The double cross plasty: a new technique for nasal stenosis

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is also observed in the CEA neodermis, completing the dermal regeneration process. Norma! epiderma! differentiation is maintained long-term. These long-term results indicate that CEA regenerate a stable normal epidermis and are capable of inducing dermal regeneration from wound bed connective tissue.--Thomas A. Angerpoinfner Scalp as a Donor Site for Grafts to Facial and Neck Burns in Children. H.J. Silverman, R.M. Zuker, and S. Mom% Can J Surg

35:312-315, (June), 1992. The authors describe the use of the scalp as a graft donor site for facial and neck burns. They believe that the advantages are excellent color match of the graft and minimal morbidity at the donor site during the acute phase of facial and neck burns. They found no alopecia or hair growth in the grafts, and the patients did not complain of excessive pain due to harvesting of the graft. Moreover, there was evidence of superior colour match in two of the three cases. There was no indication that hypertrophic scarring is reduced with this approach.--Sigmund H. Ein HEAD

AND

NECK

The Spectrum of Cervical Cystic Hygroma. ‘I Memman. P.M. Davidson, N.A. Myers, et al. Pediatr Surg Int 7:253-255, (June),

1992. This is a retrospective review of children admitted with cystic hygroma to the Royal Children’s Hospital, Melbourne. Between 1973 and 1988, 122 children were admitted with lymphangioma, of which 47 were cervical cystic hygromas. They are grouped into three prognostic categories. Group 1: simple cystic hygroma. lesions that have no evidence of invasion or involvement of the orophatynx or mediastinum. There were 33 children in this group who presented between birth and 13 years of age. About two thirds were left sided. Three children with large lesions had respiratory stridor, one requiring a tracheostomy. The surgical management consisted of complete or varying degrees of partial excision in 28 cases and aspiration in three. There were two minor recurrences which responded to re-excision. The three lesions that were aspirated did not recur. Group 2 was cystic hygroma with oropharyngea! involvement. This category included nine children, and five had respiratory distress directly attributable to the swelling. In one child with severe respiratory depression active treatment was withdrawn due to the gross nature of the mass, and the child subsequently died. The remaining eight children were followed-up for 3 to 15 years, during which time they underwent multiple attempted excisions. The operative morbidity consisted of palata! palsy in one, facial palsy in one, and uneven dental eruption and ma! occlusion in two patients. Group 3 was cystic hygroma with mediastina! involvement. In five children presenting between birth and 2 years of age with cervical swellings, mediastinal involvement was diagnosed by chest radiographs. Thoracocervical excision was performed in all five children, as a combined procedure in three and as a separate procedure in two. Morbidity included ipsilatera! diaphragmatic palsy treated by plication in one and recurrences requiring reexcision in another two.-George Ninan The Double Cross Plasty: a New Technique for Nasal Stenosis. A. Naasan, and R.E. Page. Br J Plast Surg 45:165-168, (February/

here is illustrated by two cases. First, the outline of intended reconstructed anterior nares is plotted on the skin around the stenosed orifice. Incisions are then planned from the orifice in the long axis of the marked elipse and transversely at right angles to the first incisions. This allows four skin flaps to be raised. Similar incisions are then made in the nasal aspect of the stenosed nares but offset by 45” to the previous incisions. This results in four deep flaps which interdigitate with the original ones. After raising the latter flaps, they are thinned sufficiently to destroy hair follicles as they will come to lie near the skin surface. Scar tissue is excised back to cartilage and the superficial skin flaps sutured, interdigitating with the deep flaps which are drawn down to fill the intervening spaces. This effectively produces a continuous “W” plasty encircling the nostril. A pack is left for 48 hours and thereafter the children are encouraged to undertake “digital dilatation.“-E. Muckinnon Complications in Paediatric Craniofacial Surgery: An Initial Four Year Experience. B.M. Jones, P. Jani, R.M. Bingham, et al. Br

J Plast Surg45:225-231, (April). 1992. Craniofacial surgery, developed by Tessier, has provided treatment predominantly for congenital, but also acquired deformities of the facial skeleton. These authors report their experience from 1985 to 1989 with 107 patients with congenital abnormalities. The majority had transcranial procedures, but 11 had only extensive crania! fault remodelling. The surgical procedures fell into five groups: (1) advancement and/or remodelling of the supraorbital bar and frontal region: (2) bilateral orbital translocation for hypertelorism; (3) single-stage frontofacial advancement; (4) extensive cranial vault remodelling; and (5) nasofrontal and nasoethmoidal encephaloceles. From 1987, antibiotic prophylaxis was used and continued for 10 days when oral or nasal mucosa was breached. In addition, in the latter group, wound lavage with povidone iodine was employed. Routine anticonvulsant and dexamethasone therapy was discontinued in 1988. There were five major operative complications involving hypotension. In one patient there was severe generalised bleeding, in two there was a severe oculocardiac reflex, one patient suffered a sagittal sinus tear due to the presence of an abnormal bony spur, and in one there was severe acute cerebra! oedema. There were 44 early (less than 30 days from surgery) and 3 late postoperative complications. Of these, 5 were considered life-threatening, 12 serious, and 30 minor. There were 8 episodes of infection, 5 of meningitis (a serious complication) and 3 involving local tissues. Of the 5 developing meningitis, 3 had in situ tracheostomies. Also, the duration of surgery for these cases was significantly longer than for the noninfected group. Four patients developed persistent postoperative CSB leak, but only 1 required surgical closure and was associated with infection. Unexpected less serious complications included 2 cases of transient upper motor neurone facial palsy, developing 10 days after surgery. There were no deaths. The authors draw attention to the importance of having a specialist team for this work. Because many of the procedures are undertaken for cosmetic reasons, the balance of complications in morbidity must be weighed against the advantages. Particular attention is drawn to the fact that infants undergoing monoblock frontofacial advancement and patients with preexisting tracheostomy have a significantly higher incidence of complications.-E. Mackinnon

March), 1992. This lesion may be congenital or acquired and is due to a deficiency in the normal mucus membrane lining of the nasal vestibule. The most widely accepted technique for repairing this is reported to be excision of the scar and application of a graft using a prosthesis for a prolonged period of time. The operation described

Tongue Flap in the Primary Treatment of Cleft Palate: A Report of 19 Cases. R. Thafte, P. Govilkar, and J. Pate/. Br J Plast

Surg 45:150-154, (February/March),

1992.

The authors note the previously reported importance of reconstructing the levator palati sling in the soft palate in order to