Rectangular flaps technique for treatment of congenital hand syndactyly

The authors analysed a series of 22 patients undergoing surgical correction of congenital hand syndactyly by the rectangular flap technique. Using our evaluation method, we found that good functional and aesthetic results were obtained in 77.3% of the patients, with a complication rate of 13.6%. We concluded that the rectangular flap technique has a simple design, is easily reproducible by in-training staff, has good results, and can be applied on the majority of the syndactyly cases.

[Surgical treatment of blepharospasm. Report of 2 patients]

Essential blepharospasm can be approached by several types of treatment: clinical in which the most important is the botulinum toxin with advantages and limitations; and some options of surgical treatment. The surgical technique described by Gillum and Anderson offers an alternative to patients resistant to the clinical treatment or with secondary complications. Two cases are analysed. Myectomy of all accessible orbicularis oculi, procerus and corrugator superciliaris muscle associated with blepharoplastic surgery and frontal lifting was indicated due to poor answer to clinical treatment. The results were satisfactory and both patients returned to their normal activities.

Correction of eyelid anomalies in pachydermoperiostosis

PURPOSE

Pachydermoperiostosis, or primary hypertrophic osteoarthropathy, is a rare disease, characterized by pachydermia, acropathy, and periostosis. The authors propose the surgical correction of the eyelid anomalies in one stage.

METHODS

A 30-year-old patient with moderate blepharoptosis (3 mm) and increased vertical and horizontal dimensions of the upper eyelids underwent fusiform transverse excision of skin, orbicularis muscle, and tarsus; shortening of the levator palpebrae superioris apeoneurosis by 13 mm; and 8-mm-wide wedge excision.

RESULTS

Histologic findings included hyperplasia of the tarso-conjunctival plate, obstructive cystic dilatation of the sebaceous glands, extensive fibrosis, and granulomatous reaction. Satisfactory functional and aesthetic results were observed after surgery.

CONCLUSION

Upper eyelid anomalies in pachydermoperiostosis can be corrected in a single stage bilaterally with good results.

[The early correction of the hand deformities in Apert's syndrome. A preliminary report]

The correction of cranial and limb malformations of the Apert's syndrome requires efforts of a multidisciplinary team. The esthetic and functional repercussions that this syndrome brings to their carriers are severe and so the treatment should aim tom improve the function of the hands in order to integrate these patients in a more normal social live. In our Service, in the period from 1989 to 1992 five patients carrying this syndrome had their hand correction completed before the age of three years. It was observed that surgery was possible in this early stage with no additional complication rate. Quadrangular flaps for the neocomissure and for the coverage of the fingers were successfully used even with skeletal deviations. There was improvement of the esthetics of the hands, but their function could not be evaluated properly. Anyway, because of complex abnormalities the results will never be perfect. The early treatment of these alterations allows the gain of a better hand function and moreover accelerates the physical and intellectual development of the children.

[Association of congenital upper and lower double lip]

The frequency of the congenital double lip is scarcely mentioned in the literature. There is no previous report on the bilabial congenital double lip. This association consists of a mucosae fold at the free edge of the lip, which is projected at smiling and opening of the mouth. Histologically, the mucous salivary glands are either hypertrophic or normal with little connective tissue and covered by a cornified epithelium. There is no muscle tissue found. We present the report of two cases of bilabial congenital double lip treated surgically by the elliptical resection of the mucosae folds.

Giant congenital composite melanocytic nevus on the face and scalp: treatment by multiple resections and grafting

Surgical ablation of a giant congenital composite melanocytic nevus on a good part of the side of the face and scalp in a series of operations is described and illustrated. It was technically and cosmetically successful.