Segmental excision of the distal phalanx with sparing of neurovascular bundle in macrodactyly: a report of two cases

Macrodactyly is a rare congenital condition in which overgrowth of one or more digits is seen. In this article, we introduce two patients with macrodactyly simplex congenita for which we used segmental excision of the distal phalanx with sparing of neurovascular bundles, eliminating the need for a secondary operation. © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons

Closure of palatal fistula with buccal fat pad flap

Palatal fistula as a complication of palatal surgery is difficult to manage due to the presence of fibrotic and scarred tissue and the absence of local virgin tissue. Recurrence rates are high. To investigate the efficacy of repairing small and medium sized palatal fistulas using the buccal fat pad (BFP), 20 patients (aged 2.5-19 years) with palatal fistula (10-20 mm) underwent closure surgery using a pedicled BFP flap. The nasal layer was closed by a local mucosal flap (turn down flap) and the pedicled BFP flap was used for oral lining. Full epithelialization of the BFP layer was observed within 4 weeks in all patients. A 2 mm defect in the anterior part of the previous fistula location remained in one case, which spontaneously healed after 2 months; all others closed successfully. Mild pain and cheek swelling occurred in 10 patients, which disappeared within 5 days with no surgical intervention. This study suggests the pedicled BFP flap is a simple and relatively secure method for palatal fistula management. It is recommended for fistulas less than 20 mm in length located in the posterior two-thirds of the palate. © 2010 International Association of Oral and Maxillofacial Surgeons

Cross-facial nerve graft: A report of chronically paralyzed facial muscle neurotization by a nerve graft

A 21-year-old housewife with long-standing hemifacial paralysis on the left side decided to undergo the classic two-stage cross-facial nerve graft with muscle transfer. The first stage of the operation was performed successfully with the use of a sural nerve graft. After the appearance of Tinel's sign 8 months later, gain of function in the muscles of the paralyzed side was observed and negated the need for the second-stage muscle transfer. © 2007 Springer Science+Business Media, LLC

Toward shortening interoperation period in two-stage cross facial nerve graft with muscle transfer

Cross facial nerve graft with free muscle transfer is a well-accepted method to deal with the long-standing facial paralysis, which is usually carried out in 2 separate operations including the nerve graft in first operation followed by a muscle transfer 10 to 12 months later. However, delayed rehabilitation of the nerve graft because of its long length leads to considerable interval between first and second operations.Nine patients with long-standing unilateral facial paralysis underwent 2-stage cross facial nerve graft with some modifications in techniques. In this new technique, by placing the end of the nerve graft in nasolabial fold in the first stage, we used shorter nerve grafts and reduced the interval between operations from 3.5 to 5 months. We believe that by using shorter nerve grafts in this technique, we can perform second-stage operation pretty earlier, and placing the end of nerve graft in nasolabial fold reduces the risk of nerve graft traumatization in preauricular dissection during the second stage. © 2008 by Lippincott Williams & Wilkins

Unacceptable results with an accepted soft tissue filler: Polyacrylamide hydrogel

Background: Polyacrylamide hydrogel, considered a safe and biocompatible soft tissue filler, is widely used in cosmetic procedures. Its use for facial contouring and breast augmentation in Iran has increased dramatically in recent years. Most patients and many doctors are unaware of possible and reported adverse effects related to its administration. Methods: This study enrolled 98 patients experiencing unsatisfactory results and complications of polyacrylamide hydrogel. Adverse effects related to gel administration were documented for all the patients. Lab values were requested together with related medical care and surgical treatments, and gel was extracted by incision, milking, and irrigation. Results: The most common findings at the time of presentation were inflammation (n = 51), asymmetry (n = 31), irregularity (n = 18), infection and abscess formation (n = 11), and gel migration (n = 8). In one patient, severe anaphylactoid reaction was observed 1 week after gel injection, which led to significant complications for the patient. Histologic findings showed granuloma formation (n = 17), fat necrosis (n = 9), and fibrosis (n = 17). Macroscopic gel-related complications resolved after extraction of the injected material, except for skin necrosis and hyperpigmentation, which remained unchanged. For eight patients, the gel could not be extracted by squeezing and irrigation entirely. Three patients experienced gel reaccumulation after seemingly complete removal of the gel. Conclusions: A wide range of complications seen among our patients showed that polyacrylamide hydrogel may not be as safe and biocompatible as it was thought previously. Both patients and physicians must be aware of the potential side effects of polyacrylamide hydrogel before gel administration. © 2009 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery