Fabio Ezo Aki

Correction of Stahl's Ear

Abstract. Stahls ear is a rare congenital anomaly difficult to correct surgically. This report presents the experience of the Division of Plastic Surgery, University of São Paulo Medical School for managing this anomaly. From January 1994 to September 1999, 15 patients underwent surgery (17 ears). Ages ranged from 7 to 22 (mean 15 years). Six patients were female. Four subjects were of Oriental descent, four were Negroes, and seven were Caucasians. Deformities included two bilateral, four on the left ear, and nine on the right one. Different methods were utilized for correction depending on the elasticity of the cartilage. In the presence of an elastic cartilage, sutures only are employed, otherwise the cartilage is repositioned, as described by Sugino et al. No standard characteristics were noted regarding gender or race, however, there were more unilateral cases and more on the right ear. The results were adequately satisfactory, with the two methods enabling us to recommend these surgical techniques for correction of Stahls ear.

Classic abdominoplasty: a new approach to the correction of the abdominal wall deformity in patients with bladder exstrophy - a case report

Classic bladder exstrophy is a rare congenital deformity, with an incidence that is estimated to be 3.3 per 100,000 infants born alive.1 The ratio between cases in males and females is 1:1.5.1–2 It is routinely diagnosed intrauterine during prenatal scans. This deformity is characterized by a lack of closing of the anterior bladder wall, absence of the infra-umbilical abdominal wall and pubic diastasis, with high rates of unfavorable evolution.3–4 These cases require precocious treatment because mortality rates reach 75% by fifteen years of age if not corrected surgically.5 The approach for surgical correction in these cases is a complex and controversial process that can be divided into three categories: physiologic function, cosmetic appearance and physical image, and social and psychological adaptation. To restore physiologic function to the bladder, the vesical wall is closed surgically, and a bilateral iliac osteotomy is created.6–7 This surgery is followed by treatments that are meant to promote urinary continence, which are frequently comprised by the construction of urinary reservoirs and conduits for intermittent catheterization.8–13 To restore cosmetic appearance and physical image, several surgical techniques can be used. The approach must be individualized for each case according to existing deformities and the surgical procedures that the patient has already undergone.14–15 Some of the techniques that are used for this step include the following: neo-phalloplasty, lower rotation muscle flap from the rectus abdominis muscle for the filling of the pubic region, approximation of the labia majora with reconstruction of the cleft of Venus and correction of prior scars. By describing the present case, we aim to suggest a new surgical approach, an abdominal dermolipectomy, for the correction of the cosmetic deformities after restoration of micturition.

Construção do sulco palpebral superior em pacientes orientais sem incisão cirúrgica: experiência em 13 anos

The aim of blepharoplasty in young Asian patients is to create a superior palpebral fold. There are several surgical techniques to create double eyelids in Asian patients, and these techniques may be separated into two groups: cutting-type double eyelid surgery and non-incisional techniques or minimal incision techniques. PURPOSE: This paper will report the peculiarities of the non-incisional technique and emphasize the importance of pre-surgical planning. METHODS: From January 1989 to January 2002 (13 years), the authors have performed 647 cases using the non-incisional technique. Since 1996, when they began using only two sutures at the upper eyelid, 303 cases were performed (47,60%). The patients were followed-up for a period of 2 years. RESULTS: The results were considered very satisfactory albeit the fact 19 patients (2,93%) underwent reoperations due to fold assymetry and 12 cases (1.85%) due to a complaint of narrow and barely visible folds. During the presurgical planning the shape of the fold and number of sutures were determined taking into account the thickness of the eyelid skin. 97.84% of the patients desired the fold beginning at the epichantal fold, for this procedure yields the most natural results. CONCLUSION: The authors conclude that the technique is relatively simple and reproducible, is safer and presents longer-lasting results. However, indication for the procedure should be precise, and presurgical planning is the cornerstone for obtaining good results.