Correction of Stahl's Ear

Stahl's 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 Stahl's ear.

Free flap reconstruction of tumors involving the cranial base

The authors describe their experience in treating 24 patients who underwent resection of tumors involving anterior, middle or posterior cranial fossa with immediate reconstruction. All were reconstructed with free flaps, 15 rectus abdominis, 4 radial forearm, 3 latissimus dorsi, 2 great omentum, and one scapular flap. There was one latissimus dorsi flap loss due to arterial thrombosis in a heavily irradiated patient. Three patients presented with a temporary cerebrospinal fluid leak, one of them with meningitis which resolved after intravenous antibiotics and continuous lumbar drainage. Fifteen patients were followed (mean 2 years). Five died of recurrence. Four presented local recurrence. Six patients are alive with no signs of recurrence. Free flaps, especially the rectus abdominis flap and the latissimus dorsi, are versatile flaps and may be easily positioned to cover several structures or anatomical surfaces.

Reconstruction of oropharyngeal defects utilizing a free radial forearm flap

The authors report their experience with free radial forearm flaps for oropharyngeal reconstruction. Fifteen patients who submitted to intraoral reconstruction with this flap were followed for periods ranging from 3 to 36 months, with a mean of 14 months. Ages ranged from 15 to 58 years with a mean of 41. The defects were secondary to tumor ablation (11 patients), complications of conventional treatment for congenital deformities (3 patients) and trauma resulting from a gunshot wound to the upper lip and palate (1 patient). Total necrosis of 1 flap occurred and 1 patient required reoperation on the first postoperative day for revision of the anastomoses. Our results enable us to recommend the radial forearm flap as the flap of choice for reconstruction of extensive oropharyngeal defects.

[Microsurgical transplants for facial depressions]

From 1877 to 1991, 23 patients, 15 female and eight male, age ranging from eight to 42 years were treated for hemifacial depressions with microvascular transplants. Eight had hemifacial atrophy, four had hemifacial microsomia and one sequelae of hemangioma treatment. Twelve of these patients received paraescapular flaps, five omentum flaps, five great dorsal flaps and one fascial tensor flap. Good result was achieved in 21/23 patients with good symmetry. Two flaps were lost by vascular thrombosis. On of these patients later received a second microvascular flap with good result. Two patients presented late "reabsorption" of the flap after good result in the first year of follow-up. One of them received a second microvascular flap and again the flap lost volume in a long term follow-up. Discussion focuses on this important finding in terms of physiopathology. The results of different kinds of reconstruction are compared and the fact that dermofat flaps achieved best results is emphasized.

[Primary retraction in skin grafting]

In ten patients a study of skin grafts and of the changes that occurred in the donor area was carried out: the primary retraction of the grafts in relation to their thickness was determined as well as the distension of the donor area of the graft after the excision of the same and comparison of it's thickness with that of the residual skin. The average thickness of the grafts was 318.0 micra, which corresponded to 20% of the donor skin. The primary retraction was 17.6%. The mean thickness of the residual skin at the donor area was 1,287.0 micra or 85.2% of the mean thickness of the reticular derma: the distension of the donor skin area after the removal of the graft corresponded to 2.1% of the original size.

[Free flaps for large reconstructions following tumoral resections in the head and neck]

The treatment of 21 patients who had cranio-facial reconstructions for extensive malignancies is reviewed. Microsurgical flaps obtained from latissimus dorsi, rectus abdominis, greater omentum and para-scapular regions were used. Good results were obtained in 86% of cases. Three flaps were lost in this series due to thrombosis of the microvascular anastomoses. Donor site morbidity occurred in only one case in which a dehiscence required a re-suture.