were repaired in nine consecutive patients. The first five patients had been managed conservatively for several months before repair was performed. The recent four patients were repaired within 1 month of fistula formation. Eight patients had frozen necks, which required neck resurfacing. Risky carotid artery exposure was avoided by using the transverse cervical vessels as recipient vessels. Pharyngocutaneous fistulas occurred between 8 and 30 days after a total laryngectomy. Early repair was much easier than late repair due to severe scaring and stricture associated with long-standing fistulas. All flaps survived. The mean hospitalization was 7 days. No recurrent fistulas or strictures developed after 11 to 48 months of follow-up. All patients achieved 100% oral alimentation. Five of the six patients eligible for tracheoesophageal puncture achieved fluent speech. Using the multi-island anterolateral thigh flap and transverse cervical vessels in pharyngeal reconstruction provides quick recoveries and excellent functional outcomes. Early repair is strongly recommended once a postlaryngectomy pharyngocutaneous fistula is identified.

Identification of the true cost centers and directed attending surgeon involvement are essential to the development and implementation of a successful cost-reduction process.

Glabrous dermal grafting of plantar defects after melanoma resection is extremely reliable, affords excellent cosmesis, has minimal to no donor site morbidity, and results in excellent functional outcomes. Flaps are now rarely performed for these patients at our institution. Fig. 1 Plantar melanoma defect before and after split-thickness glaborous skin grafting using the current technique.

Long-term patient functional outcome and the in-house rehabilitation process are not affected by integration of PMR into a multidisciplinary trauma team or early PMR consultation.

Isolated sagittal synostosis is a common form of craniosynostosis affecting roughly 1 in 5,000 children at birth. This results in a scaphocephalic head shape with a characteristically elongated anterior-posterior dimension and narrowed biparietal diameter. We present our experience with the correction of scaphocephaly due to sagittal synostosis using cranial vault reconstruction with a novel form of parietal bone fixation in 21 patients over 10 years. The medial fixation results in a hinging effect whereby transverse brain growth at the squamoid suture is enhanced. This results in excellent cosmetic results that are immediate and durable without the need for postoperative molding helmets. Furthermore, the complications associated with this procedure are limited.