The purpose of this study is to introduce a new method for fingertip coverage for cases of soft tissue only defects and finger tip amputations including bone. 86 lingers in 67 patients haute undergone coverage with a large rotation flap based on digital artery and nerve and Z-plashy after fingertip amputation or finger pulp avulsion from October 1991 to December 1995. There were 53 thumbs, 12 index fingers, 5 long fingers, 3 ring fingers and 13 little fingers. All injured fingers had exposure of the distal phalanx bone. A large volar flap based on either the radial or ulnar aspect including both digital neurovascular bundles was elevated just abode the pulleys and flexor tendon sheath after longitudinal incision along the lateral border of the digit. Then a large Z-plasty was performed at the MP joint crease to release the tension. The volar flap was easily rotated to cover the fingertip and was sutured with slight flexion of the interphalangeal joints. All fingertip defects healed completely. These flaps successfully covered the fingertip, and up 2/3 of the distal phalanx on the volar or lateral aspect. Sensation returned to normal and fingers could be fully extended within 3 months of surgery. All patients only required a single operation for complete fingertip coverage and did not require bony shortening. We conclude that this large rotation, axial pattern, neurovascular flap and Z-plasty provided a durable, completely sensate, well vascularized coverage fort the fingertip with minimal discomfort for the patient.
Amputation ; Arteries ; Fingers ; Humans ; Joints ; Sensation ; Tendons ; Thumb

No abstract available.
Humans ; Transplants*

No abstract available.
Facial Bones*

Primary treatment of cleft palate should result in an intact palate with separation of the oral and nasal cavities. However, the published reports of large series indicate that palatal fistula present in operated cleft palate of a small but significant groups of patients. Even in the best hands, a palatal fistula of the operated cleft palate may reoccur postoperatively. Various methods of repair including local mucosal flaps have been employed to date, but fistula repair is extremely difficult because the operative field is limited by scar formation around the palatal fistula, making wound healing unsatisfactory. In such cases, a tongue flap is commonly indicated. From May of 1991 to May of 1996, among 19 patients with palatal fistula in operated cleft palate, 11 patients were operated by anteriorly-based tongue flap. All patients were followed up for at least 6 months, with mean follow up of 18 months. Among 12 cases of 11 patients included in this study, 11 flaps survived and did not recur during follow up periods. One complication was seen in the first case. In this case, there was a flap detachment from the recipient site on the 3rd postoperative day, but he was treated successfully at a subsequent operation. There have been no problems with feeding and communication until the pedicle is cut, and no patient experienced problems either with alteration in speech or with disturbance of taste sensation following surgery. In conclusion, this study shows that the anteriorly-based tongue flap is a safe and reliable technique for closure of large palatal fistula.
Cicatrix ; Cleft Palate ; Fistula* ; Follow-Up Studies ; Hand ; Humans ; Nasal Cavity ; Palate ; Sensation ; Tongue* ; Wound Healing

The microform cleft lip is the mildest expression of cleft lip and nose deformity, but it has no specific definition, classification, and few methods have been reported for its correction. It is characterized by deformity of the nostril, skin striae of the upper lip, notching of peaked Cupid's bow, deformity of the vermilion, and anomaly of the upper lateral incisior and alveolar ridge on the affected region. Sixty-three microform cleft lip patients were operated on between Dec. 1993 and Sep. 1998 in our department(29 males and 34 females). The age of the patients ranged from 5 months to 30 years(Mean 9 years). We classified and treated the microform cleft lip as follows: Class I: Cleft lip nose with very slight lip deformity Class II: Minimal lip deformity without vermilion notching Class III: Mild lip deformity with slight vermilion notching. The goals in the correction of a microform cleft lip are to obtain an esthetically pleasing upper lip and nose, and to reestablish muscle continuity for improved function. To attain these goals, we used the above classification and satisfactory results were obtained by treating the microform cleft according to the classification.
Alveolar Process ; Classification* ; Cleft Lip* ; Congenital Abnormalities ; Humans ; Lip ; Male ; Microfilming* ; Nose ; Skin

Bronchogenic cyst is a congenital anomaly of the embryolgic foregut. A bronchogenic cyst is thought to arise from developing lung bud structure in the 7th week of gestation. Subcutaneous bronchogenic cyst is developed from isolated lung parenchyme during cell migration. Sometimes the fistula is formed between cyst and epidermis. Histologically, fistula tract is lined with sebaceous gland, which is the evidence of embryologic anomaly of cyst. The most common extrapulmonary location of bronchogenic cyst is mediastinum. Subcutaneous location is uncommon. Subcutaneous bronchogenic cyst is commonly located in suprasternal notch followed by the presternal area, neck and scapula. Subcutaneous bronchogenic cyst is predominantly found in male and the ratio is four to one. Clinically the cutaneous presentation vary from nodular swelling, sinus tract ostium to papillomatous lesion. The differential diagnosis of bronchogenic cyst include branchial cleft cyst, thyroglossal duct cyst, cutaneous ciliated cyst and mature cystic teratoma. The diagnosis of subcutanoeus cyst is entirely dependent on the histologic feature. Bronchogenic cyst is lined with ciliated pseudostratified columar epithelium of respiratory origin. Underlying wall is surrounded by the smooth muscle, cartilage and seromucinous gland. This report is on a subcutaneous bronchogenic cyst in a 5-years-old male without fistula tract. The cyst is 5 x 4 x 3 cm in size and histolgically shows the typical feature of bronchogenic cyst.
Branchioma ; Bronchogenic Cyst* ; Cartilage ; Cell Movement ; Diagnosis ; Diagnosis, Differential ; Epidermis ; Epithelium ; Fistula ; Humans ; Lung ; Male ; Mediastinum ; Muscle, Smooth ; Neck ; Pregnancy ; Scapula ; Sebaceous Glands ; Teratoma ; Thyroglossal Cyst

No Abstract Available.
Forehead*

No abstract available.
Adhesives* ; Cyanoacrylates* ; Fracture Fixation*

Cleft lip and palate is the most common deformity among the facial congenital anomalies. And although many research and studies of operative methods haute been performed, the actual measurement of length of alar flaring have not been reported in cleft lip and palate. For this, authors chose the length of alas rim and nostril sill, which are an objective parameter, to measure the complete and incomplete cleft lip before the remedy and it was proven by a numerical value that compare to the normal part, the length was elongated. Also we found elongation of the cleft side alar rim in which patients had been operated by triangular flap method. We propose two surgical operative methods of the correction of lengthened alar rim; 1 partial resection of the elongated alar rim. 2. conversion of ala into nostril floor (Millard II operation) We conclude that this study is more accurate correction of the nasal deformity by measuring and understanding the length of alar rim in cleft lip and palate patients.
Cleft Lip* ; Congenital Abnormalities ; Humans ; Palate