British journal of plastic surgery
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Meningococcal septicaemia is a severe life threatening illness that is part of the spectrum of meningococcal disease. It is of particular concern to the plastic and reconstructive surgeon because as the medical and intensive care of these patients improves, more are surviving the acute phase of the septicaemia and suffering from the associated complications such as skin necrosis and extremity loss. Recently there have been several reports in the literature concerning the management of skin infarction with both skin grafting and free flap surgery. This paper will provide an update on the proposed pathophysiological mechanisms involved, summarise the present data on plastic surgical care and suggest a stratagem for future management of these difficult cases.
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We have examined the effects of end-to-side neurorrhaphy on peripheral nerve regeneration using the median nerve as recipient nerve and either the antagonistic radial nerve or the agonistic ulnar nerve as donor nerves in rat upper limbs. A perineural window was created in all cases. Motor recovery up to 16 weeks postoperation was tested with the grasping test. ⋯ These results show that averaged 70% muscle power as compared to end-to-end neurorrhaphy with well coordinated muscle function can be achieved by axonal sprouting through end-to-side neurorrhaphy if an agonistic nerve is used as donor nerve. However, satisfying results are unpredictable. Antagonistic nerves show the ability to induce axonal regeneration, but no useful function can be expected.
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Case Reports
Facio-genito-popliteal syndrome presenting with bilateral choanal atresia and maxillary hypoplasia.
The most classic characteristics of facio-genito-popliteal syndrome are cleft lip and/or palate, anomalies of the external genitalia and popliteal pterygium. A case of facio-genito-popliteal syndrome with bilateral choanal atresia and maxillary hypoplasia is presented. No previous report of such an association was found in the literature.
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A number of modifications of the tongue blade of the Dott mouth gag for cleft palate surgery are described and illustrated. These modifications facilitate cleft palate surgery, especially on small infants and patients with micrognathia, as well as surgery under the microscope and also reduce the risk of compression of the endotracheal tube.