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Background:
Dermal regenerate templates are currently widely used in both adult and pediatric burn reconstruction. Despite this, the safety and efficacy of regenerate templates combined with full-thickness skin grafts for the reconstruction of pediatric facial defects traditionally treated with local flaps is not widely published. The aim of this s...
Context in source publication
Context 1
... underwent nonsubunit full-thickness excision of the lesion from the nasal ala defect measuring 0.8 cm. The residual defect was at the level of perichondrium of the ex- posed alar cartilage ( Figs. 1 and 2) Case 3 was an 11-year-old boy who had a congeni- tal melanocytic nevus on his right ala and lateral nasal tip extending to the nasal rim and causing contour deformity. The nevus was excised down to the peri- chondrium of the lower lateral cartilage (Figs. ...Citations
... 12 En muchas de estas madres hay una historia de traumas y abusos en su infancia, por lo que se ha sugerido que estas personas canalizan sus inseguridades y síntomas afectivos a través de conductas abusivas hacia sus hijos. Se han reportado trastornos somatomorfos en las madres de los pacientes víctima, 13 lo cual también se evidenció en la madre de esta paciente. ...
Objetivo:
Describir un paciente pediátrico con trastorno facticio por poderes o síndrome de Münchausen.
Descripción del caso:
Paciente femenino de dos años con antecedente de una hermana que falleció, pero que también tuvo cuadros de hipoglucemia. Antes del ingreso más reciente, ya había registro de hospitalizaciones previas por hipoglucemia. En esta última ocasión acudió con astenia y un síncope, documentándose glucemia de 22 mg/dL. Se realizaron estudios para determinar causa de hipoglucemia, pero todos fueron normales. Mediante intervención por Psiquiatría, la madre confesó administrar insulina a la paciente de manera exógena.
Conclusión:
El trastorno facticio por poderes es una forma grave de maltrato infantil, en donde el cuidador realiza acciones para generar morbilidad. Su identificación temprana evitará su perpetuación y un posible desenlace fatal.
... However, staged reconstruction at certain times might delay the finalized outcome. 24 We used Matriderm as a Dermal Regeneration Template in the defect reconstruction, avoiding the need for multiple stages or the complications associated with other options such as tissue expanders or the complexity of different reconstructive processes as microsurgical free tissue transfer with promising functional and aesthetic outcomes. ...
Introduction: Facial giant congenital melanocytic nevus represents a major cosmetic deformity for the child and parents and is a challenge for the plastic surgeons to achieve best cosmetic results. Herein, we present a case of single-stage surgical reconstruction using partial-thickness scalp skin graft aided with Matriderm dermal substitute for a facial giant congenital melanocytic nevus. Methods: An 8-year-old boy presented with a facial giant congenital melanocytic nevus without leptomeningeal involvement. A single-stage complete excision of the nevus was performed. A split-thickness skin graft, 12/1000-inch thick, was then harvested from the anterior scalp region for reconstruction. A 1-mm Matriderm dermal substitute was first applied, on which functional subunit skin graft was then secured to cover the defect. Eyelid reconstruction was reconstructed separately using full-thickness postauricular skin grafts. Results: Histopathology of the excised specimen confirmed the diagnosis of congenital melanocytic nevus, with no evidence of melanoma. The donor area healed with a favorable scar and no donor site morbidity or complications such as alopecia or hypertrophic scar. The postoperative result was satisfactory with minimal residual nevus around the eye, and the patient was fully satisfied with the cosmetic and functional results. Discussion and Conclusions: Resection of facial congenital melanocytic nevi, followed by single-stage reconstruction using Matriderm and skin graft from the scalp, is an excellent and fast reconstructive method with promising aesthetic outcomes and greater improvement in physiological outcome, especially in the pediatric population.
The indications for using biologic wound agents have expanded greatly since first being employed for acute burn management. The majority of the literature details the use of said agents in the adult population; however, there is little representation regarding their uses for reconstructing defects typically observed in the pediatric population. Ironically, children, and to a lesser extent adolescents, greatly benefit from their use given the reduced skin laxity and amount of surrounding tissue available for locoregional tissue transfer when compared with adults. Herein, we detail the use of acellular and cellular biologic wound agents in the pediatric population.
A congenital nevi is a pigmented patch which requires complete surgical excision for cosmetic reasons. Here, we report a case of a patient with facial hairy pigmented lesion, occupying the right half of her face since birth, who underwent complete surgical excision and staged reconstruction utilizing, preexpanded forehead and neck skin. We used two rectangular tissue expanders with 150 and 300 cubic cm of volumes inserted in the forehead and the neck, respectively. The length of the expanders selected were equal to 1.2 to 1.5 times the length of their respective lesions, whereas the width of the base of the expanders were approximately similar to the width of their defects. It is concluded with this case report that tissue expansion provides a good cosmetic and anatomical correction to cover large defects, with adjacent skin having similar properties.
