New operative technique to correct an almost complete nasal stenosis: Case presentations

A new flap technique is presented that corrects severe unilateral nasal stenosis. It seems to stop the recurrence of the stenosing process and leads to an aesthetically symmetrical aspect of the alar wings and nostrils.     

A simple and easy technique to correct inverted nipple deformities

Inverted nipple is a relatively frequent condition that is characterized by short galactophorous ducts, periductal fibrosis and lack of soft tissue under nipple base. It may be congenital or acquired. Many techniques have been described to treat this condition. We propose a new technique which is simple and easy, with very natural and long lasting results. We applied this technique on 24 nipples. The operation consisted of making six small stabbing incisions at the nipple base with subsequent release of the short fibrotic ducts using scissors and then a purse-string suture of the nipple base is performed through the small incisions while the nipple is pulled up by a skin hook. A supporting frame is applied for at least 2?weeks to support the nipple in its projected position. Postoperatively, there were no notable subsequences and the pain was minimal. We report one case of recurrence in a patient who refused to keep the supporting frame. We believe that the proper application of the supporting frame is mandatory. We highly recommend this technique to treat moderate to severe inverted nipple deformities.     

An effective technique to correct anterior mitral leaflet prolapse

Up to one-third of the patients with degenerative mitral valve disease and severe mitral regurgitation have anterior mitral valve prolapse due to chordal rupture or elongation. Surgical treatment of such a condition is often technically demanding and not infrequently associated with suboptimal results. Techniques used to treat anterior leaflet prolapse include chordal transfer, chordal shortening, artificial chordae, and anterior leaflet resection or plication. Each of these strategies has potential shortcomings, and there is considerable controversy concerning the durability of anterior leaflet prolapse repairs using these techniques. The "edge-to-edge" technique, a simple and effective method of correcting anterior mitral leaflet prolapse is described.     

Modified surgical technique to correct congenital and acquired penile curvature.

We treated 37 patients with severe congenital or acquired penile curvature with a modified Essed-Schroeder corporoplasty without excision of the tunica albuginea. After penile straightening, 34 of the 37 patients (91.9%) were able to resume normal coitus and 29 (78.4%) had excellent results, cosmetic and sexual. Postoperative progression of Peyronie's disease and shortening of the erect penis were rare. In 4 patients, partial necrosis of penile shaft skin or of the prepuce complicated the postoperative course, but there were no long-term sequelae in any case. In patients with concomitant preoperative erectile dysfunction, the dysfunction did not improve after corporoplasty; such patients should be treated primarily with a penile implant. We recommend the modified Essed-Schroeder corporoplasty as a safe and simple method to correct penile curvature.     

The femoral-based endowedge technique to increase juxtarenal seal and correct graft tilt

The endowedge technique refers to the use of balloons to align the scallops of the Gore Excluder endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz) to the renal artery to increase juxtarenal seal during endovascular repair of aneurysms with challenging anatomy. With the availability of a reconstrainable deployment system, this now can be performed without the use of brachial access. In addition, the femoral approach facilitates the use of the balloon as a fulcrum to correct unfavorable graft tilt.     

A modified technique to correct primary vesicoureteral reflux in children.

PURPOSE: The authors describe the experience of a modified technique to correct primary vesicoureteral reflux in children. METHODS: Twenty children (28 renal units) with primary vesicoureteral reflux (grade III to grade IV) were treated with this technique. The authors incised the bladder mucosa and muscle along the direction of the ureter using a right-angled probe as a guide. About 2 to 3 cm of extravesical ureter was freed and pulled into the bladder via the incision. The bladder muscle was closed under the ureter, and the mucosa was repaired over the ureter. RESULTS: One patient had residual reflux. All other patients, who underwent follow-up with sonogram and voiding cystourethrogram from 14 to 42 months after the operation, had neither recurrent reflux nor urinary tract obstruction. CONCLUSIONS: The advantages of this technique are (1) anastomosis of the ureteral orifice to the urinary bladder is not needed, so that the risk of orifice stenosis is minimized; (2) the ureteral orifice remains unchanged after the procedure, so that ureteroscopic procedures are easier to perform in future if required; and (3) pelvic dissection is not needed as in extravesical detrusorrhaphy. However, this procedure may not be suitable for patients with severe hydroureter.     

A new simple technique to correct nipple inversion using 2 V-Y advancement flaps

Nipple inversion is a particular condition characterized by shorter galactophorous ducts, periductal fibrosis, and lack of soft tissue under the nipple base. It can be congenital or acquired, and it affects about 10% of the female population. Many operative techniques have been described seeking to correct this deformity, but a unique landmark strategy does not exist yet. Although acceptable results have been reported, every surgical technique has its drawbacks. We describe our 5 years' experience in correcting inverted nipples by using a simple personal approach. Between January 2004 and January 2009, we treated 52 patients presenting with nipple inversion using 2 V-Y dermoglandular flaps performed in the dermoglandular portion of the nipple. This method is effective in the correction of moderate and severe inverted nipple deformities. Follow-up period ranged from 1 to 6 years. Results showed recurrence in 1 case and postoperative complications in 3 patients. The authors have found this to be an ideal procedure for correcting inverted nipple; the use of an easy to perform V-Y flap ensures nipple protrusion and support, lactation, and minimal scars.     

