Canadian Society of Plastic Surgeons

Justin Paletz, David D Jewer, Steven Morris
2010 Canadian Journal of Plastic Surgery  
presented by d Fisher) PurPOse: The purpose of this study is the review of a single surgeon's protocol and experience in primary palatoplasty over a 10 year period at a single cleft centre. MethODs: A retrospective review of a single surgeon's prospectively acquired database was undertaken. The study describes: 1) the demographics of the patient population, 2) the distribution of cleft palate type (Veau and Kernahan & Stark classifications) and cleft severity (palate length and cleft width),
more » ... 3) early (fistula rate) and mid-term (rate of secondary surgery for VPI) results. resuLts: 524 palatoplasties were performed from January 1, 2000 through January 1, 2010. Of these cases, 485 primary palatoplasties were performed. The mean age was 20.4 months (range 6.6 months -17.7 years). There were 276 males and 209 females. Clefts were classified according to Kernahan and Stark (CP=260, CL/P=225) and Veau Class (I=85, II-175, III-165, IV-60). Palate length was assessed according to Randall's classification (I=81, II=319, III=58, IV=2). Palate width, measured on the day of surgery, averaged 7.7 mm (range 0-19 mm). The surgical technique used was dictated by cleft type (Veau classification); 78 Furlow, 101 Veau, 191 von Langenbeck, 114 Clarke, and 1 other. There were 4 fistulas (0.8%). To date 50 patients have undergone secondary procedures for VPI (22 secondary Furlow palatoplasties and 28 pharyngeal flap pharyngoplasties). Over this 10 year period, the protocol has been consistent, with two exceptions to be discussed. COnCLusIOns: Demographics, procedures, and results of 485 consecutive palatoplasties are reviewed. The fistula rate is less than 1 percent. The intermediate VPI rate is at least 10 percent. Learning Objectives: After viewing this presentation, the learner will: Be familiar with the demographics of palatal clefts. • Have reviewed one surgeon's protocol for and results of primary • palatoplasty. Be familiarized with current trends in cleft palate repair. • 02 thE OUtcOME OF priMAry pAlAtE clOsUrE At thE sAME tiME As clEFt lip rEpAir l bergeron, l caouette-laberge, n Ouatik, h El-Khatib PurPOse: Closure of the primary palate with a vomer flap at the time of cleft lip repair is controversial. It is often suggested that it should be delayed since additional scarring could negatively affect maxillary growth. Our center has routinely closed the primary palate at the time of lip repair since 1963 and no additional growth disturbance has been noted. The purpose of this study is to compare sagittal maxillary growth of patients operated in our center to published series of cleft and normal children. MethOD: Patients with complete unilateral cleft lip and palate operated between 1983 and 1989 were included. SNA and ANB cephalometric values at 9 and 17 years old were compared to well documented series from other centers and a normal reference group. Statistical analysis was conducted to determine if our group was equal or better than reported results. resuLts: 34 patients were identified. Maxillary growth, documented with SNA and ANB angles, was better than reported in other large series of cleft children (p<0.05, one tailed t-test). As in other series, the values obtained for our cleft patients were inferior to the normal population except for ANB measurements at 9 years old, which were similar. canadian society of plastic surgeons société canadienne des chirurgiens plasticiens 03 MOdiFiEd Latissimus dorsi pEdiclEd MUsclE trAnsFEr tO rEstOrE ExtErnAl rOtAtiOn in brAchiAl plExOpAthy: A biOMEchAnic stUdy And cAsE rEpOrt p tétreault, dM tremblay, A chollet, jc lin PurPOse: Loss of external rotation due to brachial plexus injury is functionally debilitating and few secondary procedures exist to correct this deficiency. The Latissimus dorsi has been used as a tendon transfer to restore external rotation in rotator cuff tear patients. In some reports, however, patients with this transfer do not regain active external rotation past 0°, and experience no increase in force. We hypothesize that this is due to the biomechanically disadvantaged line of pull of the latissimus dorsi muscle. MethODs: Using a cadaveric biomechanical model with the arm at 0° of abduction, we determined the forces necessary to go from 0° to 40° of external rotation using two different lines of pull. The first was in the natural line of pull of the latissimus dorsi muscle, with the insertion transferred to the greater tuberosity of the humerus, and the second was in the natural line of pull of the infraspinatus muscle, with the same insertion site. resuLts: On average, 40% greater force was necessary to move the cadaveric upper limb into external rotation using the original line of pull of the latissimus muscle. Reorienting the line of pull to the axis of the infraspinatus allowed more degrees of external rotation with the application of less force. One brachial plexus patient with no active external rotation consented to a modified latissimus dorsi muscle transfer reorienting the muscle's line of pull to that of the infraspinatus muscle. Clinical results will be presented. COnCLusIOn: This biomechanic cadaveric study showed that reorienting the latissimus dorsi muscle's line of pull into that of the infraspinatus muscle decreases the force necessary for external rotation, suggesting that clinical results can be improved with this muscle transfer by modifying the origin and insertion of the muscle. Learning Objectives: Participants will learn a new technique for restoring external rotation. • COnCLusIOns: There is a significant prevalence of clinically undetectable malignant and pre-malignant lesions at the time of contralateral prophylactic mastectomy. Learning Objective: At the end of this lecture, the participants will be able to report the rate of • malignant and pre-malignant lesions in a contralateral prophylactic mastectomy specimen.
doi:10.1177/229255031001800203 pmcid:PMC2933097 fatcat:pyjqor5ti5dadjw5utpayaqebe