1/6. En coup de sabre.A man born in 1961 was apparently well until his marriage in May 1986. In August of that year, his attention was drawn to the presence of a reddish patch over the right forehead. It was initially asymptomatic. It continued to progress to form an apparent linear furrow extending from the receding hairline to the vertex and temporal part of the scalp. At this juncture, the patient experienced moderate pain when laughing. Five years later the patient experienced a constant boring pain affecting the right eyeball. Consultation with an ophthalmologist led to sacrificial enucleation of the right eye despite the lack of a precise diagnosis. Nevertheless, the initial condition continued to progress causing disfigurement of the right side of the face. Examination of the face was marked by perceptible asymmetry. A linear atrophic plaque in the form of a furrow was identified on the right side of the forehead extending from the eyebrow to the vertex and temporal part of the scalp. The skin over the furrow was taut and bound down (Fig. 1). A hematoxylin and eosin-stained section prepared from the lesion revealed marked thickening of the dermis. The collagen bundles were hypertrophied and closely packed together. The staining was homogeneously eosinophilic. It was largely devoid of inflammatory infiltrate. The changes in the blood vessels were conspicuous by narrowing of the lumina, thickening of the walls, and a sparse perivascular lymphocytic infiltrate. Pilosebaceous units were completely absent, whereas a few atrophic pulled-up sweat glands were located in the mid-dermis. Similar changes were observed in the subcutaneous tissue. The epidermis was largely atrophied, with flattening of the rete ridges.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. Correction of temporo-masseteric contour deformity using the dual paddle thoracodorsal artery perforator adiposal flap.In cases of facial asymmetry with denervation atrophy of the masticatory muscles associated with head and neck tumors involving the trigeminal nerve, facial contour depression occurs selectively over the temple and masseteric area, separated by an uninvolved area over the zygomatic arch. The authors developed a new thoracodorsal artery perforator flap with two separate adiposal paddles based on their own perforators from the same mother vessel, the thoracodorsal vessel. Nearly normal temporo-masseteric contour was achieved in two patients. By freely positioning two adiposal paddles supplied by independent perforators based on the same vessel, separate non-contiguous regions of the face could be reconstructed correctly with one microvascular anastomosis in a single-stage operation, without the need for a secondary procedure to reduce the bulk over the zygomatic arch.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
3/6. Epidermal nevus syndrome: a neurologic variant with hemimegalencephaly, gyral malformation, mental retardation, seizures, and facial hemihypertrophy.The epidermal nevus syndrome (ENS) is a sporadic neurocutaneous disorder that consists of epidermal nevi and congenital anomalies involving the brain and other systems. From among over 60 patients with ENS presenting with neurologic manifestations, we identified 17 who had hemimegalencephaly based on pathologic or radiologic studies. Associated brain and neurologic abnormalities included gyral malformations in 12 of 12, mental retardation in 13 of 14, seizures in 16 of 17 (including 9 with infantile spasms), and contralateral hemiparesis in 7 of 12. All had ipsilateral epidermal nevi of the head, and several had ipsilateral facial hemihypertrophy. We concluded that these abnormalities comprise a recognizable neurologic variant of ENS that we believe represents the full expression of primary brain involvement. Several patients also had evidence of acquired brain lesions such as infarcts, atrophy, porencephaly, and calcifications, which are best explained by prior ischemia or hemorrhage. Given repeated observations of blood vessel anomalies in ENS patients, we hypothesize that underlying vascular dysplasia predisposes to these acquired lesions. The same cause may be invoked to explain the wide variety of neurologic symptoms reported in ENS patients without hemimegalencephaly. While the cause of ENS remains unknown, several observations suggest a somatic mutation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/6. mandibular reconstruction with a microvascular free groin osteocutaneous graft based on the deep circumflex iliac vessels.Two cases in which mandibular reconstruction was accomplished by a free groin osteocutaneous composite graft with microvascular anastomosis of its feeding deep circumflex iliac vessels are presented. The immediate and long-term postoperative results were found to be very satisfactory.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
5/6. Free dermal fat flaps to the face.patients with extensive facial asymmetry continue to be a challenge in reconstructive surgery. Surgical techniques using microvascular anastomoses and free flap transfers can now be applied in the management of patients with such conditions as Romberg disease, postirradiation hypoplasia of the face, and goldenhar syndrome, and in patients with bronchial arch developmental defects. Four patients are presented in this paper to demonstrate the use of free dermal fat in reconstruction of facial asymmetry. One patient with a moderate facial defect was treated with a free dermal fat graft, and the other 3, who had more extensive defects, were treated with deepithelialized free dermal fat flaps using direct microvascular anastomoses between the donor and recipient vessels. The groin was the donor area in each case. Results appear to indicate that free dermal fat flaps are useful in reconstructive procedures for patients with extensive facial defects.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/6. Cross-facial vein grafting in complicated flap reconstructions of the face and mandible.Microvascular flap reconstructions of facial and mandibular defects are achieving increasingly widespread application and, as a result, more patients are considered for such procedures after large tumors, congenital abnormalities, previous surgery (including failed and successful microsurgical procedures) and radiation have compromised potential recipient vessels on the side of the defect. In three such cases, contralateral facial vessels with vein grafts have been used to provide flap-recipient vessels. Each flap was successful. Cross-facial vein grafting is a relatively simple solution for utilizing undamaged vessels as recipient pedicles in complicated flap reconstructions of the face and mandible.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |