No abstract

Microsurgery in the pediatric population is still challenging because of technical difficulties in the small vessel diameter anastomosis and flaps dissection. The present study reports our experience of microsurgical reconstruction with free tissue transfer and replantation. Twenty-eight pediatric patients under the age of 15 years underwent different microsurgical procedures over a 10-year period. Twenty-one patients (75 %) underwent elective free tissue transfer, while emergency replantation was done in seven patients (25 %). The overall successful microsurgical procedures were 25/28 (89 %). All the 21 free tissue transfers survived (100 %), while three of the seven emergency replantations were lost (57 % survival rate) in this group. Microvascular surgery in children is a feasible, safe, and reliable modality with high survival rate. The indications, success, failure, and complication rates are very near to adults. Over the age of 10 years, procedure is nearly similar to adults. Between the age of 5 and 10 years, successful outcome can be achieved also but with greater challenges in surgical technique. Below the age of 5 years, more challenges could be problematic for successful outcome. Experienced surgical team remains one of the most important factors to obtain good results. Knowledge of multiple reconstructive options and mastering one of them seems essential for satisfactory results.

Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular incision facilitates reduction in relatively difficult cases and enables clear visualization of posterior border of the mandible to confirm adequate fracture reduction.

Our results proposed a diagnostic approach for VMs of the head and neck. MRI, venography, and clinical examination had important impact in decision-making, whereas histopathology had no impact. A management approach has been suggested for each type and its subtypes.

This technique is very simple, very rapid, easy to execute, and gives satisfactory results in up to 86% of patients. This article also highlights the important information that must be discussed with the patients preoperatively.

The use of a dermo-fascial flap to support the glandular pedicle in reduction mammoplasty improves the shape; projection and contour of the breast. It also helps to have long lasting results and reduce recurrent breast ptosis especially in patients with poor skin quality.

In recent years, transpulmonary thermodilution techniques (PICCO) offer an attractive and more ideal end point for fluid resuscitation. The study included 30 adult burned patients between 25 and 60% TBSA. The study group received fluid resuscitation guided by the PICCO. The control group resuscitated using Parkland formula, guided by traditional monitoring parameters. Fluid administration in the initial 72 hours after burn injury was significantly higher in the study group. Furthermore, it was difficult, perhaps even impossible, to achieve the goals of normovolemia and cardiac output normalization during the early postburn period. Nevertheless, the attempt to achieve them was associated with a significant tissue edema. Although PICCO is a very beneficial tool in the estimation of amounts of fluid resuscitation, the values of ideal end points need to be adjusted in burn patients. The traditional values of intrathoracic blood volume, extravascular lung water, and cardiac index are associated with significant tissue edema that can easily complicate sepsis in these immunocompromised patients.

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