Background:
The use of Integra Dermal Reconstruction Template has emerged as an option for wound reconstruction, after resection of congenital nevi, especially giant congenital nevi. There have been many reports on Integra use in the literature for this purpose. This systematic review with pooled analysis examines the current literature regarding Integra use after resection of congenital nevi, including patient characteristics and reported outcomes.
Methods:
Systematic electronic searches were performed using PubMed, Ovid, Embase, and Cochrane library databases for studies reporting the use of Integra to reconstruct defects after nevi resection. Studies were analyzed if they met the inclusion criteria. Pooled descriptive statistics were performed.
Results:
Thirteen studies that met the inclusion criteria were included for analysis, yielding 31 procedures in 31 patients. Eleven of the thirteen studies were case reports representing 17 of the 31 patients. One study was retrospective, and the other study was a prospective study. The mean follow-up was 2.67 years (range, 0.2-13 years). The overall wound closure rate was 100%. The overall initial Integra take rate was 90.3% and the skin graft take rate was 100%. The rate of reported complications was 14.8%. The average age of patients was 7.36 years. The average size of the nevus was 6.29% TBSA (range, 0.005%-26%), and the time to definitive skin grafting was 3.28 weeks. Significant heterogeneity was found among the published studies.
Conclusion:
We conclude that the use of Integra appears to be a safe and viable option for defect reconstruction after the primary or secondary excision of congenital nevi of different sizes and on most parts of the body. Long-term follow-up studies and prospective cohort studies are required in order to fully estimate the incidence of complications. However, the rarity of this condition make these types of studies very difficult.
Objectives:
It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome.
Methods:
In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits.
Results:
DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid).
Conclusions:
DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.
INTRODUCTION: Nasal defects occur mostly after cancer surgery or as a result of trauma, and are of importance in reconstructions. It is highly likely that the cosmetic consequences of nasal defect reconstructions will affect the individual's social life as the location of the nose is in the middle zone of the face.
METHODS: 40 male patients and 36 female patients who underwent operations on nasal defects for various reasons, such as trauma, cancer surgery etc. Depending on several reasons, including size, the location of the defect and surgical border. A simple, easy and reliable algorithm that could be used in nasal defects was developed RESULTS: The youngest patient, a 3-year-old girl with xeroderma pigmentosum and she has a basal cell carcinoma in her nose and the eldest patient at the age of 92, who had basal cell carcinoma at the tip of the nose. The mean age is 57.75.
The largest defect after surgery is 10x7 cm (mass 8x5 cm). Radial forearm free flap was applied to close this defect. The smallest defect was 0.6 cm (6 mm-lesion 3 mm) and this defect was closed primarily. The diagnosis of the largest lesion was basosquamous cell carcinoma, the smallest lesion was basal cell carcinoma.
DISCUSSION AND CONCLUSION: The nose is a complex structure that is made up of such sub-units as the dorsum, lateral nasal walls, type, alar wings, soft triangle and columellate. If a reconstruction is performed after the defects in these sub-units are evaluated according to a certain algorithm, better results could be obtained.
Purpose:
To evaluate the use of acellular dermal matrix in the management of nasal lining deficiency at the time of Le Fort I osteotomy.
Methods:
This was a retrospective cohort study of patients with residual/recurrent oronasal fistulae who underwent Le Fort I osteotomy. In instances where there was an inadequate volume of nasal mucosa for tension-free closure or for defects >1 cm in width, the acellular dermal matrix was used for augmentation. Demographic and cleft-related factors were recorded. Complications (recurrent fistula, infection, seroma, and wound dehiscence) were recorded.
Results:
Over the 3-year period, the authors used acellular dermal matrix to augment nasal lining in 8 subjects. The sample's mean age was 18.7 ± 3.1 years; 5 subjects were male. Six patients had bilateral cleft defects. The mean follow-up time was 20.2 ± 3.2 years. There were no episodes of infection, seroma, wound dehiscence, or recurrent fistula.
Conclusion:
Acellular dermal matrix is a useful adjunct for managing nasal liningdeficiency at the time of Le Fort I osteotomy. There were no episodes of bone graft extrusion, infection, tooth loss, or bone graft loss. The Enemark scores improved significantly across both subsets (P <0.001). There was 1 recurrent fistula in the allograft bone alone group.Residual alveolar clefts and oronasal fistulae can be successfully managed at the time of Le Fort I osteotomy using allograft bone and acellular dermal matrix.