The upside-down technique.: A novel method to correct posterior leaflet prolapse

The upside-down technique is a method for ‘in situ’ secondary cordae transposition for posterior leaflet lesions. The segmental prolapse of the posterior leaflet is corrected by rotating the resected segment upside-down and reattaching it to the annulus and adjacent leaflet segments. As the procedure is completed, the original annular attachment becomes the new free edge. The secondary chords, originally positioned at the base of the segment, become primary chordae. It is indicated in all cases when quadrangular resection is not feasible such as in case of calcified annulus, posterior leaflet hypoplasia, or when the prolapsing portion is wide.     

Surgical technique to correct complex ureterointestinal stricture with defunctionalized limb of Turnbull stoma

We describe a novel technique to repair a long ischemic ureterointestinal stricture using the defunctionalized limb of a Turnbull stoma in a patient who had previously undergone two attempts at open surgical revision.     

应用逆向工程技术设计儿童髋关节畸形矫正截骨模板的研究

目的 探讨利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术设计截骨模板,以期为临床提供一种相对精确的截骨方案.方法 选取1例需行Steel三相截骨的先天性髋关节脱位患儿,男性,6岁.采用连续螺旋CT对患者骨盆行连续断层扫描,将扫描所得.dicom格式图像导入Mimics Innovation Suite 14.1软件,采用表面遮盖显示法进行双侧髋关节三维表面重建,建立患者髋关节模型,以.stl格式保存并导入Imageware 12.0软件,通过镜像还原患髋矫形后位置,模拟Steel三相截骨,提取患髋截骨区域,通过旋转、移动截骨区域,设计截骨模板. 结果 通过三维重建得到的髋关节三维模型可以直观显示患髋的解剖形态.通过重建患侧髋关节并模拟截骨,实现了截骨模板设计,生成的截骨模板可以通过快速成型技术生成实体模板. 结论 通过三维重建与逆向工程技术构建的截骨模板可以应用于Steel三相截骨矫正术,且截骨精确.     

上颌埋伏阻生牙矫治联合外科导萌的临床研究

目的：探讨上颌埋伏阻生牙的矫正畸形技术联合外科导萌术的临床运用效果。方法：选取口腔科门诊患有上颌埋伏阻生牙80例病例,运用方丝弓技术,同时联合外科导萌术联合治疗,另外选取80例上颌埋伏阻生牙患者为对照组,治疗方法为常规活动矫正器,进行治疗效果的比较。结果：联合治疗组患者的治疗效果满意,上颌牙覆盖度,牙槽整齐,导萌牙无松动,牙周无红肿发炎,2年随访疗效稳定而且综合治疗时间明显减少（P〈0．05）。结论：矫正畸形术联合外科导萌术对于上颌埋伏阻生牙的矫正治疗效果显著,值得临床推广。     

Posttraumatic enophthalmos and diplopia

Malposition of the globe and failure to fuse visual images are late-developing complications of orbital injury. This article reviews the causes of specific sequelae, such as enophthalmos, hypophthalmos, and diplopia, and describes a procedure of strategic implantation of autogenous bone grafts to correct the condition(s). Using quantifiable methods of assessing globe position and motility, the authors demonstrate improvement in 18 of 19 patients. Vision is reported unchanged or improved in 13 sighted patients. Several cases are presented with analyses of preoperative and postoperative photographs. Indications, contraindications, advantages, and disadvantages of the surgical procedure are described and compared to others.     

Simple technique of selecting the correct feeding gastrostomy button

Feeding gastrostomy is often performed in children with neurological conditions e.g. cerebral palsy or cystic fibrosis. A feeding button is often used to replace the gastrostomy tube for convenience. The button often leaks and the correct size and length is difficult to choose. The authors describe an easy and perfect way of choosing the correct size and length button by using Foley catheters.     

眶部退行性病变的上睑松垂整形术

目的探索旨在恢复上睑正常解剖结构及机能状态的手术方法，力求术后效果完美自然。方法采用眶隔筋膜重叠缝合或眶隔膜悬垂缘切除的方法，使松弛悬垂的眶隔膜重获紧绷状态。同时常规将松弛的外眦韧带折叠收紧，缝合在略高于睦裂水平线的眶缘骨膜上，有效地矫正了外眦角的下垂畸形。结果本组患者1269例，1087例随访3个月至3年，效果满意。结论以上措施重建了上睑眶隔膜的张力，恢复了眼睑的生理位置及眶周组织的张力与弹性，针对性地矫正了松垂睑各层次退行性病变．美容效果良好且持久。     

眶部退行性病变的上睑松垂整形术

目的探索旨在恢复上睑正常解剖结构及机能状态的手术方法,力求术后效果完美自然.方法采用眶隔筋膜重叠缝合或眶隔膜悬垂缘切除的方法,使松弛悬垂的眶隔膜重获紧绷状态.同时常规将松弛的外眦韧带折叠收紧,缝合在略高于睑裂水平线的眶缘骨膜上,有效地矫正了外眦角的下垂畸形.结果本组患者1 269例,1 087例随访3个月至3年,效果满意.结论以上措施重建了上睑眶隔膜的张力,恢复了眼睑的生理位置及眶周组织的张力与弹性,针对性地矫正了松垂睑各层次退行性病变,美容效果良好且持久.