Guido Molea

Non-surgical correction of deformational auricular anomalies.

Less severe congenital auricular anomalies can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. We present a series of 46 patients affected by various ear deformities (non cryptotia, non Stahls ear, non prominent ear) that we treated by splintage during the early neonatal period. These deformational auricular anomalies were classified according to the limitation to the external ear architecture development: vertically, horizontally and focally deformed ears. This new classification guided us in splint shaping and positioning. Excellent or satisfactory results were achieved in 98% of the splinted ears. Ear splintage is an effective technique for treatment of neonates with deformational auricular anomalies.

Choosing the correct sense of rotation in 180° propeller flaps

bleomycin-A5 injection for head and neck lymphangioma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:139e44. 17. Shou BQ, Shou WD, Yang Z, et al. Intralesional injection of pingyangmycin for treatment of venous-venular malformation in the maxillofacial regions of children: report of 306 cases. Shanghai Kou Qiang Yi Xue 2006;15:136e9. 18. Roggiani M, Stoehr JA, Leonard BA, et al. Analysis of toxicity of streptococcal pyrogenic exotoxin A mutants. Infect Immun 1997;65:2868e75. 19. Kullendorff CM. Efficacy of bleomycin treatment for symptomatic hemangiomas in children. Pediatr Surg Int 1997;12:526e8. 20. Tai KW, Lii CK, Chou MY, et al. Relationship between intracellular glutathione level and the mode of cell death induced by pingyangmycin. Oral Oncol 2003;39:13e8. 21. Puig S, Casati B, Staudenherz A, et al. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005;53:35e45. 22. Green D. Mechanism of action of sclerotherapy. Semin Dermatol 1993;12:88e97.

Reconstruction of lower eyelid and periorbital district: an orbicularis oculi myocutaneous flap

The upper eyelid has long been considered a good source of skin graft, but it is infrequently used as a unipedicled flap, based either medially or laterally, to reconstruct the skin of the lower eyelid. Here we describe a procedure in which we use the upper eyelid skin and underlying orbicularis muscle as a myocutaneous flap to reconstruct the lower eyelid and periorbital region.

Splintage for correction of congenital ear deformities

Many congenital ear deformities involve abnormal plical folding, most commonly affecting the helix and the antihelix. Non-hypoplastic auricular deformities can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. At this time, oestrogen activity is increased and the ear cartilage is very malleable. The splinting therapy, devised and popularized in Japan, has not been widely used in Europe. A series of 26 patients having various ear deformities treated by splintage in the early neonate period is presented. Excellent results were achieved in 82% of the splinted ears. In the other 18% results were satisfactory or good. No complications occurred in the series. In conclusion, ear splintage is an effective technique that should be more frequently offered to parents of affected neonates.

Peripheral Nerve Reconstruction with Autologous Grafts

A nerve gap is defined as the distance between two ends of a divided nerve. It is caused not just by the nerve tissue lost due to the trauma, or to the following debridement, but also by the actual retraction of the nerve stumps. The retraction is due to the elastic properties of the nerve fibers. Only small nerve gaps, in which minimal tension is required to contrast the elastic properties of the nerve, can be directly repaired (Fig. 1). Any significant tension at the repair site must be managed using other techniques. Peripheral nerve injuries causing gaps larger than 1-2 cm require bridging strategies for repair. Various methods exist to reconstruct nerve lesions with a significant gap: nerve grafts as autologous non-vascularised nerves, vascularised nerve grafts, interposition of venous or arterial segments or interposition of synthetic conduits. Despite the easier availability and execution of these last options, the gold standard, in nerve repair, remains the use of nerve grafts.

Digital nerve reconstruction by multiple Y-shaped nerve grafts at the metacarpophalangeal joint level.

Digital nerve injuries are common; injuries of the common digital nerves are less frequent than those involving the proper digital nerves. Traditional techniques used to reconstruct peripheral nerves are: direct suture, autologous nerve grafts, autologous vein grafts, vascularised nerve graft and alloplastic nerve grafts. Autologous nerve grafts remain the most common conduits for segmental defects. Difficulties can arise when attempting to repair complex nerve gaps, particularly when joining the proximal stump of the common digital nerve with two distal stumps of proper digital nerves as in lesions involving the web space. We present below a case of such a lesion. We describe the use of the lateral antebrachial cutaneous nerve (LABCN) as donor nerve, by exploiting its natural branchings.

Collodion baby associated with congenital auricular anomalies: postpartum splinting of a rare congenital auricular deformity.

A female full term newborn was transferred, immediately after birth, to our Intensive Neonatal Care Unit with diagnosis of collodion baby. On admission the skin surface was covered by a cornified substance of uniform texture, thinner at the joints’ level, which gave the whole body a varnished appearance; the newborn showed oedema of upper and lower limbs, ectropion, lip eversion, flattening of the nose and bilateral deformities of ear. Laboratory investigations and urinalysis were normal. Initial treatment included:

Staggered Wedge Technique for Ear Reconstruction

Sir:Simple wedge resection is widely used for reconstruction of full-thickness helical rim defects smaller than 1.0 to 1.5 cm.1 For reconstruction of defects up to 2.5 cm, crescentic or star excisions can be used. However, these techniques can frequently cause skin contraction and ear cupping.For de

Extensive scrotal calcinosis

We have treated three patients in the last 5 years for scrotal calcinosis; age range, 19–42. The technique we used was very similar to that described by Demirdover et al. consisting in excision of the affected scrotal tissue and direct closure [1, 5]. We have found it useful to pre-plan the extensive scrotal skin excision (Fig. 1) with a W plasty design (Fig. 2) to interrupt the final scar (Fig. 3). Our three patients healed uneventfully. In case of a recurrence, which we did not have, we would probably advise defect reconstruction with skin grafts.

Necrotizing fasciitis as a complication of chickenpox

SummaryChickenpox is a very common childhood illness, with a low rate of complications among hospitalized children. A rare case of acute necrotizing fasciitis occurring as a complication of chickenpox in a seven year old white boy is reported.This severe complication is a potentially lethal bacterial infection of subcutaneous tissues and fascia, with possible necrosis of underlying muscle. Confused terminology and rarity of the disease can lead to a wrong or delayed diagnosis. This case is presented to remind surgeons of the devastating potential of necrotizing fasciitis in children and to emphasize the necessity of a prompt and aggressive therapeutic approach.