RESUMO
The experience with free flaps and conventional reconstructive procedures for 118 patients with Rombergapos;s disease and hemifacial microsomia over a 10-year period is presented. The groin free flap was used most frequently for patients with Rombergapos;s disease, whereas the scapular free flap was used for patients with hemifacial microsomia. The rectus abdominis or the latissimus dorsi free flap was chosen only when additional volume was required. To achieve better contour, secondary procedures, such as defatting the flap, pedicled temporal fascial flaps, cartilage and bone grafts, orthognathic surgery, and bone distraction were performed in severe cases. For patients with Rombergapos;s disease, excellent results were achieved in 35% (n = 28) of mild cases, in 72% (n = 27) out of 38 moderately and in 41% (n = 5) out of 12 severely affected patients. In hemifacial microsomia group (n = 40) excellent results were obtained in 66% of cases.
Assuntos
Assimetria Facial/cirurgia , Hemiatrofia Facial/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adulto , Transplante Ósseo , Criança , Feminino , Humanos , Masculino , Microcirurgia , Escápula/transplanteRESUMO
Two hundred free flaps for reconstructing the head and neck regions in 192 patients with non-oncological pathology were studied. Pathological entities included Romberg's disease, hemifacial microsomia, acquired facial palsy, trauma, and burn sequelae. Indications for selecting a specific free flap for reconstructing each case, details of anastomoses, reexploration, flap success, operative time, length of hospitalization, and complications were studied. The long-term results of cosmetic and function were also obtained. Patient age ranged from 6 to 40 years. The most common diagnosis was Romberg's disease 39% (n = 75), followed by hemifacial microsomia 20% (n = 40). The free flap most frequently used was the scapular 32% (n = 64), followed by the groin free flap 21% (n = 42). A total of 190 flaps (95%) were successful, whereas only 10 (5%) were lost. The mean operative time was 5:30 h and the average hospital stay was only 6 days. There were no major complications and no deaths in the study group. The patients were followed for at least 1 year in all cases. It is concluded that free flaps are safe and reliable procedures for reconstructing complex head and neck non-oncological defects.
Assuntos
Queimaduras/cirurgia , Assimetria Facial/cirurgia , Hemiatrofia Facial/cirurgia , Traumatismos Faciais/cirurgia , Lesões do Pescoço/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adolescente , Adulto , Queimaduras/complicações , Criança , Contratura/cirurgia , Humanos , Lipodistrofia/cirurgia , Estudos RetrospectivosRESUMO
The frontotemporal fasciocutaneous island flap is a useful source of tissue for correcting aesthetic units of the face. The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. This flap is based on the temporal vessel system and its own fascia. Its provides excellent venous drainage and its pedicle length and arc of rotation may be increased. The donor scar is hidden under the hair-bearing area. The frontotemporal fasciocutaneous island flap was used in patients with inferior eyelid defects, for cheek reconstruction, for providing coverage of superior and inferior lip defects, for restoring the normal anatomy of columellar defects, and for reestablishing the contour of menton defects. The frontotemporal fasciocutaneous island flap was employed successfully in 9 patients at the Hospital Gea Gonzalez. The wide treatment possibilities for the reconstruction of aesthetic units in the face with the frontotemporal fasciocutaneous island flap are illustrated.
Assuntos
Face/cirurgia , Traumatismos Faciais/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Adolescente , Adulto , Bochecha/cirurgia , Procedimentos Cirúrgicos Dermatológicos , Pálpebras/cirurgia , Neoplasias Faciais/cirurgia , Fasciotomia , Feminino , Humanos , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.
Assuntos
Transplante Ósseo/métodos , Mandíbula/cirurgia , Neoplasias Mandibulares/reabilitação , Retalhos Cirúrgicos , Adolescente , Adulto , Ossos Faciais/transplante , Feminino , Fíbula/transplante , Humanos , Ílio/transplante , Masculino , Côndilo Mandibular/cirurgia , Traumatismos Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Resultado do TratamentoRESUMO
Ocular exposure, conjunctival irritation and corneal keratitis are disturbing consequences of facial paralysis with lagophthalmos. Many techniques have been described for correcting this condition. A new method for decreasing the palpebral fissure is presented. An ear cartilage graft is interposed between the tarsal plate and the levator palpebrae superioris muscle. 12 patients with paralysis of the orbicularis oculi muscle, as assessed by electromyography, were treated with this technique. The palpebral fissure was decreased by 2-3 mm in all cases. 11 patients showed significant improvement of their eye symptoms. One patient, in whom the palpebral fissure could not be closed sufficiently to protect the eye, required additional lengthening by 4 mm of the cartilage graft and a lateral tarsorrhaphy.
Assuntos
Cartilagem da Orelha/transplante , Doenças Palpebrais/cirurgia , Músculos Faciais/cirurgia , Paralisia Facial/complicações , Cirurgia Plástica/métodos , Adulto , Doenças Palpebrais/etiologia , Doenças Palpebrais/patologia , Pálpebras/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-OperatórioRESUMO
Se utilizaron injertos cruzados de nerviofacial para el tratamiento quirúrgico de parálisis facial permanente asociada a microsomia hemifacial en 15 pacientes. Las edades al momento de la cirugía variaron de 2 meses a 10 años. Los pacientes fueron divididos en grupos de acuerdo a su edad al momento de la indicación de cirugía. Se concluye que los injertos cruzados de nervio facial en pacientes con parálisis facial asociada a microsomia hemifacial proporcionan buenos resultados en especial cuando la cirugía se realiza en las primeras semanas de vida extrauterina
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Fatores Etários , Assimetria Facial/complicações , Eletrofisiologia/métodos , Eletromiografia/métodos , Neurotransmissores/fisiologia , Paralisia Facial/cirurgia , Fatores de Risco , Procedimentos Cirúrgicos OperatóriosRESUMO
Se estudió el efecto de la estimulación de campos eléctricos para promover el crecimiento axonal a lo largo de injertos de nervio sural a facial en casos de parálisis facial congénita asociada a microsomia hemifacial. Con este propósito se estudió un total de 17 pacientes con parálisis facial unilateral permanente asociada a microsomia hemifacial pre y postoperatoriamente. Se realizó un injerto de nervio sural a facial en todos los casos y se les aplicó estimulación a largo plazo con campos eléctricos a la mitad de los pacientes seleccionados mediante un proceso aleatorio: Aunque ocurrió mejoría en ambos grupos, los resultados indicaron que la recuperación tanto clínica como electrofisiológica fue significativamente mejor en los pacientes quienes recibieron estimulación postoperatoria de campos eléctricos. Los resultados sugieren que la estimulación de campos eléctricos en pacientes sometidos a injertos de nervio sural a facial inducen una mejoría adicional sobre los pacientes no estimulados
Assuntos
Humanos , Assimetria Facial/cirurgia , Assimetria Facial/diagnóstico , Estimulação Elétrica/métodos , Nervo Facial/fisiopatologia , Nervo Facial/transplante , Paralisia Facial/congênito , Paralisia Facial/fisiopatologiaRESUMO
Crossed facial nerve grafts for treating congenital or acquired permanent facial palsy were studied in 23 patients, ages ranging from 2 months to 38 years. Patients were divided into groups according to time after onset of paralysis. It is concluded that although crossed facial nerve grafts offered the possibility of reinnervation after facial palsy, the degree of recovery was critically dependent upon the time after onset of the facial palsy before the reinnervation procedure.